Korean J Androl.  1999 Dec;17(3):157-162.

Pathophysiologic Manifestations of Diabetic Erectile Dysfunction

Affiliations
  • 1Department of Urology, Endocrinology and Pathology, Inha University School of Medicine, Inchon, Korea.
  • 2Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

PURPOSE: Diabetes mellitus is one of the most common causes of erectile dysfunction (ED). The pathogenesis of ED in diabetic patients is not clear, although vasculogenic and neurogenic factors are involved. This study was designed to further characterize the pathophysiologic manifestations of ED in diabetic patients.
MATERIALS AND METHODS
Fifty-seven important patients aged 20 to 71 (mean 45) years participated in this study. On the basis of their medical history, physical examination, and multidisciplinary impotence work-ups, patients were divided into diabetic (n=25) and non-diabetic (psychogenic; n=32) groups. To evaluate vasculogenic manifestations, a pharmacological erection test and penile duplex ultrasonography were performed. To evaluate neurologic manifestations, nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining was performed on cavernous tissue samples obtained by percutaneous biopsy. Staining was assessed by counting the number of nitric oxide synthase (NOS)-containing nerve fibers present in four random fields (power 400x). In the diabetic group, we additionally assessed the duration of diabetes, the duration of treatment, and the latency between the onst of ED and the time diabetes was diagnosed.
RESULTS
The pathophysiologic causes for ED in the diabetics proved to be neurogenic in 44%, vasculogenic in 20%, and mixed (combined neurogenic and vasculogenic) in 36%. Vascular assessment in the diabetics showed that penile rigidity was decreased and end-diastolic velocity was increased compared with the nondiabetics. Latency to the onset of ED from the diagnosis of diabetes was 0 to 15 (average 5.3) years, and it was closely correlated with the status of NOS-containing nerves (p<0.05). The status of NOS-containing nerves also correlated well with the degree of diabetic control but not with the control method.
CONCLUSIONS
Diabetes causes ED by a variety pathophysiologic mechanisms, including neurogenic, vasculogenic, or both. Early and appropriate control of diabetes is required to prevent ED.

Keyword

Diabetic mellitus; Nitric oxide synthase; Penile erection

MeSH Terms

Biopsy
Diabetes Mellitus
Diagnosis
Erectile Dysfunction*
Humans
Male
NADP
Nerve Fibers
Neurologic Manifestations
Nitric Oxide Synthase
Penile Erection
Physical Examination
Ultrasonography
NADP
Nitric Oxide Synthase
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