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

Impotence in males is a well recognised complication of diabetes mellitus, commonly held to be due to an autonomic neuropathy. The aim of this study was to determine the incidence of periphero-conus neuropathy in diabetic impotence. Nineteen diabetic males seeking treatment for loss of potency had bulbocavernosus reflex latency (BCRL) and sacral reflex latencies (SRLs) performed. The conduction studies indicated that impotence in these cases was associated with peripheral neuropathy in 21% of patients and that BCRL and SRLs are sensitive and useful diagnostic tests.
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PMID:Bulbocavernosus reflex latency in the investigation of diabetic impotence. 270 41

Measurement of thermal thresholds provides a means of assessing neurological deficit and in particular of recognising a neuropathic process affecting unmyelinated and small myelinated fibres of the peripheral nerve. These groups of fibres cannot be tested by nerve conduction studies but are particularly susceptible to disease in diabetes. Thresholds for thermal sensation on the sole of the foot were measured in 33 men presenting with erectile dysfunction. All 15 men with erectile dysfunction, which had been considered on clinical grounds to be neuropathic, had abnormal thermal thresholds. Diabetics with non-neuropathic erectile dysfunction had normal results. Whereas tests of unmyelinated sensory fibre function were abnormal in all those with neuropathic erectile dysfunction, electrophysiological measurement of the bulbocavernosus reflex was normal in five of nine men with diabetic neuropathic impotence.
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PMID:The value of testing for unmyelinated fibre, sensory neuropathy in diabetic impotence. 334 3

The usefulness of nocturnal penile tumescence (NPT) monitoring with stamps was evaluated in diabetic males with impotence. The stamps, which were similar in paper and size to Japanese 10-yen postage stamps, were wrapped around the penis before sleep and the stamp ring was checked for breakage the next morning. Clinical features of the subjects were investigated by penile blood pressure index (PBPI), neurological examinations, psychological tests, and hormonal measurements. Nineteen out of 37 patients with impotence had a breakage of the stamp rings on one or more of 3 nights. The patients with non-breakage of stamp rings had significantly more serious diabetic neuropathy (peripheral and autonomic), depressive tendency, loss of libido, and a higher prevalence of heavy smoking than those with breakage of the stamp rings. PBPI and hormonal findings showed no difference between the breakage and non-breakage patients. These results show that the diagnostic value of this method is nearly the same as that of NPT recording with a strain gauge.
Diabetes Res Clin Pract 1988 Feb 19
PMID:Nocturnal penile tumescence monitoring with stamps in impotent diabetics. 335 20

The 11-year experience with 395 consecutive patients in whom an inflatable prosthesis was implanted for the treatment of chronic erectile impotence is reported. Among these patients the most common etiology was vascular disease, followed by diabetes mellitus and radical pelvic surgery. The original American Medical Systems prosthesis with PPT cylinders shows a 61 per cent complication and revision rate with followup from 3 to 11 years. The newer inflatable prostheses manufactured since 1983 have needed revision in only 13 per cent of the patients followed to 4 years. Salvage procedures and increased product reliability have resulted in 97 per cent of the patients being satisfied. Five types of inflatable prostheses are compared and advantages are discussed.
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PMID:Eleven years of experience with the inflatable penile prosthesis. 336 71

The results of investigations in 50 impotent patients with neurological disease are presented. Using intracorporeal papaverine, Doppler duplex scanning, cardiovascular reflex testing and skin thermal threshold monitoring, the vascular and neurological components were assessed in each of three clinical groups with probable or overt neuropathy. These comprised spinal injury, diabetes and pelvic trauma. Anatomical detail of the penis was well seen using these techniques. In 15 patients with spinal injuries, although the aetiology was predominantly neurological, six exhibited poor flow in the deep penile arteries following injection of papaverine. This was associated with poor erections in these patients, suggesting a vascular pathology. In 27 patients with diabetes the results showed a mixed pattern. Vascular disease was almost universal, combined with varying degrees of autonomic and peripheral neuropathy, and only three had full erections with papaverine. Those with pelvic trauma (8 patients) also had a mixed picture, although some had good erections following papaverine injection. Duplex Doppler scanning of the deep penile arteries correlated with the quality of papaverine-induced erection. Thermal testing was a highly sensitive indicator of small nerve fibre dysfunction, possibly at an earlier stage than standard autonomic testing. A vascular component to impotence was shown to be common in those with neurological impairment, and may alter management.
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PMID:Results of investigation of impotence in patients with overt or probable neuropathy. 342 44

