Diabetes-induced erectile dysfunction: epidemiology, pathophysiology and management

Area of Science:

• Urology
• Endocrinology
• Diabetology

Background:

• Erectile dysfunction (ED) significantly impacts diabetic men, with a prevalence of at least 50%.
• The pathophysiology of diabetes-induced erectile dysfunction (DIED) is complex and multifactorial.
• Understanding DIED mechanisms is crucial for effective management.

Purpose of the Study:

• To review the multifactorial pathophysiology of DIED.
• To outline the current multimodal treatment strategies for DIED.
• To discuss future therapeutic directions for DIED.

Main Methods:

• Literature review of proposed mechanisms for DIED.
• Analysis of current treatment guidelines for DIED.
• Exploration of emerging treatment strategies.

Main Results:

• DIED involves elevated advanced glycation end-products, free radicals, impaired nitric oxide synthesis, and RhoA/Rho-kinase pathway activation.
• Treatment is multimodal, prioritizing hyperglycemia and comorbidity management.
• Oral medications are first-line, followed by second-line treatments, and penile prostheses as third-line therapy.

Conclusions:

• Effective DIED management requires addressing underlying hyperglycemia and comorbidities.
• A stepwise treatment approach, from oral medications to prostheses, is recommended.
• Future DIED treatments aim to target the core pathophysiological mechanisms.