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Erectile dysfunction (ED) is defined as the persistent or recurrent inability to achieve or sustain a penile erection, whose prevalence and severity increase in the older age. It is correlated with the use of several cardiovascular drugs or it can be associated with coronary heart disease. ED prevalence is estimated to be about 50% in patients with coronary heart disease whereas it can be an independent risk factor for future events in patients without cardiovascular disease. Diagnostic work-up in ED includes a cardiovascular screening, although the real benefit of that recommendation is at present unclear. Although patients affected by ED cannot be considered tout court at high cardiovascular risk, a more thorough evaluation may help identifying a high-risk subgroup needing a different therapeutic approach.

Erectile dysfunction (ED) is defined as the inability to get and maintain a sufficient erection to ensure an acceptable sexual activity for the subject and the partner. Although ED does not represent per se a serious disease, it carries a notable and severe influence on quality of life, with significant implications on familiar and social relationship; DE may cause depression, shame, impairment of personal esteem and relational problems. Among many possible etiologies of ED, atherosclerotic disease of penile arteries represents one of the most frequent causes, so it should always be looked for in patients with multiple risk factors for cardiovascular disease or an established coronary or peripheral artery disease. Up to 75% of patients with ED have a stenosis of the iliac-pudendus-penile artery system, deputy to perfusion of male genital organ. Recently the potential treatment of this pathologic condition by percutaneous approach has emerged with valid angiographic results and with a significant improvement in symptoms and quality of life. This review focuses on the normal anatomy and physiology of erection, the pathophysiology of ED, the common points between ED and ischemic cardiomyopathy and, lastly, the new chance of endovascular intervention for ED, to give our cardiologist colleagues the opportunity to screen and adequately treat patients with vascular ED.

Erectile dysfunction (ED) is a common clinical problem and its prevalence increases in frequency with age. ED is a risk marker for major cardiovascular events independently of other more common risk factors in men with and without known cardiovascular disease. On the basis of the "artery-size hypothesis" patients with cardiovascular disease often report ED before disease detection, in average 3 years. Thus, by an early identification of ED, the cardiol- ogist is given a unique opportunity to better assess the cardiovascular risk of each patient. Although there is a general impression that ED has an important predictive role, its diagnosis in clinical practice is widely suboptimal owing to misconceptions from the side of the patient and a suboptimal management of the personal relationship from the side of the physician. This paper explores the critical connection between ED and cardiovascular disease and evaluates how this association may influence clinical practice.

Aim: Preliminarily we analyzed the rate incidence of organic and psychological causes of erectile dysfunction in large cohort of patients observed during last year. Particularly we wanted to analyze the factors of risk correlated to the vascular erectile dysfunction., Methods: The epidemiological study has been conducted on a cohort of 101 patients (age 25-75 years) suffering from erectile dysfunction since 1-10 years (average: 2.6 years) and administrated during the last year by the Institute of Andrology at the University of Catania., Results: The organic erectile dysfunction had a frequency more elevated in comparison to the psychological erectile dysfunction, respectively engraving in 54.5% and in 45.5%. Between the organic causes of erectile dysfunction, the vascular arterial forms of erectile dysfunction represented highest rates (32.7% of the patients). The group of patients affected by vascular arterial erectile dysfunction showed several factors of risk, present in all the patients in single or combined way (comorbidity). The rate of such factors was >30% for 4 examined factors: hypertension (57.5%), smoke (45.4%), diabetes mellitus (39.3%), hyperlipidaemia (33.3%)., Conclusions: The erectile dysfunction is frequently associated to organic causes, prevalently of arterial vascular nature. The correction of the factors of risk could lead to a better control of the erectile dysfunction and reduce the extension of the vascular arterial damage to other districts.

Erectile dysfunction (ED), defined as the inability to achieve and/or maintain an erection sufficiently long for a satisfactory sexual performance or intercourse, is an important and common medical problem. ED is not a life-threatening disorder, but it influences the daily routine, social interactions, well-being and quality of life of the patient. Recent epidemiological data have shown a high prevalence and incidence of ED. The Massachusetts Male Aging Study found that 52% of men between the ages of 40 and 70 years reported ED with 9.6% having mild, 22.2% moderate and 17.2% complete or severe ED. In a large Italian cross-sectional study the overall prevalence of self-reported ED was 12.8% and the frequency of ED increases with age. ED may signal serious underlying and potentially life-threatening diseases, such as diabetes, hypertension, cardiovascular disease, peripheral vascular disease and other neurological and endocrine disorders. Also well documented is the role of some drug groups, certain types of surgery, injuries and the role of risk factors related to lifestyle such as smoking, alcohol consumption and inappropriate dietary habits accompanied by an abnormal serum level of cholesterol. The current availability of effective and safe oral drugs for ED in conjunction with the tremendous media interest in the condition, have resulted in an increasing number of men seeking help for ED. As a consequence, many physicians without background knowledge and clinical experience in the diagnosis of ED are involved in making decisions concerning the evaluation of such patients. The result of this is that some males with ED may undergo little or no evaluation before treatment is initiated and, in such circumstances, the disease causing the symptom (ED) may remain untreated. Baseline diagnostic evaluation for ED can identify the underlying pathological condition or the risk factors associated with ED in 80% of patients. This article reports a sequential approach for the diagnosis of ED that may diagnose reversible causes of ED and also unmask medical conditions that manifest with ED as the first symptom.

