Sub-Albuginean Adipocyte Accumulation is Associated with Erectile Dysfunction: First Clinical Evidence and Pathophysiological Implications

Abstract

The aim of this study is to determine the presence of adipocyte accumulation under penile tunica albuginea in a group of refractory erectile dysfunction patients. Nine erectile dysfunction patients (case group) and eleven potent patients with Peyronie’s disease (control group) underwent penile prosthesis implantation and curvature correction surgeries, respectively. In both groups, sub-albuginean tissue samples were taken within the operative time. Groups were compared in terms of clinical characteristics, co-morbidities and presence of sub-albuginean adipocyte accumulation. Of the nine patients in the case group, eight presented cavernous fat cell accumulation, while only one patient in the control group presented this finding (p<0.05). A significant association (p<0.05) was found between adipocyte accumulation and erectile dysfunction (OR 35 CI 95% 1.98-1727.62). A similar association with chronic arterial hypertension was also found (OR 20 CI 95% 1.29-1008.46). This is the first human study to report an association between erectile dysfunction and penile sub-albuginean fat accumulation. Metabolic syndrome-related conditions could cause disruption in androgen homeostasis, leading to adipocyte accumulation. Venous leakage secondary to accumulation of fat under tunica albuginea could be an important element in the pathophysiology of erectile dysfunction, especially in metabolic syndrome patients that do not respond to medical therapy.