Early Onset ED and Abnormal Cavernosal Arterial Inflow
Early Onset ED and Abnormal Cavernosal Arterial Inflow
Endothelial dysfunction, a marker for atherosclerosis and hence arterial disease, has recently been proffered as the main offender within the vascular system to predict not only the future onset of erectile dysfunction (ED) but also as the main cause of the ED. To glean more insight into whether arterial disease is indeed operative during the early onset of ED, we reviewed the duplex ultrasound scans of 23 men with ED who were younger than 50 years of age. Depending on the criteria used for abnormal arterial responses, it was determined in this cohort of young men that there was only a 4–13% incidence of abnormal arterial responses. These observations suggest that the penile arterial system does not appear to be primarily involved in the etiology of the majority cases of ED that occur in young men.
It seems inevitable that most men, if they live long enough, will develop some form of erectile dysfunction (ED). The validity of this statement emanates from the data extracted from the Massachusetts Male Aging Study (MMAS) where ~40% of men in their 40s had some form of ED, with this prevalence increasing by about 10% per decade such by the time a man is in his 60s or 70s, he has about a 60% or 70% chance, respectively, of having ED. Although men <40 years of age were not included in this MMAS survey, logic would dictate that the ED, at least in some of these men who presented with ED in their 40s, developed their condition sometime earlier than 40 years of age.
The initial and most common recognizable change in erectile function, which most men experience, is that they are unable to maintain or sustain their erection as long as they previously did. When sophisticated testing is performed in men with ED in order to ascertain the etiology of their ED, the majority of these men are found to have a physiological rather than a psychological reason for their ED.
More specifically, it is the vascular system that is found to be at fault in most of these men with ED. The vascular system of the penis comprises both the arterial vessels, which deliver the blood to the corporal sinusoids, and the corporal smooth muscle mass that is responsible for trapping the blood emanating from the arterial system within the corporal sinusoids, thereby preventing the corporal blood from leaking out of the penis; that is, the process of veno-occlusion. Data from studies conducted about three decades ago suggested that regardless of age, the most common problem with the vascular system of the penis in men with ED was not related to the arterial inflow but was due to cavernosal veno-occlusive dysfunction (CVOD) or venous leakage. As the veno-occlusive mechanism of the penis is totally dependent on the integrity of the corporal smooth muscle, the presence of CVOD in a patient tends to suggest some type of abnormality with this smooth muscle mass.
Despite these early observations that CVOD or venous leakage is very common in men with ED regardless of their age, the last decade has seen a multitude of reports linking endothelial dysfunction, a marker of subsequent atherosclerosis and hence arterial disease, as the major cause of ED. These studies have even suggested that the onset of ED can presage the onset of atherosclerosis, specifically coronary artery disease by about 3 years and, as a result, patients who present with ED should be considered having their cardiovascular system evaluated for the presence of subclinical coronary artery disease. If this presumptive association between endothelial dysfunction, arterial disease and ED is indeed correct, it would be expected that those men who present with ED at an early age should have some evidence of penile arterial dysfunction, specifically either abnormal cavernosal arterial dilatation and/or decreased cavernosal blood flow.
In order to glean some preliminary insight into whether early onset ED may be associated with penile arterial dysfunction, we retrospectively reviewed the charts of the last 23 patients of ours who were between the ages of 18 and 49 and who had a duplex scan of the penis performed as part of an evaluation for their ED.
Abstract and Introduction
Abstract
Endothelial dysfunction, a marker for atherosclerosis and hence arterial disease, has recently been proffered as the main offender within the vascular system to predict not only the future onset of erectile dysfunction (ED) but also as the main cause of the ED. To glean more insight into whether arterial disease is indeed operative during the early onset of ED, we reviewed the duplex ultrasound scans of 23 men with ED who were younger than 50 years of age. Depending on the criteria used for abnormal arterial responses, it was determined in this cohort of young men that there was only a 4–13% incidence of abnormal arterial responses. These observations suggest that the penile arterial system does not appear to be primarily involved in the etiology of the majority cases of ED that occur in young men.
Introduction
It seems inevitable that most men, if they live long enough, will develop some form of erectile dysfunction (ED). The validity of this statement emanates from the data extracted from the Massachusetts Male Aging Study (MMAS) where ~40% of men in their 40s had some form of ED, with this prevalence increasing by about 10% per decade such by the time a man is in his 60s or 70s, he has about a 60% or 70% chance, respectively, of having ED. Although men <40 years of age were not included in this MMAS survey, logic would dictate that the ED, at least in some of these men who presented with ED in their 40s, developed their condition sometime earlier than 40 years of age.
The initial and most common recognizable change in erectile function, which most men experience, is that they are unable to maintain or sustain their erection as long as they previously did. When sophisticated testing is performed in men with ED in order to ascertain the etiology of their ED, the majority of these men are found to have a physiological rather than a psychological reason for their ED.
More specifically, it is the vascular system that is found to be at fault in most of these men with ED. The vascular system of the penis comprises both the arterial vessels, which deliver the blood to the corporal sinusoids, and the corporal smooth muscle mass that is responsible for trapping the blood emanating from the arterial system within the corporal sinusoids, thereby preventing the corporal blood from leaking out of the penis; that is, the process of veno-occlusion. Data from studies conducted about three decades ago suggested that regardless of age, the most common problem with the vascular system of the penis in men with ED was not related to the arterial inflow but was due to cavernosal veno-occlusive dysfunction (CVOD) or venous leakage. As the veno-occlusive mechanism of the penis is totally dependent on the integrity of the corporal smooth muscle, the presence of CVOD in a patient tends to suggest some type of abnormality with this smooth muscle mass.
Despite these early observations that CVOD or venous leakage is very common in men with ED regardless of their age, the last decade has seen a multitude of reports linking endothelial dysfunction, a marker of subsequent atherosclerosis and hence arterial disease, as the major cause of ED. These studies have even suggested that the onset of ED can presage the onset of atherosclerosis, specifically coronary artery disease by about 3 years and, as a result, patients who present with ED should be considered having their cardiovascular system evaluated for the presence of subclinical coronary artery disease. If this presumptive association between endothelial dysfunction, arterial disease and ED is indeed correct, it would be expected that those men who present with ED at an early age should have some evidence of penile arterial dysfunction, specifically either abnormal cavernosal arterial dilatation and/or decreased cavernosal blood flow.
In order to glean some preliminary insight into whether early onset ED may be associated with penile arterial dysfunction, we retrospectively reviewed the charts of the last 23 patients of ours who were between the ages of 18 and 49 and who had a duplex scan of the penis performed as part of an evaluation for their ED.
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