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

During a fourteen-month period, 497 men were evaluated for a primary complaint of erectile dysfunction. The initial evaluation consisted of a history taken in a conventional manner and supplemented by a patient-completed sexual function questionnaire, a physical examination, and serum testosterone, serum prolactin, and nocturnal penile tumescence studies. When appropriate, additional evaluations, including penile vascular studies, two-hour oral glucose tolerance tests, and psychiatric consultation were obtained. Abnormal glucose metabolism was present in 161 men (32%). Five men (1%) had insulin-dependent diabetes mellitus (IDDM), 80 men (16%) had noninsulin-dependent diabetes mellitus (NIDDM), 55 men (11.1%) had newly diagnosed noninsulin-dependent diabetes mellitus, and 21 men (4.2%) had impaired glucose tolerance tests. One hundred forty-seven of these men (91.3%) had organic pattern impotence, and 14 (8.7%) had psychogenic pattern impotence.
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PMID:Erectile dysfunction in men with diabetes mellitus. 357 82

Diabetes-related impotence is commonly noted within 10 years of the onset of diabetes. It is frequently due to microangiopathy and is associated with symptomatic neuropathy. Careful history-taking, physical examination, laboratory tests, and frequently, sophisticated diagnostic tests are indicated in the evaluation of these patients. Nocturnal penile tumescence and rigidity testing has become the gold standard of noninvasive evaluation.
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PMID:Diabetes-related impotence and its treatment in the middle-aged and elderly: Part I. 358 87

Previous studies of the relationship of gonadal function to impotence in men with diabetes mellitus have yielded conflicting results. Pituitary-testicular function was studied in 28 impotent diabetic men and 15 normal men. Impotence was documented by clinical history and subdivided into categories of primary organic (n = 16), primary psychogenic (n = 7), and unclassified (n = 5) on the basis of nocturnal penile tumescence (NPT) testing, psychological testing, and penile vascular studies. All NPT parameters were diminished (P less than or equal to 0.001) in the impotent diabetic men compared to values in the normal men. Endocrine studies revealed increased urinary LH (P less than or equal to 0.05) and diminished serum free testosterone levels in the diabetic men with primary organic impotence. These changes were not found in normal men or diabetic men with primary psychogenic impotence. Six months of treatment in a home blood glucose-monitoring program resulted in significant improvement in metabolic control but no improvement in pituitary-testicular function, NPT, or sexual performance in the primary organic impotent group. Eight patients with primary organic impotence and no evidence of penile vascular disease had significant improvement (P less than or equal to 0.01) in NPT results as well as subjective improvement in sexual function after 6 months of parenteral testosterone administration. These studies suggest that primary gonadal dysfunction may be related to organic impotence in diabetes, and improvement in selected patients can occur with androgen therapy.
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PMID:Gonadal dysfunction in diabetic men with organic impotence. 358 93

Primary care treatment of diabetes-related impotence frequently revolves principally around patient referral and counseling. Sex or marital counseling or psychotherapy has a moderately high success rate for patients with psychogenic impotence. However, penile prosthesis implantation in properly selected patients with irreversible diabetic impotence has a final success rate, in terms of patient and partner satisfaction, of approximately 90%. Intracorporal self-administered papaverine alone or in combination with phentolamine has a limited role in producing erections satisfactory for intercourse.
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PMID:Diabetes-related impotence and its treatment in the middle-aged and elderly: Part II. 359 58

Bulbocavernosus reflex to stimulation of the vesicourethral junction and glans penis was recorded in 14 normal controls and 24 diabetic men complaining of erectile impotence. In all normal subjects the bulbocavernosus reflex to stimulation of these sites could be obtained, and mean latencies were 59.2 +/- 8.0 msec. and 33.3 +/- 3.7 msec., respectively (p less than 0.00001). A total of 66 per cent of the diabetics (16 patients) exhibited abnormal (delayed or absent) bulbocavernosus reflex to stimulation of the vesicourethral junction, while only 12.5 per cent (3 patients) had delayed response to glans penis stimulation. The latter tended to remain within normal limits, although the mean latency was significantly different from that of normal subjects (p less than 0.05). Abnormalities of the bulbocavernosus reflex to stimulation of the vesicourethral junction correlated strongly with the presence of peripheral and autonomic neuropathy, diabetes and organogenic impotence. Our results indicate that this is an informative test for the evaluation of visceral afferents arising from the bladder neck and, hence, in the differential diagnosis of organogenic versus psychogenic erectile impotence.
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PMID:Bulbocavernosus reflex to somatic and visceral nerve stimulation in normal subjects and in diabetics with erectile impotence. 359 20

The neurovascular causes of diabetic impotence are presented. 55 men presenting impotence and diabetes mellitus were examined in an extended diagnostic program. Nocturnal penile tumescence and Papaverin-test showed psychogenic impotence in 10 of these men, which lead to psychosexual therapy of the couple. Because of regional erectile lesions (Mb. Peyronie, penile trauma, inborn penile deviation, Priapism) 8 further diabetics were successfully operated. The remaining 37 patients with diabetes mellitus showed vascular erectile lesions (increased venous drainage in 7 and decreased arterial inflow in 30 men) and were operated upon with the following methods: Microsurgical arterialisation of the penile vein via a V. saphena-graft to the iliaque artery was done in 4 patients. There was an amelioration in 2 and a longterm failure in the remaining 2 men. Vein ligation of both internal iliaque veins and lateral penile veins in 7 patients resulted in 2 short term improvements and 5 failures. Flexible penile prostheses (AMS- and Jonas-prostheses) in 26 patients showed good results in 24 and infectious complications in 2 of them (Explanation of both prostheses, ones partial penile amputation). Vascular interventions for diabetic impotence seem to be of questionable value and therefore the implantation of penile prostheses should be preferred. In diabetics, infection of the alloplastic implants is particularly dangerous and may lead to septicemia and penile amputation.
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PMID:[Impotence in diabetes mellitus. Etiological factors and therapeutic possibilities]. 363 59

