Endocrine Abstracts

Background: The recognition of the erectile dysfunction (ED) pathogenesis is essential to identify the appropriate ED management. Since vascular ED (vED) could be a manifestation of a systemic arterial damage, the watershed in the ED diagnostic framework is the discrimination between psychological (pED) and vED. However, reliable tools to directly diagnose pED are currently lacking.

Aim of the study: To identify which parameters could predict pED. Moreover, we suggest a new intracavernosal injection (ICI) procedure to optimize the ED diagnostic work-up.

Methods: A retrospective, real-world analysis was carried out including all men who underwent ICI procedure at the Andrology Unit of Modena (Italy) from 2018 to 2021. Data about previous medical history and ED characteristics were collected. A first ICI procedure with 5 μg of prostaglandin E-1 (PGE-1) was performed. In the absence of a full drug-induced erection (immediate or delayed), an echo-color doppler penile evaluation after administration of PGE-1 10 μg was conducted, measuring intracavernosal blood flows, to document a possible vascular etiology. Hormonal measurements, including testosterone, luteinizing hormone, follicle-stimulating hormone, estradiol, prostate-specific antigen, prolactin and thyroid-stimulating hormone serum levels, were performed to rule out a possible hormonal DE etiology.

Results: Out of 179 enrolled patients, 70.4% showed pED, 21.7% vED and 7.8% hormonal genesis. Multinomial logistic regression analysis identified absence of cardiovascular disease (P=0.017), presence of spontaneous morning erections (P=0.018) and normal penile erections with masturbation (P=0.035) as predictors of pED. Clinically, normal ICI test response was detected in 86 patients and abnormal response in 93 subjects. Among the latter, 54 patients experienced a delayed response. The combination of ICI test with late penile erections evaluation was able to diagnose pED (sensitivity 97%, specificity 100%), avoiding unnecessary retesting.

Discussion: We propose a two-steps ICI procedure that allows to recognize pED with a high sensitivity/specificity, saving costs and time and limiting adverse events. Moreover, the presence of spontaneous morning erections and valid penile erections after masturbation could guide the diagnostic work-up, indirectly identifying those patients deserving of a deeper evaluation of vascular health.