Testosterone undecanoate restores erectile function in a subset of patients with venous leakage: a series of case reports.
BACKGROUND
Androgens are critical for maintaining penile structure and function and androgen deficiency alters the function of the corporal veno-occlusive mechanism in animal models. However, there are limited research and data supporting this association in humans.


METHODS
Case reports of hypogonadal men (N = 12) with low plasma testosterone and moderate to severe erectile dysfunction are presented. Comorbidities varied, including diabetes mellitus type I or II, metabolic syndrome with possible related hypertension, dyslipidemia, or obesity. Oral phosphodiesterase type 5 (PDE5) inhibitor therapy did not improve erectile function. Each patient underwent baseline dynamic infusion pharmacocavernosometry and cavernosography revealing various degrees of corporal veno-occlusive dysfunction. The patients underwent treatment with 1,000 mg injectable testosterone undecanoate (Nebido) on day 1, followed by another injection after 6 weeks and every 3 months thereafter. Dynamic infusion pharmacocavernosography was repeated in all 12 patients after 3 months of treatment.


RESULTS
Five of the 12 patients reported significant improvement in erectile function within 12-20 weeks of androgen treatment and are currently under follow-up. Compared with baseline pharmacocavernosography, repeat radiological studies in patients who reported improvement in erectile function did not show veins draining the corporal bodies. The patients who responded to androgens also noted improvement in sexual desire domain (International Index of Erectile Function [IIEF] scores increased from 4 +/- 0.7 to 8 +/- 0.3) and erectile function domain (IIEF scores increased from 6 +/- 2 to 24 +/- 1).


CONCLUSIONS
The observations made in these limited series of case reports suggest that testosterone improved erectile function in hypogonadal patients by restoring veno-occlusive function. Prospective, multi-institutional, double-blind placebo-controlled trials in hypogonadal patients are indicated.
Yassin
Aksam A
AA
Clinic of Urology/Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany, and Department of Urology, Gulf Medical College School of Medicine, Ajman, United Arab Emirates;. Electronic address: yassin@t-online.de.
Saad
Farid
F
Research Department, Gulf Medical College School of Medicine, Ajman, United Arab Emirates.
Traish
Abdulmaged
A
Department of Biochemistry and Urology, Boston University School of Medicine, Boston, MA, USA.
D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007006:Hypogonadism / Q000150:complications* / Q000188:drug therapy; D018783:Impotence, Vasculogenic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects; D010413:Penis / Q000000981:diagnostic imaging; D011859:Radiography; D012039:Regional Blood Flow / Q000187:drug effects; D013739:Testosterone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome; D014463:Ultrasonography; D014664:Vasodilation / Q000187:drug effects; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000494:pharmacology
D014665:Vasodilator Agents; D013739:Testosterone; C010792:testosterone undecanoate