Testing Endothelial Function of Brachial and Cavernous Arteries in Patients with Erectile Dysfunction

Abstract

Introduction There is considerable clinical and scientific evidence that endothelial dysfunction may be an important clinical link connecting erectile dysfunction (ED) with cardiovascular diseases. Aims To modify the method of assessment of endothelial function of cavernosal arteries, to develop a new algorithm for evaluating its results, and to investigate the relationship between postocclusive changes in the diameter of brachial and cavernous arteries. Methods The study participants were 212 patients presenting to our department complaining of ED and 40 healthy volunteers without sexual problems, which formed the control group. All patients with ED underwent complex evaluation and ultrasound assessment of postocclusive changes in the diameter of cavernosal arteries modified by us and standard ultrasound assessment of endothelium-dependent flow-mediated dilation of the brachial artery. Main Outcome Measures As the main outcome measure, the percent of increase of the cavernosal arteries diameter (PICAD) was recorded. Results In the patients with arteriogenic ED, PICAD values were significantly less than in other groups (P < 0.001 for pairs of comparison). At the same time there were no differences between the control group and groups of patients with psychogenic and organic nonarterial ED. The sensitivity and specificity of a PICAD value of 50% in diagnosis of arteriogenic ED were 100% and 98.2%, respectively. In all groups and in the entire sample of patients studied we did not find a correlation between PICAD and postocclusive changes in the diameter of brachial arteries. Conclusion The method of ultrasound assessment of postocclusive changes in the diameter of cavernosal arteries is reliable and a highly informative tool for diagnosis of arteriogenic ED. It cannot be substituted by techni-cally simpler method of ultrasound examination of brachial arteries, while results of the latter could help to define the necessity of performing an examination of cavernous arteries.

The effect of vardenafil on endothelial function of brachial and cavernous arteries

“…We used the method of US assessment of postocclusive changes in the diameter of cavernosal arteries, which was shown to be reliable and highly informative tool for evaluation of the penile arterial circulation. 11 We believe that this method in future would be useful in investigations of other aspects of cavernosal arteries' endothelial function, which plays a key role in the pathogenesis of arteriogenic ED.…”

“…However, we and others have shown that patients with arteriogenic ED have abnormal endotheliumdependent vasodilation of both brachial and cavernous arteries. 11,20 Differences in baseline status of endothelial function could result in differences in pharmacological effects.…”

The endothelial cell in health and disease: its function, dysfunction, measurement and therapy

“…Interestingly, patients with arteriogenic ED (assessed by Doppler ultrasonography with intracavernosal prostaglandin E1 injection) showed greater increases in cavernous versus brachial artery dilation in response to a PDE5 inhibitor and no correlation was found between cavernous and brachial arteries. 83,84 This report 84 indicates that for diagnosing arteriogenic ED, measuring FMD in cavernous arteries is highly sensitive and specific and is superior to measuring FMD in the brachial artery. Various methods of endothelial function measurement are being used in research studies to establish and further elucidate the link between endothelial dysfunction and ED 4,6,8,9,[85][86][87][88] with the goal of establishing a simple diagnostic test for vasculogenic ED.…”

“…82 Endothelialdependent vasodilation of the cavernous arteries is being elicited using a special sphygmomanometric cuff inflated at the base of the penis to suprasystolic pressure for 5 min, similar to blood pressure cuffinduced FMD of the brachial artery. Using these methods Mazo et al 83,84 showed that a PDE5 inhibitor increased FMD in both penile and brachial arteries. Interestingly, patients with arteriogenic ED (assessed by Doppler ultrasonography with intracavernosal prostaglandin E1 injection) showed greater increases in cavernous versus brachial artery dilation in response to a PDE5 inhibitor and no correlation was found between cavernous and brachial arteries.…”

“…Various methods of endothelial function measurement are being used in research studies to establish and further elucidate the link between endothelial dysfunction and ED 4,6,8,9,[85][86][87][88] with the goal of establishing a simple diagnostic test for vasculogenic ED. [80][81][82][83][84][89][90][91] Clinical implications of endothelial function testing…”