Enhanced External Counterpulsation as a New Treatment Modality for Patients with Erectile Dysfunction.
Froschermaier, S, Urologia Internationalis 1998;61:168-71
Erectile Dysfunction (ED) is essentially endothelial dysfunction, here compromising nitric oxide production and consequent vasodilation within the penile arteriolar system. Viagra works by blocking the breakdown of cGMP, nitric oxide's second messenger, so it stands to reason that measures designed to improve penile endothelial function will help with ED. Arginine supplementation improves overall and penile endothelial function, and helps when ED is vascular in origin. Several papers have documented the nitric oxide generating feature of EECP, and Urano's paper (article 10 û this section) showed us that vascular endothelial dysfunction, as measured by flow mediated brachial artery vasodilation, essentially normalizes following a course of treatment.
We know from Werner's paper (article 5 û this section) that blood flow to the pelvic region (internal iliac artery) increases by 140% during an EECP treatment, so we can predict that EECP might be helpful in ED. Fricchione's study (article 5 û section 1), which focused on the effect of EECP on quality of life parameters, noted that love life improved in 1/3 of their subjects following EECP. In this paper, Froscheimer studied the effects of EECP on both subjective and physiologic parameters of erectile function in 13 men with ED.
All 13 men had a stable sexual relationship. 6 of the men were diabetic and 12 were cigarette smokers. Physiologic and functional measurements of erectile function were carried out before and 4 weeks after a standard 35 hour course of EECP. Each man graded the quality of erectile function on the following 4-point scale,
Froschermaier, S, Urologia Internationalis 1998;61:168-71
Erectile Dysfunction (ED) is essentially endothelial dysfunction, here compromising nitric oxide production and consequent vasodilation within the penile arteriolar system. Viagra works by blocking the breakdown of cGMP, nitric oxide's second messenger, so it stands to reason that measures designed to improve penile endothelial function will help with ED. Arginine supplementation improves overall and penile endothelial function, and helps when ED is vascular in origin. Several papers have documented the nitric oxide generating feature of EECP, and Urano's paper (article 10 û this section) showed us that vascular endothelial dysfunction, as measured by flow mediated brachial artery vasodilation, essentially normalizes following a course of treatment.
We know from Werner's paper (article 5 û this section) that blood flow to the pelvic region (internal iliac artery) increases by 140% during an EECP treatment, so we can predict that EECP might be helpful in ED. Fricchione's study (article 5 û section 1), which focused on the effect of EECP on quality of life parameters, noted that love life improved in 1/3 of their subjects following EECP. In this paper, Froscheimer studied the effects of EECP on both subjective and physiologic parameters of erectile function in 13 men with ED.
All 13 men had a stable sexual relationship. 6 of the men were diabetic and 12 were cigarette smokers. Physiologic and functional measurements of erectile function were carried out before and 4 weeks after a standard 35 hour course of EECP. Each man graded the quality of erectile function on the following 4-point scale,
and recorded the percentage of attempts at intercourse that were successful. As a physiologic measure, peak penile artery blood flow rate was recorded. Froschermaier's findings are presented below is tabular and graphic form.
Penile artery systolic flow essentially doubled, and perceived quality of erection on a four-point scale improved from 1.5 to 2.3. Pre-EECP, intercourse was not possible for 7 of the men, and was successful in <20% of attempts in 6. Only 2 of the 13 men did not benefit from EECP; erectile dysfunction improved in 7, while in 4 ED fully resolved. Only 3 of the 13 subjects reported spontaneous morning erections pre-EECP, while post-EECP 11 men noted morning erections. Patients come to us for relief of refractory angina, but they don't mind it a bit when their love life improves.
