Volume 2 • Issue 2 • 1000111 Andrology ISSN: 2167-0250 ANO, an open access journal Open Access Research Article Andrology-Open Access Palma et al., Andrology 2013, 2:2 http://dx.doi.org/10.4172/2167-0250.1000111 Keywords: Erectile dysfunction; Androgens; Metabolic syndrome Introduction Erectile function depends on the interaction of psychological factors and an appropriate balance between the endocrine and nervous systems, together with an adequate vascular bed [1]. Disruption of any of these elements could impair normal erections. In last years, diferent authors have presented androgens as cornerstones of this complex neurophysiological process [2-4]. Testosterone may play a pivotal role in maintaining penile nerve, smooth muscle and endothelium structure and function; maintaining tunica albuginea structural integrity and connective tissue matrix ibroelastic properties; and regulating diferentiation of cavernous pluripotent cells into trabecular smooth muscle [1]. Several studies have shown that patients not responding to oral Phosphodiesterase 5 Inhibitors (PDI5), especially those afected by Metabolic Syndrome (MS), may have a quantitative or qualitative alteration in androgen metabolism [2-5]. Currently, obesity and MS related androgen alterations are thought to play a pivotal role in the pathophysiology of Erectile Dysfunction (ED) [4-6]. he role of androgens in the diferentiation of pluripotent sub- albulginean cells into trabecular smooth muscle has been poorly studied. Traish et al. in an animal model have shown that hypogonadism secondary to surgical castration produces severe ED associated with replacement of normal smooth muscle by adipocytes, in the penile sub- albuginean region [7]. Adipocyte accumulation is thought to impair penile vascular bed performance, leading to venous leakage and lack of normal [1,5,7]. We hypothesized that penile sub-albuginean fat accumulation is associated to refractory ED. Venous leakage secondary to fat cell accumulation under tunica albuginea may play a pivotal role in the pathophysiology of this disorder. In the present study, we compared the histology of the penile sub-albuginean region of refractory ED patients undergoing penile implant surgery and potent patients with Peyronie’s disease undergoing curvature correction procedures. Materials and methods Patients his study has been performed according to the Declaration of Helsinki and was approved by FundacióPuigvert ethics committee. Informed consent was obtained from every patient. Between May 2009 and June 2011, twenty patients were recruited. Inclusion criteria included men with severe ED not responding to PDI5, intracavernous/ intraurethral alprostadil and vaccum assisted therapy with indication for penile implant surgery (case group) and potent men with stable *Corresponding author: Ramon Rodrigo, Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile, Tel: 56-2-9786126; Fax: 56-2-7372783; E-mail: jose.vinay@gmail.com Received November 01, 2013; Accepted November 27, 2013; Published December 05, 2013 Citation: Palma C, Vinay J, Sarquella J, Sanchez J, Castro A, et al. (2013) Sub- Albuginean Adipocyte Accumulation is Associated with Erectile Dysfunction: First Clinical Evidence and Pathophysiological Implications. Andrology 2: 111. doi: 10.4172/2167-0250.1000111 Copyright: © 2013 Palma C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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. Nineerectile 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 inding (p<0.05). A signiicant 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 irst 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. Sub-Albuginean Adipocyte Accumulation is Associated with Erectile Dysfunction: First Clinical Evidence and Pathophysiological Implications Cristian Palma 1-3 , Jose Vinay 2 , Joaquim Sarquella 1 , Josvany Sanchez 1 , Ariel Castro 4 , Cesar Rojas-Cruz 5 , Ferran Algaba 6 , Ivan Gallegos 7 and Ramon Rodrigo 8* 1 Andrology Department, Puigvert Foundation, Barcelona, Spain 2 Urology Department, University of Chile Clinical Hospital, Santiago, Chile 3 Urology-Andrology, Clínica Las Condes, Santiago, Chile 4 Epidemiology Unit, University of Chile Clinical Hospital, Santiago, Chile 5 Urology-Andrology, Centro Urológico FOSCAL, Clínica Carlos Ardila Lulle, Bucaramanga, Colombia 6 Pathology Section, Puigvert Foundation, Barcelona, Spain 7 Pathology Department, University of Chile Clinical Hospital, Santiago, Chile 8 Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile