Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (4): 680-686. doi: 10.19723/j.issn.1671-167X.2024.04.022

Previous Articles     Next Articles

Retrospective study on the impact of penile corpus cavernosum injection test on penile vascular function

Yan CHEN1,2,Kuangmeng LI3,Kai HONG1,2,Shudong ZHANG1,Jianxing CHENG1,2,Zhongjie ZHENG1,2,Wenhao TANG1,2,Lianming ZHAO1,2,Haitao ZHANG1,2,Hui JIANG4,*(),Haocheng LIN1,2,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
    3. Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
    4. Department of Urology, Peking University First Hospital, Beijing 100034, China
  • Received:2024-03-16 Online:2024-08-18 Published:2024-07-23
  • Contact: Hui JIANG,Haocheng LIN E-mail:jianghui55@163.com;haochenglin292@163.com
  • Supported by:
    the National Natural Science Foundation of China(82371633);the Fundamental Research Funds for the Central Universities: Peking University Clinical Scientist Program(BMU2023PYJ H012)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To investigate the impact of age, various hormonal levels, and biochemical markers on penile cavernous body vascular function in patients with erectile dysfunction (ED). Me-thods: A retrospective analysis of clinical data from male patients with ED who underwent color duplex Doppler ultrasonography (CDDU) and intracavernosal injection test (ICI) at the Reproductive Medicine Center of Peking University Third Hospital from January 2020 to August 2023. Data were managed and processed using SPSS 29.0, and a multivariable Logistic regression analysis was conducted. Results: A total of 700 ED patients were included, with 380 showing negative ICI results and 320 positive. In the study, 84 patients had a peak systolic velocity (PSV) < 25 cm/s, while 616 had PSV≥25 cm/s; 202 patients had end-diastolic velocity (EDV)>5 cm/s, and 498 had EDV≤5 cm/s. 264 patients had abnormal PSV and/or EDV results, and 436 had normal results for both. Patients with vascular ED had significantly lower estrogen levels (t=-3.546, P < 0.001), lower testosterone levels (t=-2.089, P=0.037), and a higher rate of hyperglycemia (χ2=12.772, P=0.002) compared with those with non-vascular ED. The patients with arterial ED were older (t=3.953, P < 0.001), had a higher rate of hyperglycemia (χ2=9.518, P=0.009), and a higher estrogen/testosterone ratio (t=2.330, P=0.020) compared with those with non-arterial ED. The patients with mixed arteriovenous ED had higher age (t=3.567, P < 0.001), lower testosterone levels (t=-2.288, P=0.022), a higher rate of hyperglycemia (χ2=12.877, P=0.002), and a larger estrogen/testosterone ratio (t=2.096, P=0.037) compared with those with normal findings. Multifactorial Logistic regression analysis indicated that higher levels of estrogen were a protective factor for vascular ED (OR=1.009, 95%CI: 1.004-1.014), and glucose≥7.0 mmol/L was a risk factor (OR=0.381, 95%CI: 0.219-0.661). Older age was a risk factor for arterial ED (OR=0.960, 95%CI: 0.938-0.982). Additionally, older age (OR=0.976, 95%CI: 0.958-0.993) and glucose levels of 5.6-6.9 mmol/L (OR=0.591, 95%CI: 0.399-0.876) were also risk factors for mixed arterio-venous ED. Conclusion: Hyperglycemia and aging may impair penile cavernous body vascular function, while higher levels of estrogen may have a protective effect on it.

