Men with diabetes may require more aggressive treatment for erectile dysfunction

Walsh, Thomas J.; Hotaling, James M.; Smith, Alexandria; Saigal, Christopher S.; Wessells, Hunter

doi:10.1038/ijir.2013.46

Cited by 22 publications

(19 citation statements)

References 16 publications

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“…The current mainstay of treatment for ED in men with diabetes is therapy with PDE5 inhibitors (62)(63)(64). They have been reported to have a major impact on erectile function and quality of life, and should be offered as first-line therapy to men with diabetes wishing treatment for ED (65-70) (see Figure 2).…”

Section: Treatment Of Edmentioning

confidence: 99%

Sexual Dysfunction and Hypogonadism in Men With Diabetes

Bebb¹,

Millar²,

Brock³

2018

Canadian Journal of Diabetes

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Section: Treatment Of Edmentioning

confidence: 99%

Sexual Dysfunction and Hypogonadism in Men With Diabetes

Bebb¹,

Millar²,

Brock³

2018

Canadian Journal of Diabetes

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“…Men with DM are more likely to require more aggressive treatments for ED. In a recent study including 19 236 diabetics it was shown that they were more than 50 % more likely to be prescribed secondary ED treatments, and more than twice as likely to undergo penile prosthesis surgery compared to non-diabetics (Walsh et al, 2014). DED is among the 2 main reasons for implantation of an implant.…”

Section: Penile Implantsmentioning

confidence: 99%

A Comprehensive Review of Erectile Dysfunction in Men with Diabetes

Kamenov

2014

Exp Clin Endocrinol Diabetes

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Erectile dysfunction (ED) is more common in men with diabetes (DM). Dependent on the selected population, age, DM type and duration, the prevalence of diabetic ED (DED) varies from 32 to 90%. In 12?30% of men ED is the first sign of diabetes, diagnosed later. Today men with diabetes live longer than ever, and develop more late diabetic complications. Having in mind also the global ageing of the world population all this data suggests an increasing number of men with DED in the future. The main factors playing in the complex pathogenesis of DED are diabetic neuropathy (oxidative stress, polyol pathway, advanced glycation end-products, nerve growth factor deficiency, dysfunction of protein kinase C, tissue remodeling, etc.), macrovascular arterial disease (endothelial dysfunction, abnormal collagen deposition and smooth muscle degeneration, dyslipidemia, arterial hypertension, veno-occlusive dysfunction, etc.), hypogonadism, structural remodeling of the corporeal tissue, psychogenic components and adverse drug reactions. The diagnostic process is based on the results of questionnaires, neurological, vascular (Doppler) and other more rarely used investigations. Because of the complex pathogenesis of DED diabetic men represent a ?difficult? treatment group. The difficulties are from the ?beginning?, because patients do not talk about their problem spontaneously, and doctors do not ask about it. The treatment of DED should be team work, preferably including also specialists in sexual medicine. Psychological support and counseling of the couple is necessary in most cases. The general measures include implementation of a healthier lifestyle, improved glycemic-, lipids-, and arterial pressure control, and careful re-evaluation of the concomitant medications. The specific treatment includes as first line therapy the inhibitors of phosphodiesterase type 5 (PDE-5) with lesser effectiveness compared to non-DM men. There are rare studies with selected diabetic populations and even less with head-to-head comparisons between the PDE-5 inhibitors. Men with DM have a higher prevalence of hypogonadism. Testosterone replacement therapy should be started in symptomatic men with proven hypogonadism and no contraindications. Vacuum constriction devices and intracavernous or intraurethral applications of vasoactive drugs are the second line therapy. Vascular surgery rarely comes into consideration. The penile implant is the last and effective option in men with severe DED.

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“…[3] also reported that the odds ratio of ED was 3.0 for diabetic men in a population undergoing a health investigation. Furthermore, reduced efficacy of phosphodiesterase type 5 inhibitors (PDE5) for treating diabetes‐related ED (DMED) necessitates development of new therapeutic strategies [4,5].…”

Section: Introductionmentioning

confidence: 99%

Effect of Chronic Administration of PDE5 Combined with Glycemic Control on Erectile Function in Streptozotocin-Induced Diabetic Rats

Choi

Kwon

Cho

et al. 2015

The Journal of Sexual Medicine

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Introduction Chronic treatment with phosphodiesterase type 5 inhibitors (PDE5) is effective in an animal model of diabetes-induced erectile dysfunction (DMED). In addition, recent research indicates that glycemic control can restore DMED. Aims We evaluated the effect of chronic administration of PDE5 combined with glycemic control on DMED. Methods Sprague-Dawley rats (8 weeks old) were divided into five groups (n = 10 each): normal control (C), diabetes (DM), DM treated with insulin (DM-I), DM treated with PDE5 (DM-P), and DM treated with insulin and PDE5 (DM-I + P). Rats in the diabetic groups received an injection of streptozotocin (45 mg/kg). After 10 weeks of induced diabetes, the DM-I group was treated with a daily injection of neutral protamine Hagedorn, and the DM-P group was treated with a daily dosage of 20 mg/kg PDE5 (DA-8159) for 4 weeks. The DM-I + P group was treated with both treatments simultaneously. After 14 weeks of induced diabetes, an evaluation of erectile function and histological and biochemical markers of corporal tissue was performed. Main Outcome Measures Erectile function and histological and biochemical markers in corporal tissue. Results Rats in the DM group showed markedly lower erectile parameters than those in the C group, whereas rats in the DM-I and DM-P groups showed intermediate erectile function between the DM and C groups. Rats in the DM-I + P group showed restored erectile function, comparable with group C. A comparison of apoptotic index, expression of the endothelial marker, and phosphorylation of endothelial nitric oxide synthase and Akt displayed a similar pattern with the results from cavernosometry (DM < DM-I = DM-P < DM-I + P = C, P < 0.05). The distribution of phosphorylated myosin phosphatase target subunit 1 was in the reverse order. Conclusions Chronic administration of PDE5 or glycemic control with insulin resulted in restoration of overt DMED. The combination of both treatments was superior to monotherapy with insulin or PDE5.

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Men with diabetes may require more aggressive treatment for erectile dysfunction

Cited by 22 publications

References 16 publications

Sexual Dysfunction and Hypogonadism in Men With Diabetes

Sexual Dysfunction and Hypogonadism in Men With Diabetes

A Comprehensive Review of Erectile Dysfunction in Men with Diabetes

Effect of Chronic Administration of PDE5 Combined with Glycemic Control on Erectile Function in Streptozotocin-Induced Diabetic Rats

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