Vascular damage as a risk factor for benign prostatic hyperplasia and erectile dysfunction.
OBJECTIVE
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).


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.


RESULTS
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.


CONCLUSIONS
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.
Berger
Andreas P
AP
Department of Urology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. andreas.p.berger@uibk.ac.at
Deibl
Martina
M
Leonhartsberger
Nicolai
N
Bektic
Jasmin
J
Horninger
Wolfgang
W
Fritsche
Gernot
G
Steiner
Hannes
H
Pelzer
Alexandre E
AE
Bartsch
Georg
G
Frauscher
Ferdinand
F
D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D001808:Blood Vessels / Q000000981:diagnostic imaging* / Q000293:injuries*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000503:physiopathology; D007172:Erectile Dysfunction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011467:Prostate / Q000098:blood supply* / Q000000981:diagnostic imaging; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012039:Regional Blood Flow; D012307:Risk Factors; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional; D001743:Urinary Bladder / Q000098:blood supply / Q000000981:diagnostic imaging