Key words: Erectile dysfunction, Color duplex Doppler ultrasonography, Intracavernosal injection, Blood vessels, Risk factors

CLC Number: 

  • R698.1

Table 1

Comparison of clinical indicators between ICI-negative and ICI-positive patients"

Items ICI-negative (n=380) ICI-positive (n=320) Statistics P
Age/years 35.04±9.63 33.52±8.52 t=2.213 0.027
Estrogen/(pmol/L) 103.50±27.88 111.91±33.87 t=-3.546 ＜0.001
Prolactin χ2=1.456 0.583
  ＜2 μg/L 2 (0.5) 0
  2-18 μg/L 343 (90.3) 293 (91.6)
  >18 μg/L 35 (9.2) 27 (8.4)
Testosterone/(nmol/L) 11.72±3.70 12.36±4.27 t=-2.089 0.037
Uric acid/(μmol/L) 405.11±86.55 401.80±88.71 t=0.499 0.618
Total cholesterol/(mmol/L) 4.88±1.01 4.79±0.91 t=1.246 0.213
Triglycerides χ2=4.607 0.203
  ＜1.50 mmol/L 230 (60.5) 207 (64.7)
  1.51-1.99 mmol/L 70 (18.4) 40 (12.5)
  2.00-4.99 mmol/L 71 (18.7) 65 (20.3)
  >5.00 mmol/L 9 (2.4) 8 (2.5)
HDL/(mmol/L) 1.14±0.25 1.12±0.24 t=0.889 0.374
LDL/(mmol/L) 3.03±0.83 3.01±0.75 t=0.433 0.665
Glucose χ2=12.772 0.002
  ＜5.6 mmol/L 249 (65.5) 244 (76.3)
  5.6-6.9 mmol/L 80 (21.1) 56 (17.5)
  ≥7.0 mmol/L 51 (13.4) 20 (6.3)
HbA1c χ2=1.080 0.583
  ＜5.6% 11 (28.9) 3 (21.4)
  5.7%-6.4% 6 (15.8) 4 (28.6)
  ≥6.5% 21 (55.3) 7 (50.0)
Estrogen/Testosterone 9.57±3.56 9.86±4.02 t=-1.023 0.307

Table 2

Comparison of various clinical indicators between patients with PSV < 25 cm/s and ≥25 cm/s"

Items PSV＜25 cm/s (n=84) PSV≥25 cm/s (n=616) Statistics P
Age/years 38.01±9.17 33.84±9.06 t=3.953 ＜0.001
Estrogen/(pmol/L) 110.33±31.82 106.94±30.92 t=0.941 0.347
Prolactin χ2=0.244 >0.999
  ＜2 μg/L 0 2 (0.3)
  2-18 μg/L 77 (91.7) 559 (90.7)
  >18 μg/L 7 (8.3) 55 (8.9)
Testosterone/(nmol/L) 11.36±3.70 12.10±4.02 t=-1.610 0.108
Uric acid/(μmol/L) 395.24±80.32 404.74±88.43 t=-0.933 0.351
Total cholesterol/(mmol/L) 5.02±0.98 4.82±0.96 t=1.802 0.072
Triglyceride χ2=2.546 0.467
  ＜1.50 mmol/L 46 (54.8) 391 (63.5)
  1.51-1.99 mmol/L 15 (17.9) 95 (15.4)
  2.00-4.99 mmol/L 20 (23.8) 116 (18.8)
  >5.00 mmol/L 3 (3.6) 14 (2.3)
HDL/(mmol/L) 1.10±0.22 1.13±0.25 t=-1.189 0.235
LDL/(mmol/L) 3.09±0.88 3.01±0.78 t=0.783 0.434
Glucose χ2=9.518 0.009
  ＜5.6 mmol/L 48 (57.1) 445 (72.2)
  5.6-6.9 mmol/L 21 (25.0) 115 (18.7)
  ≥7.0 mmol/L 15 (17.9) 56 (9.1)
HbA1c χ2=2.218 0.330
  ＜5.6% 1 (11.1) 13 (30.2)
  5.7%-6.4% 3 (33.3) 7 (16.3)
  ≥6.5% 5 (55.6) 23 (53.5)
Estrogen/Testosterone 10.60±4.22 9.58±3.70 t=2.330 0.020

