TESTOSTERONE REPLACEMENT THERAPY IMPROVES PEAK SYSTOLIC VELOCITY DURING THE DYNAMIC PENILE COLOR-DUPLEX ULTRASOUND IN PATIENTS WITH HYPOGONADISM

Maurizio Carrino1, Francesco Persico1, Luigi Pucci1, Francesco Chiancone1, Enrico Maisto1, Simone Sannino1, Paolo Fedelini1
  • 1 AORN A. Cardarelli, UOSD Andrologia, U.O.C. Urologia (Napoli)

Objective

Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance (1). The diagnosis of ED is based on anamnesis, objective exam, hormonal panel, dynamic penile color-duplex ultrasound (D-PCDU) with PGE1. Many studies have found that the restore of normal blood testosterone levels in men with hypogonadism is correlated with an improvement in the blood flow of the cavernous arteries.
The aim of our study was to evaluate the correlation between testosterone replacement therapy, Peak Systolic Velocity (PSV) and the caliber of penile arteries during the D-PCDU in men with Late Onset Hypogonadism (LOH).

Materials and Methods

We evaluated 35 consecutive LOH men (mean age 44,5 years) affected by Erectile Dysfunction that underwent Testosterone replacement therapy (TTh) with testosterone undecanoate 1000 mg/4mL (Nebid) from February 2013 to October 2016. Patients with Induratio Penis Plastica, PSA > 4 ng/ml, diabetes mellitus, hypertension, metabolic syndrome, more than 20 cigarettes/die, BMI > 35, obstructive sleep apnea syndrome (OSA) were excluded. At the baseline we collected data on demographic and anthropometric features (age, weight, height, BMI), lifestyle characteristics (smoke, alcohol), any comorbidities (hypertension, diabetes mellitus, etc.). Then the patients underwent to clinical evaluation (comprised general, genital, neurologic and urologic examination). If the patient respects inclusion criteria, IIEF-5 (International Index of Erectile Function-5) questionnaire and D-PCDU were performed. A dose of 10 mcg of alprostadil was used in all patients. IIEF-5 and D-PCDU were repeated after 12 months of replacement therapy. PSV and the caliber of penile arteries were evaluated during the D-PCDU.

Results

33 of 35 patients showed an increase of the PSV and a decrease of the diastolic velocity. 2 of 35 patients did not show an improvement in D-PCDU parameters after TTh. A statistically significant global differences in PSV and diastolic velocity before and after the TTh was reported (P-value < 0.05). All 35 patients showed an improvement of the IIEF-5 after therapy, with a statistically significant differences before and after the TTh (P-value < 0.05). No correlation between the caliber of basal penile arteries and testosterone was found (P-value > 0.05).

Discussions

Endogenous testosterone has long been recognized as being critical for the normal promotion of sexual desire; however, many studies also have suggested a potentially important role in many aspects of the erectile process. Testosterone deficiency is one of the most frequent cause of ED in younger men and can be one of many etiologic factors in older men (2). Most men have a lowering of their blood testosterone levels with age, but these levels usually are not low enough to induce ED. Preclinical studies have indicated that testosterone is important for preserving the veno-occlusive function and therefore erectile function (3). Clinical studies showed that TTh improved erectile function (4). Administration of TTh improves libido, sexual function and nocturnal penile tumescence (NPT) response in men with hypogonadism (5). Canguven et al. demonstrated that TTh improved also peak systolic velocity and significantly decreased the end diastolic velocity in men with LOH (6).
Our data suggest that TTh is correlated with an improvement of PSV during the D-PCDU in men with LOH. No correlation between the caliber of penile arteries and testosterone was found. In terms of erectile function, our findings, based on the IIEF-5 score, showed that TTh significantly improved erectile function.

Conclusion

Our study suggests that TTh is associated with an improvement of PSV during the D-PCDU in men with LOH. This therapy also improved erectile function as showed by IIEF-5 score. No correlation between the caliber of penile arteries and testosterone was found. Larger prospective studies with repeated measurements of D-PCDU, IIEF-5, and blood chemistry would be of great value.

Reference

1. Impotence. NIH Consens Statement 1992;7-9;10(4):1-31.
2. Endocrine aspects of male sexual dysfunctions; Buvat J, Maggi M, Gooren L, et al.; J Sex Med. 2010;7(4 pt 2):1627-1656.
3. Are androgens critical for penile erections in humans? Examining the clinical and preclinical evidence; Traish AM, Guay AT; J Sex Med 2006;3:382–404.
4. Treatment of sexual dysfunction of hypogonadal patients with long-acting testosterone undecanoate (Nebido); Yassin AA, Saad F; World J Urol 2006;24:639–44.
5. Relationship between testosterone and erectile dysfunction; Rajfer J. et al.; Rev Urol 2000; 2:122–8.
6. RigiScan data under long-term testosterone therapy: improving long-term blood circulation of penile arteries, penile length and girth, erectile function, and nocturnal penile tumescence and duration; Canguven et al.; Aging Male. 2016 Dec;19(4):215-220. Epub 2016 Oct 1.

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