Diagnostic steps in the evaluation of patients with erectile dysfunction.
OBJECTIVE
The necessity for a thorough diagnostic evaluation for erectile dysfunction has been questioned after the availability of effective oral therapies. We determined the impact of the different diagnostic steps on the management strategy for erectile dysfunction.


METHODS
The study included all patients who presented at an andrology outpatient clinic during a 4-year period. Baseline evaluation included medical and sexual history, blood tests, physical examination and intracavernous injection test. Patients with normal initial screening were evaluated with specific diagnostic procedures. The results were analyzed to identify the diagnostic potential of each screening step separately.


RESULTS
Overall 1,644 patients presented at the clinic during the study period, of whom 368 (22.4%) were excluded from study due to severe psychiatric (5.2%) or cardiovascular (2.7%) disease, or to a history of erectile dysfunction less than 3 months in duration (14.5%). In the remaining 1,276 patients with a mean age plus or minus standard deviation of 56 +/- 14 years, and a mean duration of erectile dysfunction of 4.9 +/- 3.4 years medical history revealed erectile dysfunction associated medical conditions in 57%, blood tests identified previously undiagnosed medical conditions in 6.2%, and physical examination and the intracavernous injection test were diagnostic in 13.9% and 2.6%, respectively. Initial screening was negative in 259 cases (20.3%), in which specific diagnostic procedures identified an underlying vascular pathology in 165 (12.9%) and unfavorable penile geometry in 16 (1.3%). The remaining 78 men (6.1%) had no evidence of organic disease.


CONCLUSIONS
Baseline diagnostic evaluation for erectile dysfunction can identify the underlying pathological condition or erectile dysfunction associated risk factors in 80% of patients. Such screening may diagnose reversible causes of erectile dysfunction and also unmask medical conditions that manifest with erectile dysfunction as the first symptom. Specific diagnostic procedures may be limited in patients with primary erectile dysfunction or those without risk factors. Such clinical data support previously published guidelines for erectile dysfunction management.
Department of Urology and Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Dimitrios
D
Hatzichristou
Konstantinos
K
Hatzimouratidis
Michael
M
Bekas
Apostolos
A
Apostolidis
Vasilios
V
Tzortzis
Konstantinos
K
Yannakoyorgos
D000328:Adult; D000368:Aged; D000465:Algorithms; D000527:Alprostadil; D003937:Diagnosis, Differential; D007172:Erectile Dysfunction / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D018783:Impotence, Vasculogenic / Q000175:diagnosis / Q000209:etiology; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010208:Papaverine; D010348:Patient Care Team; D010413:Penis / Q000098:blood supply; D010646:Phentolamine; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011388:Prolactin / Q000097:blood; D011458:Prostaglandins E; D013739:Testosterone / Q000097:blood; D018608:Ultrasonography, Doppler
D011458:Prostaglandins E; D013739:Testosterone; D011388:Prolactin; D010208:Papaverine; D000527:Alprostadil; D010646:Phentolamine