Table 3

Comparison of various clinical indicators between patients with EDV≤5 cm/s and >5 cm/s"

Items EDV≤5 cm/s (n=498) EDV>5 cm/s (n=202) Statistics P
Age/years 33.92±8.96 35.38±9.60 t=-1.913 0.056
Estrogen/(pmol/L) 107.80±31.74 106.22±29.25 t=0.613 0.540
Prolactin χ2=1.287 0.505
  ＜2 μg/L 1 (0.2) 1 (0.5)
  2-18 μg/L 455 (91.4) 181 (89.6)
  >18 μg/L 42 (8.4) 20 (9.9)
Testosterone/(nmol/L) 12.15±4.06 11.68±3.78 t=1.395 0.164
Uric acid/(μmol/L) 402.30±89.47 406.79±82.57 t=-0.635 0.526
Total cholesterol/(mmol/L) 4.80±0.97 4.92±0.96 t=-1.531 0.126
Triglyceride χ2=4.516 0.211
  ＜1.50 mmol/L 322 (64.7) 115 (56.9)
  1.51-1.99 mmol/L 72 (14.5) 38 (18.8)
  2.00-4.99 mmol/L 94 (18.9) 42 (20.8)
  >5.00 mmol/L 10 (2.0) 7 (3.5)
HDL/(mmol/L) 1.13±0.25 1.13±0.24 t=-0.307 0.759
LDL/(mmol/L) 3.01±0.79 3.05±0.82 t=-0.618 0.537
Glucose χ2=5.785 0.055
  ＜5.6 mmol/L 363 (72.9) 130 (64.4)
  5.6-6.9 mmol/L 86 (17.3) 50 (24.8)
  ≥7.0 mmol/L 49 (9.8) 22 (10.9)
HbA1c χ2=2.608 0.271
  ＜5.6% 8 (23.5) 6 (33.3)
  5.7%-6.4% 5 (14.7) 5 (27.8)
  ≥6.5% 21 (61.8) 7 (38.9)
Estrogen/Testosterone 9.60±3.68 9.94±4.01 t=-1.066 0.287

Table 4

Comparison of clinical indicators between patients with abnormal PSV and/or EDV results and those with normal results"

Items Abnormal PSV and/or EDV (n=264) Normal PSV and EDV(n=436) Statistics P
Age/years 35.95±9.57 33.37±8.78 t=3.567 ＜0.001
Estrogen/(pmol/L) 106.73±30.09 107.72±31.61 t=-0.408 0.683
Prolactin χ2=0.477 0.949
  ＜2 μg/L 1 (0.4) 1 (0.2)
  2-18 μg/L 239 (90.5) 397 (91.1)
  >18 μg/L 24 (9.1) 38 (8.7)
Testosterone/(nmol/L) 11.57±3.77 12.28±4.09 t=-2.288 0.022
Uric acid/(μmol/L) 402.29±82.28 404.39±90.60 t=-0.315 0.753
Total cholesterol/(mmol/L) 4.92±0.95 4.79±0.97 t=1.729 0.084
Triglyceride χ2=4.847 0.185
  ＜1.50 mmol/L 152 (57.6) 285 (65.4)
  1.51-1.99 mmol/L 49 (18.6) 61 (14.0)
  2.00-4.99 mmol/L 55 (20.8) 81 (18.6)
  >5.00 mmol/L 8 (3.0) 9 (2.1)
HDL/(mmol/L) 1.13±0.23 1.13±0.25 t=-0.202 0.840
LDL/(mmol/L) 3.05±0.83 3.01±0.77 t=0.730 0.466
Glucose χ2=12.877 0.002
  ＜5.6 mmol/L 165 (62.5) 328 (75.2)
  5.6-6.9 mmol/L 66 (25.0) 70 (16.1)
  ≥7.0 mmol/L 33 (12.5) 38 (8.7)
HbA1c χ2=6.096 0.058
  ＜5.6% 7 (28.0) 7 (25.9)
  5.7%-6.4% 8 (32.0) 2 (7.4)
  ≥6.5% 10 (40.0) 18 (66.7)
Estrogen/Testosterone 10.10±4.10 9.46±3.55 t=2.096 0.037