To evaluate the diagnostic power of penile/brachial index (PBI) in patients studied for male sexual impotence, we prospectively interviewed 503 patients referred to our vascular laboratory for PBI measurements. Since the predictive values of diagnostic tests are affected by the prevalence of the disease in the population studied, we calculated the independent likelihood ratio for various PBI levels obtained. For the purpose of this analysis, "organic" impotence was defined as occurring in patients who had no nocturnal erections, whereas "clinical" impotence was defined as occurring in those patients who could not achieve penetration during intercourse. The patients were divided into four groups by the presence or absence of risk factors, including peripheral vascular disease (PVD) and diabetes mellitus. Patients taking medications that may affect potency (n = 175) were excluded from this analysis. The results show that the predictive power of PBI is less in diabetic patients with PVD and least in those without either PVD, diabetes, or drugs. In patients with PVD but no other risk factors, PBI is highly diagnostic with a sharp cut-off point at 0.6. Thus, the diagnostic power of PBI can be improved by considering the risk factors in the patients studied.
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PMID:Predictive power of penile/brachial index in diagnosing male sexual impotence. 352 32

Diabetic nerve damage leads to a wide variety of unpleasant problems: painful sensations, muscle weakness, numb feet predisposing to ulcers, impotence, and a series of distressing effects due to autonomic dysfunction. At present, there is no single effective treatment for the many clinical syndromes--each of which may well have a different cause. Improved blood glucose control must remain the first line of treatment, hopefully to improve nerve structure and function but also to raise the pain threshold. A variety of sedatives and analgesics may also help some patients. Inhibition of the enzyme aldose reductase with resultant interference with neural sorbitol and myo-inositol metabolism would seem to have a good theoretical basis in therapy, and detailed results of long term clinical trials of aldose reductase inhibitors such as sorbinil and tolrestat are awaited with interest. Their role in the future could be more important in prevention of nerve damage than in attempting to reverse gross end-stage nerve destruction. In diabetic subjects with loss of pain sensation in the foot due to neuropathy or in the more advanced state of foot ulceration, intensive educational and clinical efforts should be exerted to prevent this distressing and common problem. In the future, a more detailed understanding of the biochemical abnormalities occurring in nerves and their effect on nerve function, structure and vasculature may lead to more satisfactory and logical treatments for this the commonest single complication of diabetes.
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PMID:Diabetic neuropathies. Current concepts in prevention and treatment. 353 Jul 5

Non-insulin-dependent diabetes mellitus is predominantly a disease of aging, with more than 70 percent of non-insulin-dependent (type II) diabetic patients older than 55 years of age. The prevalence of macrovascular, microvascular, and neurologic complications in outpatients with type II diabetes between the ages of 55 and 74 was compared with that in a similarly aged nondiabetic group of patients. The association between duration of diabetes, hypertension, age, and other putative risk factors that are prevalent in this elderly diabetic population and the occurrence of complications was explored. This cross-sectional survey confirmed a significant increase in retinopathy, neuropathy, impotence, and macrovascular complications in patients with type II diabetes. Within the diabetic population, duration of disease was associated with the occurrence of retinopathy and neuropathy, but not associated with such macrovascular complications as coronary artery disease. Gender, type of therapy, and previously identified risk factors for vascular disease such as hypertension had little impact on the prevalence of complications in this population. The notion that type II diabetes in the elderly represents "mild" diabetes with regard to complications must be discarded. Further identification of risk factors within this diabetic population may suggest therapeutic approaches that will prevent or ameliorate the development of complications.
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PMID:Non-insulin-dependent diabetes in older patients. Complications and risk factors. 353 94

The effect of cigarette smoke extracts and experimental diabetes on rat penile prostacyclin (PGI2) synthesis was investigated. Cigarette smoke extracts induced a dose-related inhibition of methacholine-stimulated PGI2 secretion. Induction of diabetes by streptozotocin resulted in diminished PGI2 secretion, which was further inhibited by cigarette smoke extracts in an additive fashion. Treatment with insulin prevented the inhibition of PGI2 in diabetic animals. Since PGI2 is a potent vasodilator, it may mediate the increased blood flow to the penis responsible for erection following parasympathetic stimulation. The inhibition of PGI2 secretion by cigarette smoke extracts or diabetes, or both, may therefore provide a mechanism to account for the epidemiological observation that smoking and diabetes are major risk factors for male impotence.
Diabetes Res 1986 Nov
PMID:The effect of cigarette smoke and diabetes mellitus on muscarinic stimulation of prostacyclin synthesis by the rat penis. 354 22

The nerve conduction velocity of the dorsal nerve of the penis was evaluated with a direct measuring technique in impotent men with and without diabetes mellitus. The average nerve conduction velocity was 37 M. per second in impotent diabetics and 45 M. per second in nondiabetics. The latency of the bulbocavernosus reflex showed no significant difference between the groups and was within normal limits. The measurement of the nerve conduction velocity of the dorsal nerve of the penis is a valuable test for assessment of impotence in patients with diabetes mellitus.
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PMID:Penile electrodiagnosis. Value of bulbocavernosus reflex latency versus nerve conduction velocity of the dorsal nerve of the penis in diagnosis of diabetic impotence. 357 87


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