RE: THE PREVALENCE OF HYPERTENSION, HYPERLIPIDEMIA, DIABETES MELLITUS AND DEPRESSION IN MEN WITH ERECTILE DYSFUNCTION

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To the Editor. 

Seftel et al identified the high prevalence of hypertension, hyperlipidemia, diabetes and depression in men with erectile dysfunction (ED). We support the proposition that ED could be used as a marker of these concurrent conditions. However, ED should also be actively identified and treated in men presenting with these common concurrent conditions. Although ED is not life threatening, it has a serious effect on quality of life.¹ More importantly, a delay in treatment may lead to deterioration in the cavernous smooth muscle function.² Consequently, progression to advanced ED may be more resistant to treatment.

ED is a manifestation of generalized arteriosclerosis, which is commonly present in patients with hypertension, hyperlipidemia and diabetes mellitus.³ In particular, penile arteriosclerosis decreases arterial inflow, and, hence, penile tissue oxygenation. This state facilitates corporeal fibrosis that ultimately leads to severe veno-occlusive dysfunction, which may decrease the therapeutic efficacy of phosphodiesterase 5 (PDE-5) inhibitors.², ⁴ Furthermore, it has also been suggested that denervation of the penis, for example following radical prostatectomy, results in apoptosis of the cavernous smooth muscle cells, particularly beneath the subtunical area.² This condition, in turn, also impairs the veno-occlusive mechanisms, and, hence, leads to ED. Similar mechanisms may also be involved in the pathogenesis of ED associated with diabetic penile neuropathy. Thus, decreased penile oxygenation leading to corporeal fibrosis and veno-occlusive dysfunction represent the current concepts in the etiology of ED.

Interestingly, studies investigating early treatment of ED with PDE-5 inhibitors to improve potency rates following radical prostatectomy demonstrate improved penile oxygenation due to preserved corporeal blood flow.² Thus, progression of corporeal fibrosis associated with penile arteriosclerosis/neuropathy has been shown to be delayed/prevented with PDE-5 inhibitors. Therefore, we propose the early use of PDE-5 inhibitors in patients presenting with hypertension, hyperlipidemia and diabetes with concomitant ED. These drugs will maintain corporeal oxygenation, and, hence, preserve penile smooth muscle function. Furthermore, by delaying the progression of corporeal fibrosis the efficacy of PDE-5 inhibitors may also be sustained.

Respectfully,

David H. W. Lau

Departments of Urology and Clinical Biochemistry, Royal Free Hospital, London, United Kingdom

Sashi Kommu

Department of Urology, Institute of Cancer Research, London, United Kingdom

Dimitri P. Mikhailidis

Department of Clinical Biochemistry, Royal Free Hospital, London, United Kingdom

Robert J. Morgan

Department of Urology, Royal Free Hospital, London, United Kingdom

and

Faiz H. Mumtaz

Department of Urology, Chase Farm Hospital, Enfield, United Kingdom

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References 

1. Shabbir M , Mikhailidis DM , Morgan RJ . Erectile dysfunction: an underdiagnosed condition associated with multiple risk factors . Curr Med Res Opin . 2004;20:603
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2. Montorsi F , Briganti A , Salonia A , Rigatti P , Burnett AL . Current and future strategies for preventing and managing erectile dysfunction following radical prostatectomy . Eur Urol . 2004;45:123
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3. Jeremy JY , Mikhailidis DP . Cigarette smoking and erectile dysfunction . J R Soc Health . 1998;118:151
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4. Moreland RB . Is there a role of hypoxemia in penile fibrosis: a viewpoint presented to the Society for the Study of Impotence . Int J Impot Res . 1998;10:113
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