Table 5

Multivariate Logistic analysis of ICI results"

Variable Group description B SE Wald df P OR 95%CI
Estrogen 0.009 0.003 13.170 1 ＜0.001 1.009 1.004-1.014
Glucose ＜5.6 mmol/L(Reference group) 12.928 2 0.002
5.6-6.9 mmol/L -0.311 0.198 2.467 1 0.116 0.732 0.497-1.080
≥7.0 mmol/L -0.996 0.282 11.764 1 ＜0.001 0.381 0.219-0.661

Table 6

Multivariate Logistic analysis of PSV results"

Variable B SE Wald df P OR 95%CI
Age -0.041 0.011 12.851 1 ＜0.001 0.960 0.938-0.982
Estrogen/Testosterone -0.053 0.029 3.443 1 0.064 0.948 0.897-1.003

Table 7

Multivariate Logistic analysis of PSV and/or EDV results"

Variable Group description B SE Wald df P OR 95%CI
Age -0.025 0.009 7.146 1 0.008 0.976 0.958-0.993
Glucose ＜5.6 mmol/L(Reference group) 7.020 2 0.030
5.6-6.9 mmol/L -0.525 0.201 6.851 1 0.009 0.591 0.399-0.876
≥7.0 mmol/L -0.278 0.277 1.005 1 0.316 0.758 0.440-1.304
1 Liu K , Sun T , Luan Y , et al. Berberine ameliorates erectile dysfunction in rats with streptozotocin-induced diabetes mellitus through the attenuation of apoptosis by inhibiting the SPHK1/S1P/S1PR2 and MAPK pathways[J]. Andrology, 2022, 10 (2): 404- 418.
doi: 10.1111/andr.13119
2 Ayta IA , Mckinlay JB , Krane RJ . The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences[J]. BJU Int, 1999, 84 (1): 50- 56.
doi: 10.1046/j.1464-410x.1999.00142.x
3 Feldman HA , Goldstein I , Hatzichristou DG , et al. Impotence and its medical and psychosocial correlates: Results of the Massachusetts male aging study[J]. J Urol, 1994, 151 (1): 54- 61.
doi: 10.1016/S0022-5347(17)34871-1
4 金淼, 颜建飞, 齐信王, 等. 彩色多普勒超声结合阴茎勃起硬度分级对勃起功能障碍的诊断价值研究[J]. 中国性科学, 2023, 32 (8): 5- 8.
5 Yuan C , Jian Z , Gao X , et al. Type 2 diabetes mellitus increases risk of erectile dysfunction independent of obesity and dyslipidemia: A Mendelian randomization study[J]. Andrology, 2022, 10 (3): 518- 524.
doi: 10.1111/andr.13132
6 Leroy TJ , Broderick GA . Doppler blood flow analysis of erectile function: Who, when, and how[J]. Urol Clin North Am, 2011, 38 (2): 147- 154.
doi: 10.1016/j.ucl.2011.03.003
7 蓝晓锋, 姜凡, 彭梅, 等. SMI技术对血管性阴茎勃起功能障碍的诊断价值[J]. 中国超声医学杂志, 2018, 34 (11): 1028- 1031.
doi: 10.3969/j.issn.1002-0101.2018.11.023
8 范叶柏, 陈翔, 金拓, 等. 阴茎海绵体注射在勃起功能障碍诊治中的应用[J]. 中国男科学杂志, 2016, 30 (10): 70- 72.
9 张羽, 湛永健, 湛炜璋, 等. 阴茎海绵体彩色双功能多普勒超声检查在血管性阴茎勃起功能障碍诊断中的应用[J]. 微创医学, 2015, 10 (3): 293- 295.
10 Sasayama S , Ishii N , Ishikura F , et al. Men's health study: Epidemiology of erectile dysfunction and cardiovascular disease[J]. Circ J, 2003, 67 (8): 656- 659.
doi: 10.1253/circj.67.656
11 Grover SA , Lowensteyn I , Kaouache M , et al. The prevalence of erectile dysfunction in the primary care setting: Importance of risk factors for diabetes and vascular disease[J]. Arch Intern Med, 2006, 166 (2): 213- 219.
doi: 10.1001/archinte.166.2.213
12 Manolis A , Doumas M . Sexual dysfunction: The 'prima ballerina' of hypertension-related quality-of-life complications[J]. J Hypertens, 2008, 26 (11): 2074- 2084.
