Vascular damage as a risk factor for benign prostatic hyperplasia and erectile dysfunction
Article first published online: 13 OCT 2005
Volume 96, Issue 7, pages 1073–1078, November 2005
How to Cite
Berger, A. P., Deibl, M., Leonhartsberger, N., Bektic, J., Horninger, W., Fritsche, G., Steiner, H., Pelzer, A. E., Bartsch, G. and Frauscher, F. (2005), Vascular damage as a risk factor for benign prostatic hyperplasia and erectile dysfunction. BJU International, 96: 1073–1078. doi: 10.1111/j.1464-410X.2005.05777.x
- Issue published online: 13 OCT 2005
- Article first published online: 13 OCT 2005
- Accepted for publication 31 May 2005
- diabetes mellitus;
- transrectal colour Doppler ultrasonography
Michael G. Wyllie
Ian Eardley, UK
Jean Fourcroy, USA
Sidney Glina, Brazil
Julia Heiman, USA
Chris McMahon, Australia
Bob Millar, UK
Alvaro Morales, Canada
Michael Perelman, USA
Marcel Waldinger, Netherlands
To assess benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), both considered to be associated with urogenital ageing, in ageing men in a cross-sectional population study, comparing them with healthy controls by using symptom scores and contrast-enhanced colour Doppler ultrasonography (CDUS).
PATIENTS, SUBJECTS AND METHODS
Transrectal CDUS and quantitative measurement of colour pixel intensity (CPI) are excellent minimally invasive techniques for assessing normal and pathological blood flow. CDUS was performed using the microbubble-based ultrasound enhancer for evaluating prostate, bladder neck and corpus cavernosum vascularity in young healthy men, men with BPH, and men with severe vascular damage (diabetes mellitus type 2). Resistive index measurements and computer-assisted quantification of CPI were used to objectively evaluate perfusion. The International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF) were applied to quantify the symptoms.
In patients with BPH, perfusion of the transition zone (TZ) of the prostate was significantly lower and the resistive index of the TZ significantly higher (both P < 0.001) than in healthy controls. The perfusion patterns of men with BPH and those who also had severe vascular damage (diabetes mellitus type 2) showed that vascularity in the latter group was lower in the prostatic TZ and the corpora cavernosa. In patients with BPH the IPSS, quality-of-life and IIEF scores were significantly worse than in the control group. Men with concomitant atherosclerosis had even worse symptom scores.
These results strongly support the hypothesis that age-related impairment of blood supply to the lower urinary tract is important in the development of BPH and ED. Vascular damage may cause chronic ischaemia and thus be a contributing factor in the pathogenesis of BPH and ED.