Management of erectile dysfunction in diabetic patients

ABSTRACT

Diabetes is one of the major risk factors for erectile dysfunction [ED]. The aim of this study is to review all flies of our impotent diabetic patients in order to assess the role of diabetes and other concomitant risk factors in causing impotency and to discuss the role of major diagnostic and therapeutic tools. Patients and From June 2000 to June 2002, 275 male patients were referred to our andrological clinic, where 136 patients [49%] suffered from ED. Of those patients 58 [43%] were diabetic. The mean age of the diabetic patients was 47 years and mean duration of illness 7 years. Only 4 patients suffered from insulin-dependent diabetes. In 16 patients [31%] hypercholesterolemia and hyperlipidemia were registered, Eleven patients [19%] were smokers and 23 patients [39%] suffered from cardiovascular diseases CVD. Organogenic ED could be diagnosed in 48 patients [83%]. Four patients underwent nocturnal penile tumescence NPT, 40 intracavernous injection ICI of vasoactive drugs, 24 of them with color Doppler ultrasonography. Veno-occlusive dysfunction merely due to autonomic neuropathy, could be diagnosed as a major pathology. In non-diabetic patients the mean age was 57 years, in only half of the patients ED was of organic origin and only 20% of patients suffered from CVD. We treated 43 patients [72%] conservatively, only 24 patients [39%] responded to sildenafil. In the non-diabetic group about two- third of the patients responded to sildenafil. Vacuum device was adopted by 14 patients and only 3 patients rejected this treatment and choose the implantation of penile prostheses PP, with other 12 patients. Only 4 patients were treated successfully by ICI of vasoactive drugs. ED represents a major health problem especially in diabetics. Special attempts should be made at early diagnosis and treatment of diabetes and other risk factors and to diagnose this disease early and treat it appropriately. As only less than half of the patients responded well to sildenafil, more efforts should be done to discover new oral treatment for ED in order to avoid other invasive treatment such as vacuum device, ICI of vasoactive drugs and especially implantation of PP. Unfortunatly the new drug apomorphine proved to be less effective than sildenafil, tadalafil and vardenafil are promising drugs, still not yet in clinical use