doi: 10.1097/HJH.0b013e32830dd0c6
13 Selvin E , Burnett AL , Platz EA . Prevalence and risk factors for erectile dysfunction in the US[J]. Am J Med, 2007, 120 (2): 151- 157.
doi: 10.1016/j.amjmed.2006.06.010
14 2023年ADA糖尿病最新诊断标准(187)[J]. 临床心电学杂志, 2023, 32(6): 466.
15 Boerl L , Capogrosso P , Ventimiglia E , et al. Sexual dysfunction in men with prediabetes[J]. Sex Med Rev, 2020, 8 (4): 622- 634.
doi: 10.1016/j.sxmr.2018.11.008
16 Ponholzer A , Temml C , Mock K , et al. Prevalence and risk factors for erectile dysfunction in 2 869 men using a validated questionnaire[J]. Eur Urol, 2005, 47 (1): 80- 85.
doi: 10.1016/j.eururo.2004.08.017
17 Fontaine C , Morfoisse F , Tatin F , et al. The impact of estrogen receptor in arterial and lymphatic vascular diseases[J]. Int J Mol Sci, 2020, 21 (9): 3244.
doi: 10.3390/ijms21093244
18 Yafi FA , Jenkins L , Albersen M , et al. Erectile dysfunction[J]. Nat Rev Dis Primers, 2016, 2, 16003.
doi: 10.1038/nrdp.2016.3
19 Burnett AL . Novel nitric oxide signaling mechanisms regulate the erectile response[J]. Int J Impot Res, 2004, 16 (Suppl 1): S15- S19.
20 Seeland U , Demuth I , Regitz-zagrosek V , et al. Sex differences in arterial wave reflection and the role of exogenous and endogenous sex hormones: Results of the Berlin Aging Study Ⅱ[J]. J Hypertens, 2020, 38 (6): 1040- 1046.
21 刘文华, 张治芬, 汤珊珊, 等. 17β-雌二醇下调MCP-1及RhoA表达发挥心血管保护作用[J]. 国际生殖健康/计划生育杂志, 2017, 36 (5): 373- 377.
22 Gayard M , Guilluy C , Rousselle A , et al. AMPK alpha 1-induced RhoA phosphorylation mediates vasoprotective effect of estradiol[J]. Arterioscler Thromb Vasc Biol, 2011, 31 (11): 2634- 2642.
23 马洁桦. 阴茎海绵体雌激素受体β在勃起功能障碍发病中的作用及机制研究[D]. 南京: 南京师范大学, 2012.
24 Irwin GM . Erectile dysfunction[J]. Prim Care, 2019, 46 (2): 249- 255.
25 Pathak RA , Broderick GA . Color Doppler duplex ultrasound parameters in men without organic erectile dysfunction[J]. Urology, 2020, 135, 66- 70.
[1] Hui WEI, Jingfeng ZHANG, Zhongqiang YAO, Jinxia ZHAO. Clinical characteristics and relevant factors of rheumatoid arthritis patients with anemia of chronic disease [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 307-312.
[2] Jie ZHAO, Chun FU, Xiujuan ZHAO, Haiyan XUE, Shu LI, Zhenzhou WANG, Fengxue ZHU. Risk factors for ventilator-associated pneumonia in patients with chest trauma in intensive care unit [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 351-358.
[3] Bowen LI, Qiang ZHANG, Yixin SUN. Establishment and validation of a risk prediction model for scoliosis after Nuss procedure in children and young adults with pectus excavatum [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 941-946.
[4] Xiaoyong YANG, Fan ZHANG, Lulin MA, Cheng LIU. Clinical characteristics and influencing factors of extraglandular invasion of prostatic ductal adenocarcinoma [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 956-960.
