The management of erectile dysfunction in men with diabetes mellitus unresponsive to phosphodiesterase type 5 inhibitors

Abstract

Introduction: Erectile dysfunction is associated with diabetes mellitus with an estimated prevalence of 52.5% in the diabetic population. The first-line therapy for erectile dysfunction is phosphodiesterase type 5 inhibitors, but data suggest that diabetic men may be less responsive than non-diabetic men. Thus, other treatments, including intracavernosal injections, intraurethral prostaglandin, vacuum erection devices and penile prosthetic surgery, should be considered in management of diabetic men with erectile dysfunction refractory to phosphodiesterase type 5 inhibitors. Furthermore, combination therapy of phosphodiesterase type 5 inhibitors and other oral treatments such as arginine or L-carnitine may have synergistic effects resulting in better outcomes. In addition, there are novel therapies such as low-intensity shockwave therapy and stem-cell therapy, which may also be effective in targeted treatment modalities.Furthermore, studies suggest that erectile dysfunction can be improved by targeting concurrent comorbidities or metabolic diseases such as depression, hypertension, hypogonadism, and dyslipidaemia. We present an evidence-based narrative review focusing on the management of erectile dysfunction in diabetic men who have not responded to phosphodiesterase type 5 inhibitors. Conclusions:Both clinicians and patients should be aware of the different management options in diabetic patients who have not responded to phosphodiesterase type 5 inhibitors.

A review of experimental techniques for erectile function researches and development of medical technology using animal erectile dysfunction models in sexual and reproductive medicine

“…PDE‐5 inhibitors increase the concentration of cyclic GMP in the corpus cavernosum smooth muscle, relax the smooth muscle, and affect erectile function. 5 , 80 , 81 , 82 , 83 Although PDE‐5 inhibitors have been shown to be effective against several types of ED, there are cases in which it is ineffective against ED associated with diabetes mellitus or neuropathy after radical prostatectomy. 4 , 5 The effect of chronic administration of PDE‐5 inhibitors as a treatment for refractory ED was investigated.…”

“… 5 , 80 , 81 , 82 , 83 Although PDE‐5 inhibitors have been shown to be effective against several types of ED, there are cases in which it is ineffective against ED associated with diabetes mellitus or neuropathy after radical prostatectomy. 4 , 5 The effect of chronic administration of PDE‐5 inhibitors as a treatment for refractory ED was investigated. 5 , 81 It has been shown to be effective against arterial ED models and ED associated with renal failure.…”

“… 4 , 5 The effect of chronic administration of PDE‐5 inhibitors as a treatment for refractory ED was investigated. 5 , 81 It has been shown to be effective against arterial ED models and ED associated with renal failure. Chronic administration of PDE‐5 inhibitors suppresses the development of collateral circulation and fibrosis of the corpus cavernosum tissue.…”

Not only a matter of glucose: The andrological consequences of diabetes mellitus

“…Cayetano-Alcaraz et al comprehensively reviewed available management options in diabetic patients not-responding to PDE5i. 10 comprehensively reviewed the relationship between ED and both diet and antihyperglycemic drugs. 12 A beneficial effect has been described for all drug classes considered, although many antihyperglycemic drugs currently used are still poorly evaluated in this setting and further evidence is needed to draw conclusions.…”

“…Cayetano‐Alcaraz et al. comprehensively reviewed available management options in diabetic patients not‐responding to PDE5i 10 . Thus, innovative therapeutical approaches have been developed to improve the ED management in diabetic men.…”