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Erectile dysfunction in diabetic men: the neurological factor revisited
B L Bemelmans1, E J Meuleman, W H Doesburg
1Department of Urology, University Hospital Nijmegen, The Netherlands.
The Journal of Urology
|April 1, 1994
Summary
Diabetic impotence is often caused by nerve damage (neuropathy) affecting both peripheral and autonomic sensory nerves. Poorly controlled diabetes significantly increases the risk of this nerve damage and subsequent erectile dysfunction.
Area of Science:
- Neuroscience
- Endocrinology
- Urology
Background:
- The role of neurological factors in diabetic erectile dysfunction (ED) remains debated.
- Erectile dysfunction is a common complication in men with diabetes mellitus.
Purpose of the Study:
- To investigate the neurophysiological, hormonal, and vascular factors contributing to erectile dysfunction in diabetic patients.
- To compare these factors between impotent diabetic, potent diabetic, and impotent non-diabetic men.
Main Methods:
- Neurophysiological assessments included somatosensory evoked potentials (posterior tibial, pudendal nerves) and reflex testing (bulbocavernosus, urethro-anal).
- Hormonal, vascular (pharmacological tests), plasma glucose, and glycosylated hemoglobin levels were evaluated.
- Study groups comprised 27 impotent diabetics, 30 potent diabetics, and 102 impotent non-diabetics.
Main Results:
- Impotent diabetic men exhibited a higher incidence of severe peripheral and autonomic sensory neuropathy.
- Vasculogenic impotence was suggested by abnormal intracavernous pharmacological tests in impotent diabetics.
- No significant endocrine differences were found between groups, but plasma glucose and HbA1c differed significantly.
Conclusions:
- Diabetic urogenital sensory neuropathy plays a critical role in the etiology of diabetic impotence.
- Vasculopathy appears secondary to neuropathy in diabetic ED.
- Impaired diabetes regulation is strongly associated with diabetic impotence.