Efficacy of androgen replacement therapy in patients with coexistence of hipogonadism and venoocclusive erectile dysfunction

Öz

Decreases in plasma testosterone levels cause not only fatigue, depression, but also sexual symptoms such as decrease in libido or erectile dysfunction (ED). Low testosterone levels can cause venoocclusive dysfunction. In this study, we aimed to show that ED could be treated by testosterone replacement in patients with venoocclusive dysfunction and hipogonadism. Data of 500 patients applied to our clinic with ED between January 2009- March 2012 were examined retrospectively for coexistence of erectile dysfunction, hipogonadism and venoocclusive dysfunction. International Index of Erectile Disfuncion (IIEF-5) scores and plasma testosterone levels of the patients were evaluated. Venoocclusive dysfunction was determined by penile color Doppler ultrasound. After excluding other causes that can cause ED, 37 patients administered testosterone replacement therapy for hipogonadism and venoocclusive erectile dysfunction, were enrolled in the study. After 6 months, IIEF-5 scores and plasma testosterone levels of the patients were reevaluated. After treatment, 29 of 37 patients (78%) were found to improve for ED. Patients with ED, hipogonadism and venous leakage should be kept in mind. We believe this condition could be treated by testosterone replacement therapy.

Anahtar Kelimeler

• Erectile dysfunction; hypogonadism; testosterone.

Hipogonadizm, venöz yetmezlik ve erektil disfonksiyon birlikteliği gözlenen olgularda androjen replasman tedavisinin etkinliği

Öz

Serum testosteron seviyelerinde azalma güçsüzlük, halsizlik, depresif ruh hali gibi sistemik belirtilerin yanı sıra libidoda azalma, erektil disfonksiyon (ED) gibi seksüel belirti ve bulgulara da yol açabilmektedir. Düşük testosteron seviyesi korporal veno-okluziv mekanizmada da bozukluğa yol açabilmektedir. Çalışmamızda venöz yetmezlik, ED ve hipogonadizm birlikteliği olan olgularda testosteron replasman tedavisi ile venöz yetmezliğin tedavi edilebileceğini göstermeyi amaçladık. Çalışma Ocak 2009-Mart 2012 tarihleri arasında ED yakınması ile kliniğimize başvuran 500 hastanın dosya kayıtları incelenerek retrospektif olarak gerçekleştirildi. ED sebebi olabilecek diğer nedenler ekarte edilerek hipogonadizm ve venöz yetmezlik tespit edilmiş ve en az 6 ay androjen replasman tedavisi uygulanmış 37 hasta çalışmaya alındı. Tüm olgular IIEF-5 (International Index of Erectile Disfuncion) skoru, serum testosteron ölçümleri ve penil renkli Doppler Ultrasonografi (PRDUS) ile değerlendirildi. Altı aylık tedavi sonrası hastaların IIEF-5 skorları ve testosteron ölçümleri tekrarlanarak ve tedavi öncesi değerlerle istatistiksel olarak karşılaştırılarak androjen replasman tedavisinin faydalı olup olmadığı araştırıldı. Hastaların tamamının testosteron yerine koyma tedavisi ile fizyolojik seviyelerde testosteron değerlerine ulaştığı tespit edildi. Tedavi sonunda total ve serbest testosteron seviyelerinde istatistiksel olarak anlamlı artış saptanırken hemoglobin ve PSA değerlerinde değişim izlenmedi. Hastaların ortalama IIEF skorlarında da artma 37 hastanın 29'unda (%78) saptandı. Hiçbir hastada androjen replasman tedavisine bağlı herhangi bir yan etki olmadığı görüldü. ED hastalarında hipogonadizm ve hipogonadizm bağımlı venöz yetmezliğin de mutlaka akla getirilmesi ve testosteron replasmanı ile büyük ölçüde tedavi edilebileceği inancındayız.

Anahtar Kelimeler

• Erektil disfonksiyon; hipogonadizm; testosteron.

Kaynakça

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