Background: Erectile dysfunction (ED) is the inability to achieve and/or maintain an erection for satisfactory sexual performance or intercourse. ED profoundly affects the quality of life. While the effects of dialysis on ED are documented, the benefits of renal transplantation are unknown., Methods: This study evaluates the prevalence of ED and the effects of transplantation on ED in kidney transplanted patients. Erectile function was assessed using the self-administered International Index of Erectile Function (IIEF). The domains investigated by IIEF are: (1) erectile function, (2) orgasmic function, (3) sexual desire, (4) intercourse satisfaction, (5) overall satisfaction. At the entry patients underwent clinical examination by urologist and neurologist; blood was collected for biochemical analysis. One-hundred-fifteen (89%) patients filled in the questionnaire., Results: Fifty-two (45%) patients did not complain about ED, which was reported by sixty-three patients (55%). No clinical and/or biochemical difference was found between patients with and without ED. Hypertension was equally present among patients; administration of beta-blockers was significantly more frequent among patients without ED. ED was already present during dialysis in 40 patients. After transplantation ED disappeared in 8 (20%), ameliorated in 13 (32,5%), worsened in 2 (5%), remained unchanged in 17 (42,5%) and appeared "ex novo" in 27 (43%) patients. ED is significantly correlated (p<0.01) to the age of subjects., Conclusions: The data of the present study indicate that: 1) ED is still present in many transplanted men; 2) renal transplantation cures ED in only few cases; 3) ED may appear "ex novo" after transplantation.

Objective: We report a retrospective analysis of 394 patients affected by erectile dysfunction and enrolled in a self-injection program after a positive injection test with alprostadil or vasoactive mixture, evaluating the rate and the causes of drop-out. We analyzed these data in two different groups of patients, classified on the basis of the training received before home therapy., Methods: 286 patients, included in group I, were trained in a single visit, in which the technique of injection was demonstrated on a rubber model. 108 patients, included in group II, were trained in a first office visit, consisting in demonstration and guided self-injection, and a home training trial of 3 self-injections, each followed by an office visit in which any questions or problems encountered during home therapy were discussed with the physician. All the patients enrolled in the self-injection program were contacted, after a follow-up of 2-8 years, and invited to an office visit or a phone interview, in order to answer to a questionnaire., Results: 62% of the patients of group I had discontinued therapy. Among these inactive patients, 79% had ceased therapy during the initial four self-injections. The most commonly cited reason for attrition was ineffectiveness (61%), followed by recovery of spontaneous erectile activity (17%). Satisfaction rate with therapy in active patients was high, with 89% of patients reporting a score of 3 (satisfied) or 4 (very satisfied). Among the 99 patients of group II, only 4 had discontinued therapy. Two of them had dropped out because of a recovery of potency. A high rate of patients satisfied with therapy was observed also in this group (78%)., Conclusions: Data provided by the patients enrolled in a self-injection protocol confirm alprostadil as a very effective and well tolerated therapeutic option for erectile dysfunction. The high drop-out rate registered during the initial period of therapy, and ineffectiveness as the most cited reason, underline the importance of a closer monitoring of patients in the early therapy in order to improve acceptance.

