ERECTILE DYSFUNCTION IN PATIENTS WITH AUTONOMIC DIABETIC NEUROPATHY

Erectile disorders in men with diabetes mellitus (DM) in combination with autonomic neuropathy are diagnosed and rehabilitation methods of patients with erectile dysfunction (ED) are detected. Thirty patients with DM were examined (15 patients with diabetes mellitus type 1 and 15 patients with diabetes mellitus type 2 respectively). Patients with DM had ED mainly of severe form (IIEF-5 from 6 to 16 points). According to the examination results, the patients were assigned conservative therapy, including phosphodiesterase inhibitors of type V, anticholinesterase drugs, thioctic acid drugs. Conservative therapy was combined with shock wave therapy in the area of the penis. The comparison group consisted of 15 healthy men (volunteers) without ED signs (IIEF-5 21–22 points). The immune-enzyme analysis was used for detection of sex hormone status. Ultrasound, dopplergraphic and X-ray methods were used for conduction of angiography of pool vessels of internal pudendal artery (IPA). Electroneuromyography of penis nerves was made. According to the obtained results, patients with DM were diagnosed with cavernous fibrosis, angiosclerosis of IPA and penis vessels in 100% of cases. Axonopathy of motor and sensory penis nerves was detected in 100 % of cases; stenosis and occlusion changes in IPA were detected in 42.9 % of cases causing disorder and insufficiency in arterial perfusion in the IPA pool. Denervation changes in sensory and motor penis nerves and hemodynamicly significant perfusion disorders in the IPA pool were the principal pathogenetic ED factors in patients with DM. A decrease of the IPA reaction to the pharmological stimulation was noted in patients with DM, which was caused by angiosclerosis and arterial wall elasticity loss. The inefficiency of conservative therapy in patients with DM and severe ED was revealed.

diabetes mellitus, neuropathy, erectile dysfunction, ultrasound, electroneuromyography, angiography

1. International Diabetes Federation 2013. Available from: http://www.Idf.org/worlddiabetesday/toolkit/gp/facts-figures.

2. Kravchun N. A. Urogenital form of diabetic autonomous neuropathy: prevalence, etiopathogenesis, diagnostics. Problemy jendokrinnoj patologii [Problems of Endocrine Pathology], 2012, no. 2, рр. 80–90. (in Russian).

3. Hernandez Moreno P. N., Mendoza Martinez R., Hernandez Marin I., Zepeda Z. Epidemiologic assessment of erectile function in a selected mexican population. Ginecologia y Obstetrica de Mexico, 2003, vol. 71, pp. 332–342.

4. Nusbaum M. R. Erectile dysfunction: prevalence, etiology, and major risk factors. Journal of the American Osteopathic Association, 2002, vol. 102, no. 12 (suppl. 4), pp. 1–6.

5. Hajkina E. V., Reshed’ko G. K., Morozov M. V. Infections of urinary tract at patients with a diabetes mellitus. Klinicheskaja mikrobiologija i antimikrobnaja himioterapija [Clinical Microbiology and Antimicrobial Chemotherapy], 2008, vol. 3, no. 3, pp. 36–44. (in Russian).

6. Vertkin A. L. Diabetic cardiovascular autonomous neuropathy. Lechashhij vrach [Attending Physician], 2006, no. 4, pp. 29–31. (in Russian).

7. Galstjan G. R., Shvarc Ja. G., Dubskij S. A., Lepetuhin A. E., Rozhivanov R. V., Kurbatov D. G. Erectile dysfunction as implication of urogenital autonomous neuropathy at patients with a diabetes mellitus of 1 type: epidemiology, classification, pathophysiology, diagnostics and methods of treatment. Diabetes Mellitus, 2014, no. 2, pp. 126–132. (in Russian).

8. Нampel C., Gillizer R., Raherni Sefal. Diabetes mullitus and bladder function. What shold be considere? Urologe, 2003, vol. 42, pp. 1556–1563.

9. Derevjanko I. I. The complicated infections of urinary tract: diagnostics and treatment. Consilium Medicum, 2003, vol. 5, no. 7, pp. 376–378. (in Russian).

10. Rozhivanov R. V., Akimova A. N., Dubskij S. A., Kurbatov D. G., Dedov I. I. Features of diseases of genitourinary system at a diabetes mellitus. Diabetes Mellitus, 2009, no. 2, pp. 40–45. (in Russian).

11. Siu S. C., Lo S., Wong K. W., Ip K. M., Wong Y. S. Prevalence of and risk factors for erectile dysfunction in Hong Kong diabetic patients. Diabetic Medicine, 2001, vol. 18, no. 9, pp. 732–738.

12. Vinik A., Richardson D. Erectile dysfunction in diabetes. Сurreent Diabetes Reviews, 1998, vol. 6, no. 1, pp. 16–33.

13. Feldman H. A., Goldstein I., Hatzichristou D. G., Krane R. J., McKinlay J. B. Impotence and its medical and psychosocial correlates: result of the Massachusetts Male Aging Study. Journal of Urology, 1994, vol. 151, pp. 54–61.

14. Bacon C. G., Hu F., Giovannucci E. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care, 2002, vol. 25, no. 8, p. 1417.

15. Disturbances of sexual function at men at a diabetes mellitus, in Kogan M. I. (ed.). Moscow, 2005, 224 p. (in Russian).

