Penile Hemodynamic Patterns Highlighting the Impact of Diabetes in Young Men With Erectile Dysfunction

Erectile dysfunction (ED) in young men is often assumed to be psychogenic, which may lead to underdiagnosis of organic causes such as vasculogenic ED, particularly in the absence of overt comorbidities.

This study aims to investigate the clinical manifestations, risk assessment, and penile hemodynamic pattern in younger ED patients, with a particular focus on identifying factors associated with vasculogenic ED.

We retrospectively reviewed the medical records of patients who sought evaluation for ED and underwent penile Doppler ultrasound (PDU) between May 2016 and April 2023. Patients were categorized into younger (≤40 years) and older (>40 years) groups. Clinical characteristics, comprehensive biochemical parameters, and PDU results were collected and analyzed.

Among 1007 ED patients enrolled, 200 were classified as younger ED (19.9%) and had fewer systemic comorbidities than older patients. Notably, 21.5% of younger ED patients exhibited penile vasculogenic dysfunction. Diabetes mellitus (DM) emerged as the strongest independent predictor of vasculogenic ED (OR 5.60, p = 0.015) and moderate to severe ED (OR 4.75, p = 0.023). Younger ED patients with DM demonstrated significantly lower peak systolic velocity (PSV), elevated end-diastolic velocity (EDV), and a reduced resistive index (RI) compared with their non-diabetic counterparts. The prevalence of vasculogenic ED was highest in DM patients (58.3%), followed by prediabetes (25%) and non-DM (17.8%).

A substantial portion of young men with ED have underlying vasculogenic causes, especially related to diabetes. Early vascular impairment can be detected via PDU, even in patients without classic risk factors. This highlights the importance of considering penile vascular assessment and metabolic screening in the evaluation of younger ED patients to guide timely intervention and prevent long-term complications.