Endocrine Abstracts

Background: Erectile dysfunction (ED) represents the most frequent sexual dysfunction. Among several possible ED aetiologies, vascular ED (vED) presents the greatest implications for global individual health, resulting an early hallmark of cardiovascular diseases. Indeed, vED was demonstrated associated with a 1.25 times greater risk of developing major cardiovascular diseases. Alongside cardiovascular aspect, the evaluation of patients health, measured by the comorbidities number, in relation to the ED aetiology has never been investigated so far.

Aim of the study: To explore the potential relationship between the number of comorbidities and ED aetiology and severity.

Material and methods: A large database including all patients longitudinally evaluated for any andrological reason is kept the Andrology Unit of Modena (Italy). The current study is an interim analysis including ED patients evaluated from 2008 to 2010. For each patient, medical history, physical examination, ED characteristics, blood examination for hormonal assays and treatment choice were collected. The ED was graded using the International Index of Erectile Function (IIEF)-15 score and the number of comorbidities with Chronic Disease Score (CDS). Patients were grouped according to the ED aetiology, i.e. psychological, vascular, hormonal and neurological. CDS was compared among groups of patients generated on ED characteristics considering baseline and follow-up visits.

Results: 418 men (mean age 43.4±12.8 years) with ED were followed for 10.2±6.5 years. 368 patients (87.6%) showed a psychological aetiology, 29 (6.9%) vED, 14 (3.3%) hormonal genesis and seven (1.7%) a neurological ED. Although CDS did not differ among ED groups (P=0.226), it was directly related to patients age (Rho: 0.449, P<0.001) and inversely to ED domain at IIEF-15 (Rho: -0.319, P=0.005). At logistic regression analysis, CDS resulted not able to predict ED diagnosis, while only smoking habit was correlated to vED (Exp: 0.211: 0.082-0.541, P=0.001). As expected, CDS significantly increased during follow-up with the highest score collected at the last visit compared to baseline (1.8±2.7 vs 1.2±2.1, P<0.001). At follow-up visits, CDS was significantly higher in vascular ED (4.2±3.4) compared to psychological (2.2±3.0), hormonal (1.7±3.4) and neurological (1.0±1.1) forms (P<0.001).

Conclusions: Here, we demonstrate that the anamnestic evaluation of the comorbidities number is not useful in clinical practice to predict ED aetiology. However, the increase in CDS observed during follow-up resulted particularly evident in vED, confirming the vED role as a mirror of general health.