Seminal vesicles and diabetic neuropathy: ultrasound evaluation after prolonged treatment with a selective phosphodiesterase‐5 inhibitor

Abstract

SUMMARYWe have previously reported that infertile patients with diabetes mellitus (DM) have a particular ultrasound features of the seminal vesicles (SV) characterized by higher fundus-to-body ratio and lower pre-and post-ejaculatory difference in body antero-posterior diameter (APD). Based on these premises the aim of the present study was to investigate possible ultrasound SV changes in infertile patients with DM and diabetic neuropathy (DN), after prolonged administration of tadalafil (TAD) (a specific phosphodiesterase-5 inhibitor). To accomplish this, 20 infertile patients with symptomatic DN and erectile dysfunction were selected and arbitrarily divided into two groups which were assigned to: daily administration of 5 mg TAD for 3 months (Group A) (n = 10) and administration of placebo (Group B) (n = 10). All patients underwent to scrotal and prostate-vesicular transrectal ultrasound evaluation and semen analysis (Laboratory Manual for the Examination and Processing of Human Semen, WHO, 2010) before and after treatment. The following SV US parameters were recorded: (i) body APD; (ii) fundus APD; (iii) parietal thickness of the right and left SVs; and (iv) number of polycyclic areas within both SVs. We then calculated the following parameters: (i) fundus/body (F/B) ratio; (ii) difference of the parietal thickness between the right and the left SV and (iii) pre-and post-ejaculatory APD difference. In addition, we also evaluated the SV ejection fraction. Group A patients showed a significant reduction in F/B ratio and higher pre-and post-ejaculatory body SV APD difference compared with baseline or Group B after 3 months. These patients showed also a significant increase in SV ejection fraction and a significant improvement of the total sperm count, progressive motility, seminal levels of fructose, leucocytes and ejaculate volume. In conclusion, these results suggest that infertile DM patients with DN and erectile dysfunction had an improvement of ultrasound features suggestive of diabetic neuropathy after daily treatment with low doses of TAD.

THERAPY OF ENDOCRINE DISEASE: Effects of chronic use of phosphodiesterase inhibitors on endothelial markers in type 2 diabetes mellitus: a meta-analysis

“…Another clinical trial employing Tadalafil was excluded as it had a retrospective design and was not placebo controlled (43). An RCT considering PDE5i and T2DM was excluded as only seminal vesicle volumes were evaluated and parameters of endothelial health were not considered (44). Two studies enrolled only patients with ED, with or without T2DM and presented an open-label study design (45,46).…”

Clinical implications of measuring prolactin levels in males of infertile couples

“…All patients underwent, during the same ultrasound session, semen analysis, performed according to the WHO criteria. All patients observed the standard sexual abstinence of 4 days, according to previous studies (Colpi et al ., ; Vicari, ; La Vignera et al ., ) and in line with the WHO criteria (WHO, ).…”

“…Prostate vascularization and arterial prostatic peak systolic velocity were evaluated before ejaculation, to avoid post‐ejaculatory changes in vascular flow pattern, as reported previously (Keener et al ., ; Lotti et al ., ). SV volume was calculated using the ‘ellipsoid/prolate (d1 > d2 = d3) spheroid’ formula (d1*d2*d3*4/3*π, considering d1 = 1/2 1/2 maximum longitudinal diameter of the SV and both d2 and d3 = 1/2 anterior–posterior maximum diameter), according to previous studies (Lotti et al ., ; La Vignera et al ., ). SV echo‐texture, particularly ‘inhomogeneity’, ‘areas of endocapsulation’ and ‘wall thickening and septa’ were defined according to previous studies (Ramchandani et al ., ; Colpi et al ., ; Vicari, ; Kim et al ., ; Lotti et al ., ).…”

Urinary Tract Infection Profile at the Clinic of Infectious and Tropical Diseases at Fann University Hospital, Dakar, Senegal

“…The administration of selective inhibitors of V phosphodiesterase, commonly used for the treatment of erectile dysfunction, is associated with US modifications of the prostatevesicular tract, which include: increased difference of the anteroposterior diameter of the seminal vesicles detected before and after ejaculation, increase of the ejection fraction of the seminal vesicles. These US changes correlate with increased seminal concentration of fructose [36].…”