Analysis of questionnaire replies from 292 diabetic men aged 20-59 revealed impotence in 23% (66), compared to 9% (7) of a sample of 81 non-diabetic outpatients. Further investigation of 45 impotent diabetic men and 45 matched non-impotent diabetic controls revealed greater psychological stress and poorer glycaemic control in the impotent group. There were no significant differences in the frequency of peripheral neuropathy, retinopathy, nephropathy or large vessel disease in the 2 groups. 20% (9) of the impotent diabetic group had definite autonomic neuropathy which was not present in any of the non-impotent group. The frequency of early autonomic damage was, however, similar in both groups. Impotence in diabetic men is associated with hyperglycaemia, stress and definite autonomic neuropathy. Our data suggest that men with early autonomic neuropathy are frequently potent.
Diabetes Res 1987 Jul
PMID:Diabetic impotence: risk factors in a clinic population. 366 43

Delineation of neural, arterial, and venous components contributing to penile erectile failure is critical to proper patient selection for surgical interventions, particularly for a subset of men with impotence as the sole manifestation of pelvic arterial disease. In addition to obtaining a history and physical examination specific for disordered erectile function and vascular risk factors, we developed a sequence of testing to include noninvasive estimates of penile perfusion, pulse volume recording (PVR), and penile/brachial blood pressure indices (PBPI); somatosensory evoked potentials from dorsal penile (PEP) and posterior tibial nerve stimulation (SEP) and bulbocavernosus reflex time (BCR); stimulation of artificial erection with injection of papaverine (AE); and selective hypogastric-pudendal arteriography with patients under epidural anesthesia, and corpus cavernosography with AE. Three hundred fifty-three men complaining of impotence were screened by PVR and PBPI; among these 42 impotent men and 20 additional concurrent potent control subjects had evoked potentials and BCR measurements, and 55 men received one or more AE injections. On the basis of these results, angiographic investigation was recommended. Age and risk factors were similar in the two groups. Abnormal penile blood perfusion was associated significantly only with cigarette smoking (p less than 0.0001) or overt large vessel disease. Impotent men with (138) or without perfusion abnormalities (215) averaged 54 and 56 years of age, respectively; impotent men with normal flow patterns most commonly had treated hypertension or diabetes (79 of 215 men). Covert neurologic abnormalities were detected in 28 of 42 impotent men. Abnormal penile perfusion plus failure of AE predicted isolated ischiopudendal trunk or pudendal artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A screening sequence for vasculogenic impotence. 382 Apr

In view of the marked increase in blood flow into the penis during erection and the association of diabetes mellitus with impotence, we used the diabetic rat model to investigate the possibility that: the penis may produce prostacyclin; and prostacyclin secretion may be decreased in diabetes. Rats given a high dose of streptozotocin (120 mg/kg body weight) developed acute ketotic diabetes and were killed after 48 h. Animals given a low dose of streptozotocin (65 mg/kg body weight) developed non-ketonuric diabetes and were killed after 7 or 62 days. Aortic rings and penile tissue discs were incubated in buffer, which was assayed for 6-oxo-prostaglandin F1 alpha, the stable and spontaneous breakdown product of prostacyclin. Penile tissue from control, ketotic and non-ketonuric (7 days) animals released similar quantities of prostacyclin, whereas that from long-term non-ketonuric animals (62 days) produced significantly less prostacyclin. Production of this prostanoid by the aortic rings paralleled these changes. We conclude that: penile tissue releases prostacyclin in quantities comparable to those of the aorta; long-term diabetes leads to diminished prostacyclin release by penile and aortic tissue: the former may contribute to the pathogenesis of diabetic impotence; and since short-term ketotic diabetes does not inhibit aortic or penile prostacyclin release, duration of diabetes rather than its severity is responsible for diminished prostacyclin release.
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PMID:Experimental diabetes mellitus inhibits prostacyclin synthesis by the rat penis: pathological implications. 393 Mar 31

We recently investigated two patients with diabetes and elevated serum prolactin levels in whom no cause of hyperprolactinaemia could be found. For this reason we measured fasting serum prolactin levels in 72 diabetic males and compared the results with those of 63 healthy males and 90 nondiabetic males attending an Impotence Clinic. The diabetic group had significantly higher serum prolactin levels (13.1 +/- 0.9 ng/ml) than the two control groups (9.9 +/- 0.6 ng/ml for normal males and 7.7 +/- 0.3 ng/ml for the non-diabetic impotent group). Eighteen percent of the diabetics studied had serum prolactin levels above the normal range for males (greater than 20 ng/ml). There was no correlation between serum prolactin levels and duration of diabetes, glycosylated haemoglobin level or presence of clinically apparent retinopathy. The correlation between serum prolactin level and fasting plasma glucose was weak though statistically significant (r = 0.26, P less than 0.05).
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PMID:Hyperprolactinaemia in male diabetics. 399 96


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