16. Penson D. F., Latini D. M., Lubeck D. P., Wallace K.L., Henning J. M., Lue T. F. Do impotent men with diabetes have more severeerectile dysfunction and worse quality of life than the general population of impotent patients? Results from the Exploratory Comprehensive Evaluation of Erectile Dysfunction (ExCEED). Diabetes Care, 2003, vol. 26, no. 4, pp. 1093–1099.

17. Dedov I. I., Mel’nichenko G. A., Fadeev V. V. Endocrinology: Textbook for students of medical schools. Moscow, Meditsina [Medicine], 2000, 632 p. (in Russian).

18. Rozhivanov R. V., Suncov Ju. I., Kurbatov D. G. Erectile dysfunction at patients with a diabetes mellitus according to a control and epidemiological research. Diabetes Mellitus, 2009, no. 2, pp. 51–54. (in Russian).

19. Berrada N. S., Kadri S., Mechakra-Tahiri., Nejjari C. Prevalence of erectile dysfunction and its correlates: a population-based study in Morocco. International Journal of Impotence Research, 2003, no. 15 (suppl. 1), pp. 3–7. doi:10.1038/sj. ijir.3900968.

20. Impotency: integrated approach to clinical practice: translation from English. Ed. by A. Greguara, Dzh. P. Prajora. Moscow, Meditsina [Medicine], 2000, 240 p. (in Russian).

21. Han P. Y., Ezquerro R., Pan K. M., Hwang S., Chung J., Lu J. J. Comorbidities associated with diabetic foot complications among Asian Americans in southern California. Journal of the American Podiatric Medical Association, 2003, vol. 93, no. 1, pp. 37–41. doi: 10.7547/87507315-93-1-37.

22. Kurbatov D. G., Galstjan G. R., Rozhivanov R. V., Lepetuhin A. E., Dubskij S. A., Shvarc J. G. Restoration of a fecundity at patients with a diabetes mellitus of the 1st type. Andrologija i genital’naja hirurgija [Andrology and Genital Surgery], 2013, no. 2, pp. 51–54. (in Russian).

23. Rozhivanov R. V., Lepetuhin A. E., Dubskij S. A., Kurbatov D. G. Features of correction of sex function at the men sick with a diabetes mellitus. Saharnyj diabet [Diabetes mellitus], 2010, no. 3, pp. 30–31. (in Russian).

24. Andrology. Male health and dysfunction of genesial system: translation from English. Ed. by Je. Nishlag, G. M. Bere. Moscow, Med. inform. agentstvo, 2005, 554 p. (in Russian).

25. Yassin A., Diede H. E., Saad F., Traish A. Combination therapy of Tadalafil and Testosterone in hypogonadal non-responders. International Journal of Impotence Research, 2003, vol. 15 (suppl. 6), p. 27.

26. Buziashvili I. I. Erectile dysfunction at patients with a diabetes mellitus. Diabetes Mellitus, 2000, no. 3, pp. 12–22. (in Russian).

27. Rozhivanov R. V., Suncov Ju. I., Kalinichenko S. J., Mel’nichenko G. A., Shishkina N. S., Bondarenko O. N. Erectile dysfunction at patients with small duration of diabetes mellitus of 2 types. Diabetes Mellitus, 2004, no. 3, pp. 26–27. (in Russian).

28. Dhindsa S., Prabhakar S., Sethi M., Bandyopadhyay A., Chaudhuri A., Dandona P. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. Journal of Clinical. Endocrinology and Metabolism, 2004, vol. 89, no. 11, pp. 5462–5468.

29. Alexopoulou O., Jamart J., Maiter D.,Hermans M. P. Erectile dysfunction and lower androgenicity in type 1 diabetic patients. Diabetes and Metabolism, 2001, vol. 27 (3), pp. 329–336.

30. Willke R. J., Yen W., Parkerson G. R., Linet O. I., Erder M. H., Glick H. A. Quality of life effects of alprostadil therapy for erectile dysfunction: results of a trial in Europe and South Africa. International Journal of Impotence Research, 1998, vol. 10, pp. 239–246.

31. Fonseca V., Seftel A., Denne J. Fredlund Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials. Diabetologia, 2004, vol. 47, pp. 1914–1923.

32. Kongkanand A. The Thai Erectile Dysfunction Epidemiological Study Group: prevalence of erectile dysfunction in Thailand. Intеrnational Journal of Andrology, 2000, vol. 23, suppl. 2, pp. 77–80.

33. Kurbatov D. G., Rozhivanov R. V. Possibilities of therapy of genital neuropathy type phosphodiesterase V inhibitors at patients with a diabetes mellitus. Urologija [Urology], 2009, no. 5, pp. 48–49. (in Russian).

34. Esaulenko D. I., Rozhivanov R. V., Kalinichenko S. J. Erectile dysfunction as one of implications of a diabetes mellitus. Diabetes Mellitus, 2005, no. 1, pp. 32–33. (in Russian).

35. Markosjan G. G., Korzhachkina N. B., Nikitin S. S. New technologies in diagnostics and recovery treatment of disorders of an emiction after surgical cancer therapy of a prostate. Onkourologija [Onсourology], 2012, no. 1, pp. 82–87. (in Russian).

36. Kalinichenko S. J., Kozlov G. I., Dedov I. I. Erectile dysfunction at patients with a diabetes mellitus. A role of a sildeneafil of Citras (viagra) in diagnostics and treatment. A grant for doctors. Moscow, 2003, 45 p. (in Russian).

37. Romeo J. H., Seftel A. D., Madhun Z. T., Aron D. C. Sexual function in men with diabetes type 2: association with glycemic control. Journal Urology, 2000, vol. 163, no. 3, pp. 788–791.