Impotncia Sexual Arteriognica em Pacientes Portadores de Aterosclerose das Artrias Coronrias

Autor: Nilo Mitsuru Izukawa Tese de Doutorado, defendida em So Paulo, 1997 Instituio: Faculdade de Medicina Universidade de So Paulo (USP) Orientador: Pedro Puech-Leo Correspondncia: Nilo Mitsuru Izukawa Instituto Dante Pazzanese de Cardiologia Av. Dr. Dante Pazzanese, 500 CEP: 04012-909 Ibirapuera So Paulo, SP Resumo A impotncia sexual em pacientes portadores de aterosclerose das artrias coronrias foi estudada nesta tese. Publicaes anteriores enfatizavam a importncia dos aspectos desta doena sobre a sexualidade, concluindo ser essa a causa da disfuno ertil nesses pacientes. A aterosclerose uma molstia sistmica podendo, portanto, estar comprometendo simultaneamente as artrias coronrias e pudendas. O objetivo desta tese foi estudar a incidncia da disfuno ertil nos pacientes com aterosclerose das artrias coronrias, bem como o papel da aterosclerose e de seus fatores de risco no desenvolvimento da impotncia sexual. Oitocentos e vinte e oito pacientes portadores de aterosclerose das artrias coronrias, que passaram pela Seo de Angioplastia Coronrias do Instituto Dante Pazzanese de Cardiologia, no perodo de 01 de janeiro a 31 de dezembro de 1993, foram interrogados sobre a presena de disfuno ertil. O diagnstico foi clnico, baseado em anamnese realizada por cardiologistas daquele setor. Os pacientes impotentes que se dispuseram ao estudo diagnstico dessa doena foram submetidos ecografia Doppler das artrias cavernosas, e os que apresentaram resultados sugestivos de insuficincia arterial genital, nesse exame, foram submetidos a arteriografia seletiva das pudendas. Os fatores de risco para a doena aterosclertica foram obtidos nos pronturios dos pacientes. Duzentos e setenta e um (32,7% IC-95%:{29,5%-35,9%}) dos pacientes apresentavam impotncia sexual e 102 (37,6%) deles manifestaram desejo de submeterem-se investigao diagnstica. Foram realizadas 59 ecografia-Doppler com 37 [62,7% IC (50,4%-75%)] resultados sugestivos de insuficincia arterial do segmento hipogstrico-pudendo. Quatorze pacientes com resultado positivo nesse exame submeteram-se ao estudo arteriogrfico, encontrando-se 13 (92,8%) com obstruo arterial nas pudendas. A pesquisa dos fatores de risco demonstrou que diabete melito, idade, tabagismo e o antecedente de infarto agudo do miocrdio estavam associados de maneira estatisticamente significante no desenvolvimento da impotncia sexual. Concluiu-se que a incidncia de impotncia sexual alta entre os pacientes coronarianos, mas existe uma resistncia muito grande, por parte desses pacientes, ao estudo diagnstico invasivo. A idade, o diabete melito, o antecedente de infarto agudo do miocrdio e o tabagismo so fatores de risco correlacionados com a impotncia sexual nos pacientes desse grupo. A obstruo arterial no territrio pudendo responsvel pela disfuno ertil em um nmero considervel de pacientes portadores de aterosclerose das artrias coronrias.

Sexual Arteriogenic Impotence in Patients Having Coronary

Atherosclerosis
Summary

Erectile dysfunction among patients with coronary atherosclerosis was studied in this thesis. Previous studies emphasized the importance of psychological aspects of this condition; however, atherosclerosis of pudendal arteries also has a role in its genesis. The aim this thesis was to study the incidence of erectile disorder in patients with coronary arterial disease, as well as the role of artheriosclerosis and its risk factors in the development of that condition. Eight-hundred-twenty-eight patients with coronary atherosclerosis were seen at the Coronary Angioplasty Department in Dante Pazzanese Institute of Cardiology from January 1st to December 31 st 1993. They were inquired about erectile disorder. The diagnosis was clinical based on anamnesis carried out by cardiologist of that department. The impotent patients who showed interest in undergoing a diagnostic study of this condition were submitted to Doppler Ecography of cavernous arteries. Those with results suggestive of genital arterial insuficiency in this test were selected to Selective Arteriography of the pudendal arteries. Risk factors to arterioclerosis were obtained from the patients files. From all patients, 271 had a complaint of sexual incapacity and 102 (37,6%) wanted to undergo diagnosis investigation. Fifty-nine echographies were carried out. Thirty-seven (62,7%) were suggestive of arterial insufficiency of hypogastric-pudendal segment. Fourteen patients with a positive result in this test wanted to undergo arteriographic study. Thirteen of those had arterial obstruction in the pudendal artery. The Study of risk factors showed diabetes mellitus, age, cigarette smoking and previous myocardial infarction as statistically significant to the development of erectile dysfunction. The conclusion was that incidence of impotence is high among these patients, but they have a considerable resistance to invasive diagnostic studies. Age, Diabetes mellitus, previous myocardial infarction and cigarette smoking are risk factors associated to sexual incapacity in this group. Arterial obstruction in pudendal area is responsible for erectile disorder in a substantial number of patients having coronary atherosclerosis.