Cavernosal arterial insufficiency is a major component of erectile dysfunction in some recipients of high-dose chemotherapy/chemoradiotherapy for haematological malignancies

We studied 24 male patients aged 26-62 Sears (median 41) prospectively pres enting over a 5 year period with clinical features of hypogonadism and erec tile dysfunction (ED), who had been treated with autologous or allogeneic b one marrow/stem cell transplant for a variety of haematological malignancie s and had received either high-dose chemotherapy or high-dose chemotherapy combined with total body irradiation (TBI), Ten healthy adult controls (age d 35-50 gears) were also studied. Erectile dysfunction (ED) was assessed cl inically and by colour flow Doppler studies of the cavernosal vessels. Test icular function was assessed by testicular volume including orchidometry, F SH, LH and testosterone measurements. Libido and ejaculatory function were also recorded. Patients had severe hypogonadism as evidenced by low mean te sticular volume (7.0 +/- 2.4 ml vs 20 +/- 2.0 ml; P < 0.001), elevated gona dotrophins (FSH = 18.54 +/- 7.61 vs 5 IU/I (P < 0.001); LH = 8.02 +/- 2.89 vs 3.9 IU/I (P < 0.001)) and low normal mean testosterone levels (16.4 nmol /l +/- 9.1 vs 22.4 nmol/l (P < 0,5)), Cavernosal arterial insufficiency was found in 11/14 of TBI-treated and in 3/10 HDC-treated patients, indicative of vasculogenic damage to corpora cavernosal vessels. Patients were given a therapeutic trial with testosterone replacement therapy (TRT), Those who had diminished libido had a marked improvement in their symptoms but the ef fect of TRT on ED was equivocal. In conclusion, this is the first report to show vasculogenic insufficiency in patients with haematological malignanci es treated by BMT. Although hypogonadism can account for diminished libido, arteriogenic insufficiency is likely to be an important factor accounting for ED in these patients, especially those treated by TBI, We recommend a c omprehensive assessment including endocrine profile and colour pow Doppler study in formulating the best management plan in recipients of high-dose th erapy presenting after transplant with ED.