ERECTILE DYSFUNCTION IN PATIENTS WITH CHRONIC RENAL FAILURE: INTRACAVERNOSAL INJECTION OF PROSTAGLANDIN E1 EVALUATED WITH COLOR DOPPLER SONOGRAPHY

Purpose: We studied 30 patients with chronic renal failure, assessing the morphodynamic features of cavernosal arteries by color Doppler sonography and their clinical response to intracavernosal injection of prostaglandin E1 (PGE1). Patients and Methods: The International Index of Erectile Function (IIEF) was applied to all patients. Morphodynamic parameters evaluated by color Doppler sonography included: peak systolic velocity, end diastolic velocity, inner arterial diameter and the anatomy of cavernosal arterial blood flow. The test was performed with the flaccid penis and after the intracavernosal injection of 10mg PGE1. Results: Twenty-four patients had clinical complaints of erectile dysfunction and six patients had none. The mean peak systolic velocity of the patients without erectile dysfunction changed from 57 cm/sec to 65 cm/ sec after the intracavernosal injection of PGE1. The patients with erectile dysfunction had their peak systolic velocity increased from 1.5 to 2 times the initial value with mean change of 45cm/sec to 55cm/sec. The inner arterial diameter increased from 47% to 67% after the intracavernosal injection of PGE1 into the cavernosal artery of the patients without erectile dysfunction. In patients with erectile dysfunction, the inner cavernosal artery diameter increased by 37% to 41% of the initial value. The mean end diastolic velocity was of 12 cm/sec in both groups. The study of cavernosal artery anatomy showed patients with stenotic, bifurcated, and duplicated arteries. Eighty-three per cent of the patients with erectile dysfunction had a good clinical response to intracavernosal injection of PGE1. Two patients without complaints of erectile dysfunction had prolonged erections (four hours each). We did not observe hematomas at the site of injection in any of the patients studied. Conclusion: The color Doppler sonography may be used to evaluate the hemodynamic parameters of the erectile dysfunction in patients with chronic renal failure and penile vascular disease. The clinical response to intracavernosal injection of PGE1 in this group of patients showed excellent results with few side effects.