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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a recent experience we have studied 297 patients for impotence. 102 were considered psychogenic and 195 organic; 105 of the latter had isolated or associated arterial or venous lesions. The remaining 81 patients had preponderant organic pathology: Peyronie's disease, neurological disease, diabetes and pelvic trauma. All patients were explored by NPT (nocturnal penile tumescence), Doppler examination, intra-cavernous papaverine test, angiography and erectile flow associated with cavernography. We report our microvascular surgery results from the last seven years. 80 reconstructive vascular procedures were performed on a population of patients who averaged 50 years of age. 50 epigastric-cavernous by-passes were performed. Complete recovery has been observed in 14% with an average of 42 months follow-up. Erection improvement with possibility of vaginal intromission in 58%. Immediate or secondary thrombosis and priapism in 28%. 21 arterial epigastric-dorsal unilateral by-passes were performed with an average follow-up of 20 months. In 11 cases the arterial micro-revascularization was associated with deep dorsal vein ligature. Results are as follows: 10 excellent, 4 significant improvement, 3 failures and too short follow-up in three. 9 isolated venous ligature with a mean follow-up of 15 months. Complete recovery was observed in 3 patients, improvement in 3 and failure in 2. The author emphasizes the interest of a better selection of surgical indications, improvement of microsurgical techniques with epigastric-dorsal anastomosis associated with postoperative anticoagulant therapy whenever possible.
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PMID:[Impotence in a urologic service]. 275 48

Two-hundred-and-two impotent diabetic patients gave their consent to be investigated. Impotence is linked to diabetes mellitus in 58.9% of patients so all the other etiologies have to be systematically eliminated. Neuropathy or arteriopathy, when isolated, are found with the same frequency, but these 2 etiologies are often associated (47 patients). No statistical difference between IDDM and NIDDM was found. Mercury strain gauge plethysmography and venous occlusion coupled to ECG allows detection of arterial lesions in diabetic impotence. Patients agreed to submit to all of the various therapeutic possibilities. Combination of alpha-blockade and good glycemic control induced the best results.
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PMID:[Impotence in the diabetic]. 275 49

The etiology of impotence in the diabetic population has not been clearly defined. To assess this problem, 24 impotent diabetic subjects, 21 nonimpotent diabetic subjects, and 10 subjects with psychogenic impotence were compared with nocturnal monitoring of penile tumescence and rigidity, penile arterial blood flow, and nerve conduction of the pudendal nerve. There was no statistical difference in mean age or duration of diabetes among the various study groups. All diabetic subjects who presented with complaints of impotence had severe abnormalities on nocturnal erection monitoring. There was no significant difference in the mean penile brachial index between impotent and nonimpotent diabetic subjects (P = .335). In contrast, there was a significant difference in bulbocavernosus-reflex latency times (P less than .001) between impotent (mean latency 48.4 ms) and nonimpotent (mean latency 38.7 ms) diabetic subjects. This study strongly suggests that impotence in the diabetic population is secondary to functional abnormalities of pelvic nerves and that the bulbocavernosus-reflex latency time is an excellent diagnostic test for assessing function of pelvic nerves in the diabetic individual.
Diabetes Care
PMID:Abnormal nerve conduction in impotent patients with diabetes mellitus. 275 50

The prevalence of diabetes is greatest among older persons, yet few studies have specifically addressed the impact of age on diabetic complications. The present study examines the prevalence of four diabetic complications: retinopathy, peripheral neuropathy, autonomic neuropathy, and hypertension, as well as depression, in older male patients with noninsulin-dependent diabetes. Participants ranged in age from 53 to 80 years. Multiple risk factors, including age, duration of illness, type of treatment, metabolic control, and obesity were evaluated as predictors of these complications using logistic regression. Results suggest a significant increase in the prevalence of retinopathy with aging, independent of the effects of metabolic control, duration of illness, and other risk variables. Age was also related to prevalence of peripheral neuropathy symptoms, hypertension, and impotence. Current metabolic control was significantly associated with retinopathy, peripheral neuropathy, and hypertension prevalence. Time since diagnosis was only independently related to impotence and hypertension. These findings suggest that the increase in many diabetic complications in older persons cannot be wholly accounted for by simple disease status variables, and may result from an interaction of diabetes variables and general age-related changes.
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PMID:Effects of age on complications in adult onset diabetes. 278 81

The coefficient of variation (CV = SD/mean x 100) of the R-R interval in electrocardiogram (ECG) was measured as an indication of parasympathetic nerve function in patients with impotence. Of 762 patients 104 (13.6%) had a CV value lower than 2.0. The factors which led to the low CV value were evident in 50 patients (48%), i.e. diabetes mellitus in 26, side effects by antiulcer, antidepressant or antihypertensive agent in 16, renal failure in 1, alcoholism in 2 and age over 70 years old in 4. The possible factors of the low CV value, such as neurogenic, thyroid, cardiovascular and endocrine disorders were found in 12 patients (11.5%). In the remaining 42 patients (40.4%), CV value was decreased by unknown factors. Measurement of CV of R-R interval in ECG was safe and useful as a screening test for patients with impotence to detect the dysfunction of the parasympathetic nerve system.
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PMID:[Measurement of coefficient of variation of R-R interval in ECG for patients with impotence]. 281 1

