DOI: 10.1002/bco2.275 ISSN:

Investigating the risk factors of penile arterial insufficiency and veno‐occlusive dysfunction in patients with erectile dysfunction

Mohamad Habous, Ahmed Khattak, Mohammed Farag, Saleh Binsaleh, David Ralph, Mohammed Aziz, Carlo Bettocchi, Gordon Muir
  • Religious studies
  • Cultural Studies



To investigate the risk factors for penile arterial insufficiency (PAI), which is a known cause of erectile dysfunction (ED).


Patients who attended our urology clinic complaining of ED for more than 6 months were prospectively enrolled in this study over 1‐year period. Patient consent was taken and ethical committee approval. Complete medical history and thorough general and local examination including body mass index (BMI), Peyronie's disease (PD) and penile size measurements (length and girth) were done for all of them. Laboratory tests included testosterone, lipid profile and glycated haemoglobin (HA1c). A penile duplex ultrasound study (PDU) was done for all patients after intracavernosal injection (ICI) with alprostadil. Peak systolic velocity (PSV) and end‐diastolic velocity (EDV) were measured after 15 min. Statistical analysis was done using SPSS.


A total of 440 patients were enrolled in this analysis. The mean age was 48(23–81), and the mean BMI was 30 (18–51). Older patients had lower PSV (r = −0.361, P = 0.000) and higher EDV (r = 0.174, P = 0.001), and both correlations were highly statistically significant. Diabetics had lower PSV (r = −0.318, P = 0.000) and higher EDV (r = 0.139, P = 0.008), which were also highly statistically significant. Smokers had lower PSV (r = −0.140, P = 0.008) and higher EDV (r = 0.178, P = 0.001), which were highly statistically significant. Men with larger penises measured skin to tip had lower EDV (r = −0.119, P = 0.024), which was less significant. Interestingly, there was neither a significant correlation between BMI and PSV (0.16, P = 0.745) nor a significant correlation between testosterone and PSV (0.029, P = 0.552). Also, there was no correlation between PSV and both dyslipidaemia and penile PD.


Ageing, tobacco consumption, DM and hypertension seem to have a negative impact on penile haemodynamics, which was statistically significant. In our patients, there was no statistically significant effect on penile haemodynamics in patients with increased BMI, low testosterone or PD or according to the size of the penis.

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