Erectile Dysfunction in Patients with Alcohol Consumption
Dachille, Giuseppe, Lamuraglia, Michele, Leone, Michele, Pagliarulo, Arcangelo, Palasciano, Giuseppe, Salerno, MariaTeresa, Ludovico, Giuseppe Mario, Alcoholism
The erectile dysfunction (ED) is a significant problem of the western population. One of its important causes is the style of life. One of the aspects of the irregular lifestyle is alcohol consumption. Alcoholism is one of the most common chronic disorders in the world and leads to a large number of multiple diseases. The W.H.O. established that alcohol is responsible for around 9% of diseases in Europe. Even in low doses (>20 g/day fora man and > 10 g/day for a woman), the risk of cirrhoses, arterial hypertension, cardiac infarction, congenital malformations and tumours increases.1,2 Also, the bibliography shows significant evidence of correlation between alcoholism and sexual deficit.3,4,5 In fact, the influence of alcohol consumption on hormonal level in patients with sexual deficit was demonstrated,3 as well as the normalization of hormonal level resulting from the abstinence from alcohol consumption.4 Therefore, authors suggested that the effects of alcohol consumption on the vascular system, liver function and neurological system were an indirect cause of sexual dysfunction.3-6 However, all these studies have taken into consideration high risk patients and the bibliography presents few studies of moderate alcohol drinkers.
In the population of patients with ED the present study aims to evaluate: the correlation between erectile dysfunction and consumption of alcoholic drinks and the effect of alcohol abstinence on this population with and without assonated drugs association.
SUBJECTS AND METHODS
The study involved 155 ED patients screened by the Urology II Unit of the University of Bari, from May 2004 to May 2005. From this population we excluded all patients with clinical causes of ED as described in Table 1. Therefore, only 50 patients aged between 22 and 77 years (mean+SD, 56+14) were included in our study.
All the patients were screened by a CAGE questionnaire (each of the letters in the acronym refers to one of the questions) and by the AUDIT (Alcohol Use Disorders Identification Test). The CAGE questionnaire is a blind questionnaire that permits to identify alcohol dependence. It consists of 4 questions (cut down, annoyed, guilt, eye opened): when 2 or more answers were positive, the risk was considered high, while the presence of 1 positive answer led to a risk considered low.7 The AUDIT questionnaire permits to quantify the alcohol consumption.8,9 The quantity of alcohol consumed was evaluated for every patient. The daily consumption of alcohol was expressed in grams of anhydrous alcohol and calculated with the following formula: ml of alcoholic drink x alcoholic degree x 0,79/100.
At the same time, the patient was evaluated by the UEF (International Index Erectile Dysfunction). This questionnaire is a reproducible and valid tool that provides a quantitative index of ED severity for diagnostic and classification purposes.10,11
The patients were evaluated also by haematological screening, particularly alcohol markers (MCV, γGT) and hormonal function (FSH, LH, Testosterone Total and Free). Hepatic and renal functions as well as the level of cholesterol and triglyceride were also evaluated.
The patients were examined by the penile Doppler Ultrasound (USD). The USD was performed by an Esaote H19 sonograph (Italy, Milan) with a 7.5 MHz linear transducer equipped with Doppler technology. The penile USD study was carried out in a quiet, isolated comfortable room to ensure the patients' privacy. The Echotexture of the penis was evaluated in longitudinal and transverse planes in B Mode. The penis was examined by the Colour Doppler sonography, in the flaccid state and after the intracavernosal injection of ll^grof prostaglandin (PGEl). The response was classified as normal when the Doppler systolic peak velocity (PSV) was more then 35 mm/s and the diastolic peak velocity (PDV) was less then 5 mm/s.11'12'13 This diagnostic functional imaging technique permitted the exclusion of vascular erectile dysfunction. …