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Assessment of EndoPat Scores in Men with Vasculogenic and Non-Vasculogenic Erectile Dysfunction
Akanksha Mehta, MD, Martin Miner, M.D., Mark Sigman, M.D..
Warren-Alpert School of Medicine at Brown University, Providence, RI, USA.

Introduction
Endothelial cell dysfunction is thought to be involved in many cases of vasculogenic erectile dysfunction . The EndoPat2000 device (Itamar Medical®) attempts to evaluate endothelial cell function by the determination of the degree of reactive hyperemia following temporary brachial artery occlusion. It is possible that many patients presenting with ED have endothelial cell dysfunction where as previously potent patients whom have ED following radical prostatectomy have better endothelial cell dysfunction. In order to evaluate this hypothesis, EndoPat reactive hyperemia index (RHI) scores were compared in patients presenting with ED and no history of radical prostatectomy to patients who had ED following radical prostatectomy (RP).
Methods
We conducted a retrospective chart review of 292 men evaluated for erectile dysfunction at our institution. Patients were divided into two groups, namely those with ED after RP, and those with ED without RP. Demographic information, details of medical and surgical comorbidities related to ED, scores from the Sexual Health Inventory for Men (SHIM) and EndoPat scores for each patient were recorded. Post-prostatectomy patients with pre-existing ED were excluded from final analysis.
Results
Of the 292 patients, 98 presented after RP, while 194 had general ED. There was no significant difference in EndoPat scores between the two groups (1.97 vs. 2.08). There was no correlation between EndoPat scores and patient age, but an inverse linear relationship was seen between body mass index (BMI) and EndoPat scores.
The presence of medical comordities such as hypertention, dyslipidemia, coronary artery disease, diabetes, and hypogonadism was 50%, 56.8%, 10.6%, 16.8%, and 20.9%, respectively. Overall, there was no significant difference in EndoPat scores between patients with or without, dyslipidemia, coronary artery disease, or hypogonadism, but scores were lower in patients with hypertension (1.97 vs 2.11, p=0.025) and in diabetics (1.89 vs. 2.07, p=0.024). Of note, the prevalence of hypertension was equal (51% in ED and 48% in RP groups, p = 0.62) among the two groups of ED patients, while diabetes was more common among the general ED group (21% in ED and 9% in RP, p = 0.014). EndoPat scores in RP patients with at least one of the above medical comorbidities were not significantly different from those is general ED patients with the same comorbidities. In the general ED group, EndoPat scores did not correlate with SHIM scores (r = - 0.018, p = 0.82).
Conclusion
There was no significant difference in EndoPat scores between patients with ED after RP and patients with general ED. This does not appear to be accounted for by confounding comorbitities. This raises the question of the value of the RHI in the evaluation of men with ED. While prior studies suggest EndoPat correlates with penile duplex flow and PDE5 response, the utility of EndoPat in the workup of the high-risk ED patient for the prevention of vascular events remains to be established.


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