[5] Yuanjie NIU, Zhongcheng XIN, Guiting LIN, Pan DING, Jiancheng PAN, Yuhong FENG, Yinglu GUO. Low-level laser therapy for the treatment of male infertility and erectile dysfunction [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 627-632.
[6] Wei LIU, Wen GUO, Zhe GUO, Chunyan LI, Yunlong LI, Siqi LIU, Liang ZHANG, Hui SONG. Risk factors associated with non-radiographic bone erosion in patients with gout [J]. Journal of Peking University (Health Sciences), 2025, 57(4): 735-739.
[7] Mengxi LU, Qiuping LIU, Tianjing ZHOU, Xiaofei LIU, Yexiang SUN, Peng SHEN, Hongbo LIN, Xun TANG, Pei GAO. Association of triglyceride-glucose index and cardiovascular disease in a community-based Chinese cohort [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 430-435.
[8] Huaqiu GUO, Zhe WANG, Xue YANG, Jie BAI. Clinical features and risk factors of patients with oral bleeding in dental emergency [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 142-147.
[9] Minting DENG, Nan WANG, Bin XIA, Yuming ZHAO, Junxia ZHU. Factors associated with spontaneous re-eruption of traumatically intruded permanent anterior teeth in children and adolescents [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 148-153.
[10] Yukai LI, Hongyan WANG, Liang LUO, Yun LI, Chun LI. Clinical significance of antiphospholipid antibodies in Behcet disease with thrombosis [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1036-1040.
[11] Yang TIAN, Yongzheng HAN, Jiao LI, Mingya WANG, Yinyin QU, Jingchao FANG, Hui JIN, Min LI, Jun WANG, Mao XU, Shenglin WANG, Xiangyang GUO. Incidence and risk factors of postoperative epidural hematoma following anterior cervical spine surgery [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1058-1064.
[12] Mingrui WANG, Jinhui LAI, Jiaxiang JI, Xinwei TANG, Haopu HU, Qi WANG, Kexin XU, Tao XU, Hao HU. Risk factors for decreased quality of life in patients with kidney stones predicted by the Chinese version of Wisconsin stone quality of life questionnaire [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1069-1074.
[13] Zhicun LI, Tianyu WU, Lei LIANG, Yu FAN, Yisen MENG, Qian ZHANG. Risk factors analysis and nomogram model construction of postoperative pathological upgrade of prostate cancer patients with single core positive biopsy [J]. Journal of Peking University (Health Sciences), 2024, 56(5): 896-901.
[14] Ye YAN,Xiaolong LI,Haizhui XIA,Xuehua ZHU,Yuting ZHANG,Fan ZHANG,Ke LIU,Cheng LIU,Lulin MA. Analysis of risk factors for long-term overactive bladder after radical prostatectomy [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 589-593.
[15] Bo PANG,Tongjun GUO,Xi CHEN,Huaqi GUO,Jiazhang SHI,Juan CHEN,Xinmei WANG,Yaoyan LI,Anqi SHAN,Hengyi YU,Jing HUANG,Naijun TANG,Yan WANG,Xinbiao GUO,Guoxing LI,Shaowei WU. Personal nitrogen oxides exposure levels and related influencing factors in adults over 35 years old in Tianjin and Shanghai [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 700-707.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd