Elsevier

European Urology

Volume 44, Issue 3, September 2003, Pages 352-354
European Urology

Editorial
Is Erectile Dysfunction the “Tip of the Iceberg” of a Systemic Vascular Disorder?

https://doi.org/10.1016/S0302-2838(03)00307-5Get rights and content

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ED as the “tip of the iceberg”

Atherosclerosis is a systemic disorder that uniformly affects all major vascular beds. Nevertheless, clinical manifestations of vascular diseases rarely appear simultaneously in the same patient. This may occur because arteries supplying various districts (i.e. penis, heart, brain, lower limbs) do have different size. Fig. 1 depicts the hypothetical vascular situation of a patient with isolated ED. A >50% lumen obstruction (i.e. the cut-off to define a flow-limiting stenosis) of the penile

Exceptions to the rule

A wide range of ED prevalence in patients with various vascular diseases has been reported in the literature. Reasons are difference in population characteristics, definition of ED, sensitivity and specificity of tests used to diagnose CAD, CVD or PAD, and side-effects of concomitant pharmacological treatment. Moreover, CAD’s clinical characteristics may explain the finding of patients with previous myocardial infarction having normal sexual tests. Indeed, AMI is the initial manifestation of

Clinical implications

From a practical point of view, clinical significance of ED is different depending on from which side it is viewed. While the detection of ED in a patient with known CAD mainly rises the issue of safety of treatment with oral phoshodiesterase type 5 inhibitors, the detection of isolated ED rises a more important question about concomitant, latent, vascular diseases. Coronary artery disease is by far the most important problem that needs to be investigated. Negative tests are likely to be found

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