title: Vascular damage as a risk factor for benign prostatic hyperplasia and erectile dysfunction.
abstract: 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.
authors.affiliation: Department of Urology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. andreas.p.berger@uibk.ac.at
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Berger
authors.forename: Martina
authors.initials: M
authors.lastname: Deibl
authors.forename: Nicolai
authors.initials: N
authors.lastname: Leonhartsberger
authors.forename: Jasmin
authors.initials: J
authors.lastname: Bektic
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.forename: Gernot
authors.initials: G
authors.lastname: Fritsche
authors.forename: Hannes
authors.initials: H
authors.lastname: Steiner
authors.forename: Alexandre E
authors.initials: AE
authors.lastname: Pelzer
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Frauscher
mesh_terms: 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