PBI was measured in 555 patients chosen at random from those who visited our impotence clinic between October 1984 and September 1986. Of 555 patients with impotence 29 (5.2%) showed a low PBI level of less than 0.6. On the basis of carefully taken history, risk factors causing the disturbance of penile blood flow were found in 13 (44.8%) of these 29 patients. They included diabetes mellitus, hypertension, surgery of pelvic organ, vertebral injury, vascular disorder of brain and gangliosympathectomy. Although penile angiography is necessary to make the definite diagnosis of vasculogenic impotence, hospitalization is usually required to perform the examination. Measurement of PBI is useful as a screening test to detect vasculogenic impotence at an outpatient clinic, because this examination is noninvasive and technically easy.
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PMID:[Measurement of penile brachial index (PBI) in patients with impotence]. 281 2

In vitro studies strongly suggest the presence of autonomic neuropathy in impotent patients with diabetes mellitus. Morphologic studies reveal structural damage to the penile autonomic nerves. Biochemical, histochemical, and immunohistochemical evidence suggests a general depletion of the adrenergic, cholinergic, and NANC neurotransmitter systems that control penile erection. These in vitro studies on human tissue are, however, not performed with appropriate control tissue from potent patients with diabetes mellitus. For this reason, it is important to study diabetic penile neuropathy by developing animal models. The investigative work by Crowe and Fani in streptozocin-induced diabetes mellitus is encouraging, but more research efforts should be directed toward this objective. Clinical testing is needed to assess the functionality of the autonomic corporal nerves objectively. At present, the patient's erectile response to an intracavernosal injection of vasoactive agents is being studied. If there is an isolated autonomic neuropathy, as commonly exists in young patients with spinal cord injury, the erectile response to the intracavernosal injection is immediate and complete. This intracavernosal injection test for autonomic neuropathy records hemodynamic and not neurophysiologic responses. In patients with an accompanying hemodynamic impairment, such as cavernosal artery insufficiency or corporal veno-occlusive dysfunction, as commonly exists in patients with diabetes mellitus, the hemodynamic erectile response to the intracavernosal injection is impaired, and the presence or absence of autonomic neuropathy is subsequently masked.
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PMID:Diabetic penile neuropathy. 283 Jun 92

The distribution of four main arterial risk factors (ARF) (diabetes, smoking, hyperlipidaemia (HLP), and hypertension) was investigated in 440 impotent men (mean age 46.8) in whom the penile blood-pressure index (PBPI) (ie, the ratio of the lowest systolic pressure in one of the four main arteries of the penis to the systolic pressure in the arm) was measured. In 222 the cause (organic or functional) of impotence was sought by further investigations, such as cavernosonography. 80% of this subgroup had organic impairment of erection. In 53% of these there was evidence of an arterial lesion. Smoking (64%), diabetes (30%), and HLP (34%) were all significantly more common in the 440 impotent men than in the general male population of a similar age. Whenever two or more ARFs were present mean PBPI was significantly lower. The frequency of organic impotence increased from 49% in the absence of any ARF to 100% in patients with 3 or 4 ARFs. It is concluded that increase in the frequency of impotence with age is mainly related to arteriosclerotic changes for the arteries of the penis and that the ARF and PBPI should be evaluated first in any patient complaining of impotence.
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PMID:Is impotence an arterial disorder? A study of arterial risk factors in 440 impotent men. 285 64

For over a decade it has been known that clonidine and alpha-methyldopa lower blood pressure by activating central and peripheral alpha-2-adrenoceptors and prazosin likewise by antagonizing alpha-1-adrenoceptors. During the 1980s, the number of therapeutic indications for drugs which act via these classes of alpha-adrenoceptors has expanded greatly, particularly the non-cardiovascular applications of drugs acting on alpha-2-adrenoceptors. Novel alpha-2-agonists such as detomidine and medetomidine have been introduced into veterinary medicine as sedative/analgesics. It is possible that these and other compounds with better alpha-2-adrenoceptor selectivity than clonidine may be used in human medicine to ease symptoms of anxiety in drug- and alcohol-related withdrawal syndromes, and as preanaesthetic agents. Several novel alpha-2-adrenoceptor antagonists, such as idazoxan and atipamezole, have been developed with improved selectivity compared to the traditional antagonist at these receptors, yohimbine. At present none of these new compounds are registered for use, but several are undergoing clinical trials for a variety of therapeutic applications such as depression (idazoxan), arousal of animals sedated with alpha-2-agonists (atipamezole), and adult-onset diabetes (DG-5128). The established use of yohimbine in the treatment of male sexual impotence has been reconfirmed and several of the above compounds may be evaluated in the future to treat this disorder.
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PMID:Therapeutic applications of drugs acting on alpha-adrenoceptors. 290 75

Our ten-year experience from September, 1975, to December, 1985, with 417 penile prostheses in 290 patients is presented. Arteriosclerosis and diabetes mellitus were the two most common causes of impotence in our patient population. The Scott inflatable penile prosthesis accounted for the majority of all implants and all device failures. Complications leading to device failure and/or reoperation occurred in 36 percent of all prostheses. However, including repairs, 91 percent of patients were left with a functional prosthesis. Examination of reoperated patients showed an average increase in corporeal length of 1.67 cm with repeat prosthesis operations (p less than 0.001). No increase in incidence of prosthesis failure could be shown after multiple reoperations.
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PMID:Penile prosthesis surgery: review of ten-year experience and examination of reoperations. 291 24


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