Background: To evaluate the frequency of erectile dysfunction in patients submitted to radical prostatectomy due to prostate carcinoma and to the possibility, with appropriate treatment, of restoring adequate erections for a satisfactory sexual activity., Methods: Between 1996 and 2000, thirty-eight patients with prostate carcinoma have been submitted to radical prostatectomy. According to TNM classification upon diagnosis, thirty-three patients (87%) were stage pT2N0M0 and five patients (13%) stage pT3N0M0. Mean age of patients was 62.4 years (range 55-76). Mean follow-up was two years and seven months. Diagnosis of erectile dysfunction was made from personal history as well as that of the patient plus partner, and from nocturnal penile tumescence evaluation with Rigiscan., Results: Eighteen patients (47%) presented erectile dysfunction as a complication 16 (89%) of whom showed no nocturnal reaction at the Rigiscan test, while in the remaining two (1%), one-two nocturnal erections of less than five minutes were obtained. Of the eighteen patients, 14 (78%) showed a positive response to treatment with intracavernous drug infusion (papaverine+Phentolamine+Alprostadil), whilst only one patient benefited from treatment with oral Sildenafil., Conclusions: This study showed the high frequency (47%) of erectile dysfunction in patients submitted to radical prostatectomy as well as the need to perform radical nerve-sparing surgery (particularly in the neoplastic forms not involving the prostate capsule) which is useful not only for preserving erectile function but also on account of better response to oral Sildenafil treatment following the use of this technique.

We have assessed 24 patients consecutively treated with cryosurgery and chosen according to the guidelines of the European Study Group of Urologic Cryosurgeons. Of the 24 patients (average age about 70, range 61-79), all were not considered candidates for radical prostatectomy, 9 (37%) were clinical stage cT2 N0M0, 15 (63%) cT3 N0M0 who had not received any prior treatment, except 1 patient (61 years old) who was treated with TCT and successive recurrence of the disease (cT2). Of the 24 chosen patients, 13 (55%) were over the age of 71, 11 (45%) had important factors of co-morbidity and an elevated risk of surgery (ASA 3). The average PSA was of 19.3 ng/ml (range 2.2-61). Gleason score was 2-5 in 9 cases, 6-7 in 14 and 8-10 in 1 case. In the follow-up, we evaluated serum PSA every 3 months and transrectal ultrasound and the echoguided prostatic biopsies at 6, 12 and 24 months. Post-operative complications included: ecchymosis and edema of external genitals (16/24), fever > 38 degrees C (1/24), sloughing syndrome (6/24), urinary tract infections (10/24) acute urine retention (1/24). In 2 cases, 6 months after treatment, a transrectal resection was carried out. After a follow-up at 6 months, the PSA was 0.4 ng/ml (range 0.1-0.9), in 1 case. In positive core biopsy out of 6 showed neoplastic cells with fibrous tissue; the patient had a PSA of 0.58 ng/ml. At 12 months there were 11 assessable patients. The average PSA was 0.3 ng/ml (range 0.1-0.9). At 24 months there were 4 assessable patients, 1 of 4 showed serum PSA level of 4 ng/ml and cancer in apical biopsy. Erectile dysfunction was assessed on 8 patients affective before surgery: 1 referred to sufficient erections at penetration (1/8, 12.5%). After removal of the catheter, 4 of the 20 patients suffered stress and urge incontinence with the use of 1 pad a day. In 1 case, 18 months from surgery, slight stress incontinence was found (1 pad/day). Cryoablation is an efficient method and is given to slight post-operative morbidity and no intra-operative mortality, also in patients with high risk for open surgery. Indications may be found in patients with the following conditions: older than 72 years, severe co-morbidity and high risk for surgery, neoplasia at high risk of progression, and disease recurrence after radiotherapy. Our case history is at the moment encouraging and a larger number of cases as well as longer follow-up are needed.

The incidence of risk factors atherosclerosis and of vasculogenic importance in a group of patients with erectile failure is presented. As a single risk factor only arterial hypertension is associated significantly with arteriogenic importance. Myocardial ischemia and peripheric arteriopathy are also often associated with arteriogenic impotence. In a high percentage vasculogenic impotence can be the first sign of a generalized arteriopathy. The diagnosis of arteriogenic impotence can therefore have implications which are not only related to erectile failure.

Male impotence has assumed increasing clinical importance and the perfection of diagnostic and therapeutic methods has opened new horizons for medical treatment. The aim of this paper is to provide a review of the epidemiology of this disorder with the relative diagnostic and therapeutic correlations. The authors report a series of 161 patients who were treated for one year at most with prostaglandin E1 (Alprostadil alpha-cyclodextrin).

A correct approach to sexual disorders in vascular patients presupposes an accurate investigation before and after operation. The authors evaluate the reliability of the diagnostic methods used, pre- and postoperatively, to ascertain sexual disorders, and analyse the influence of surgery on sexual function.

The aim of this paper is to analyze important methodological questions in estimates of the prevalence and risk factors in erection disorders. Sampling problems, lack of standardization in epidemiological and clinical data recording, nosographic uncertainties, explain the wide variability of prevalence estimates (2-10%). Lack of standard epidemiological methods produces differences in risk estimates of reviewed factors.