This article is part of the supplement: Selected articles from the XXV National Congress of the Italian Society of Geriatric Surgery

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Testosterone deficiency causes penile fibrosis and organic erectile dysfunction in aging men. Evaluating association among Age, TDS and ED

Fabrizio Iacono1, Domenico Prezioso1, Antonio Ruffo1*, Ester Illiano1, Leo Romis3, G Di Lauro3, Giuseppe Romeo1 and Bruno Amato2

Author affiliations

1 Department of Urology, University “Federico II” of Naples. Via Pansini, 5 - 80131 – Naples, Italy

2 Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University “Federico II” of Naples. Via Pansini, 5 - 80131 – Naples, Italy

3 'Hospital Santa Maria delle grazie', Via Domitiana località La Schiana – 80078 – Pozzuoli, Naples, Italy

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Citation and License

BMC Surgery 2012, 12(Suppl 1):S24  doi:10.1186/1471-2482-12-S1-S24

Published: 15 November 2012



We studied the possible correlation between age, testosterone deficiency, cavernosal fibrosis and erectile dysfunction (ED).


47 patients with ED were enrolled between September 2010 and October 2011. IIEF-EF score, NPTR test using the Rigiscan method, total and free testosterone levels, and cavernosum biopsy were carried out on all patients. Patients aged 65 or over were defined as Old Age (OA) while patients under 65 were defined Young age (YA). The strength of the relationships found was estimated by Odds Ratio.


74% of patients with values of over 52% collagen fibers in the corpora cavernosa were found to have organic ED. A significant difference was found in age, percentage of collagen fibers, testosterone levels between patients with Positive Rigiscan (PR) and Negative Rigiscan (NR). Hypotestosteronaemia increased the risk of ED with PR (OR: 21.4, 95% CI: 20.2-22.6) and in both young age patients (OR: 4.3, 95% CI: 2.4-6.2) and old age patients (OR: 15.5, 95% CI: 13.4-17.6). Moreover cavernosal fibrosis increased the risk of ED with PR in both young age patients (OR: 8.2, 95% CI: 6.4-10.0 and old age patients (OR: 24.6, 95% CI: 20.8-28.4).


This study demonstrates a strong association among age, testosterone deficiency, cavernosal fibrosis and ED with PR. Age, testosterone deficiency and cavernosal fibrosis are potentially correctable factors of cavernosal fibrosis and organic ED. Further, prospective studies are needed to evaluate if testosterone treatment, alone or in association with PDE5 inhibitors, may lower the risk of cavernosal fibrosis or decrease the severity the fibrosis in ED patients.