Periodontitis in patients with severe erectile dysfunction undergoing penile prosthesis implantation: Clinical and immunohistochemical study

Abstract

Background: The relationship between periodontitis and erectile dysfunction (ED) has been poorly documented in Caucasian populations, particularly severe ED (SED) requiring penile prostheses. This study aimed to evaluate the association between periodontitis and SED in patients undergoing penile prosthesis implantation, and to identify clinical and biochemical periodontal variables associated with SED using multivariate analysis.

Methods: An observational case–control study was conducted on patients with SED (cases) and patients with other conditions, such as penile curvature and Peyronie's disease (controls). Periodontal clinical and biochemical variables were assessed, alongside histomorphometrical and immunohistochemical analyses of corporotomies from the corpora cavernosa.

Results: The study included 81 patients: 24 with SED and 57 controls. Compared to controls, the SED group showed higher age (p < 0.001), lower high density lipoproteins (HDL) levels (p = 0.012), higher diabetes prevalence (p = 0.036), fewer teeth (p < 0.001), more sites with attachment loss > 3 mm (p = 0.014), and over 3 times greater Periodontal Inflammatory Severity Index modified (PISIM) (p < 0.001). Additionally, the SED group had fewer blood vessels/mm2 (p < 0.001) and lower endothelial nitric oxide synthase (eNOS) expression (p = 0.043). Multivariate logistic regression showed that age > 55 years (odds ratio [OR] = 5.9, 95% confidence interval [CI] 1.5–22.9, p = 0.010), diabetes (OR = 7.0, 95%CI 1.3–37.9 p = 0.023), and PISIM scores > 4 (OR = 13.9, CI 2.6–73.8, p = 0.002) increased the likelihood of SED requiring prothesis implantation.

Conclusions: Periodontitis is strongly associated with SED treated with penile prostheses, linked to lower eNOS expression in penile tissue. Diabetes and age were identified as additional independent risk factors for SED.