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

Transient organic causes of impotence include alcohol consumption, drug use or inflammatory genital disease. Many diagnoses of organic impotence, with diabetes, for example, have been premature and have resulted in iatrogenic, psychogenic impotence. After a stroke, heart attack or major surgery, depression may cause impotence. Anxiety and sexual ignorance are major etiologic factors. Thus, sex education and uncomplicated sex therapy can achieve a high percentage of cure. Penile plethysmography during sleep provides useful information. Penile prostheses are helpful for appropriately motivated couples when there is permanent impotence.
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PMID:Impotence--some causes and cures. 62 40

The effect of oral prostaglandin E1 (limaprost) on erectile function was studied in a double-blind placebo controlled trial. Fifty one patients who agreed to participate were examined for their subjective symptoms and nocturnal erection was recorded using an erectometer at the beginning of the study, after an initial 6 week period, and again after a second 6 week period. Patients were randomly assigned to a group which received placebo followed by limaprost or to a group which received limaprost followed by placebo. Ten cases dropped out. In the remaining forty one patients, NPT during the limaprost phase was significantly different from that during the placebo phase. Patients with the history of diabetes mellitus, hypertension, or pelvic surgery showed relatively poor responses to oral prostaglandin E1. Oral prostaglandin E1 achieved 42.9% effectiveness in the psychogenic impotence, and this effectiveness is significantly higher than that of placebo. Oral prostaglandin E1 was suggested as an additional or alternative therapy in the management of psychogenic impotence. Psychogenic impotent who didn't respond to sex therapy and patients with slight organic causes would seem to benefit from oral prostaglandin treatment.
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PMID:[Double-blind trial of oral prostaglandin E1 on impotence]. 143 68

Three hundred and thirteen new cases were seen in more than two years at the Sexual Dysfunction Clinic at the Division of Urology, Toa Payoh Hospital (TPH). Patients were assessed by history, clinical examination, psychological evaluation, hormonal and biochemical tests; special investigations such as monitoring of nocturnal penile tumescence, cavernosography, selective pudendal arteriography and tests of neurological function were performed where indicated. Two hundred and twenty-seven patients (72.5%) had impotence due to organic causes while 86 patients (27.5%) were found to have psychogenic impotence. Diabetes mellitus and vascular disease account for the large proportion of organic impotence (81%). Patients with psychogenic impotence responded fairly well to psychosexual therapy and drug treatment in certain cases. Forty-four patients underwent medical therapy which consisted mainly of pharmacologically induced penile erections by the use of papaverine, phentolamine or prostaglandin E-1; 21 patients (48%) who were on self-injection therapy became non-compliant subsequently. One hundred and fourteen andropausal patients with low testosterone levels received hormonal replacement. Thirty-one patients underwent surgery--stripping and ligation of the deep dorsal vein of the penis (13 patients), microsurgical arterial revascularisation (two patients) and penile prosthetic implantation (16 patients). Our success rates for the operations were 54%, 100% and 88% respectively.
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PMID:Erectile dysfunction in Singapore men: presentation, diagnosis, treatment and results. 151 96

Sexual dysfunction is common among men with Type I and Type II diabetes. Tests of nocturnal penile tumescence (NPT) combined with waking tumescence and questionnaires can more accurately differentiate between primary organic and primary psychogenic impotence. This ability to differentiate the etiology of erectile dysfunction avoids the inappropriate use of penile injections and costly surgical procedures which are unnecessary in treatment of diabetic patients with primary psychogenic impotence. In patients with primary organic impotence, several new treatments are available which result in high patient satisfaction.
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PMID:Evaluation and treatment of sexual dysfunction in men with diabetes mellitus. 176 57

Penile tissue (consisting of corpus cavernosum and tunica albuginea) was obtained from 19 patients undergoing surgery for the implantation of penile prostheses. The tissue was examined for vasoactive intestinal polypeptide-like immunoreactivity in nerves, acetylcholinesterase-positive staining in nerves and noradrenaline content. Impotence was due to a variety of causes; 11 patients were classified as a 'non-neuropathic' group on the basis of their clinical history which included Peyronie's disease, vascular disease, hypertension and psychogenic impotence. Vasoactive intestinal polypeptide-like immunoreactive and acetylcholinesterase-positive nerves were present and the pattern and distribution were similar in each patient in this group. The noradrenaline content of the tunica albuginea was significantly lower than the corpus cavernosum (p less than 0.02), although there was a linear relationship between the noradrenaline contents of the two regions (r = 0.95, p less than 0.01). By comparison, a complete absence of vasoactive intestinal polypeptide-like immunoreactivity in nerves was observed in a patient with a cauda equina lesion. Five out of six diabetic patients studied revealed a marked reduction in vasoactive intestinal polypeptide-like immunoreactivity in nerves associated with the cavernous smooth muscle, while acetylcholinesterase-positive staining was reduced in three out of five diabetic patients studied. The noradrenaline content of the corpus cavernosum from diabetic patients was significantly lower (p less than 0.02) than that of the 'non-neuropathic' group. The noradrenaline content of the tunica albuginea, however, was similar in both groups. The results provide evidence that VIPergic, cholinergic and adrenergic nerves in the penis are affected in diabetes mellitus and thus may contribute to the development of impotence in diabetic patients.
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PMID:Changes in the VIPergic, cholinergic and adrenergic innervation of human penile tissue in diabetic and non-diabetic impotent males. 243 29

In 657 impotent patients in whom erection was induced by intracavernous injection of papaverine, we evaluated changes in the pulsation, diameter, and blood flow velocity of the penile arteries by duplex sonography and pulsed Doppler spectrum analysis. An additional 18 patients who were proved to have good erection by nocturnal tumescence testing were used as controls. All patients were studied before achieving full erection after papaverine injection. In the flaccid state, the inner diameter of the deep penile arteries averaged 0.51 mm, and blood flow velocity was rarely measurable. The normal arterial reaction to papaverine was an initial increase in the inner diameter of the scanned segment of the cavernous artery with good concentric pulsations and a mean peak blood flow velocity of 34.8 cm per second and a mean diameter of 0.89 mm. With this technique, we assessed the functional capability of each deep and dorsal artery. Arterial and erectile response allowed indirect evaluation of the venous system. Of the 657 patients, 48 had neurogenic or psychogenic impotence or both. In 97, impotence could be ascribed to venogenic causes, in 210 to arteriogenic causes, and to mixed arteriogenic and venogenic causes in 282 patients. The exact cause of impotence in the remaining 20 patients could not be determined. Statistically, patients who were older or had diabetes mellitus or coronary artery disease tended to have smaller penile arteries and lower peak blood flow velocity after papaverine injection.
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PMID:Functional evaluation of penile arteries with duplex ultrasound in vasodilator-induced erection. 268 8

The ability of the MMPI to discriminate between primary psychogenic impotence and primary organic impotence in males with diabetes mellitus was assessed. In order to provide the MMPI with the optimal situation to discriminate between the two groups, we attempted to form a homogeneous sample in terms of physical conditions. Thirty impotent diabetic males were classified as primary organic or primary psychogenic based on nocturnal penile tumescence data. Beutler et al.'s MMPI decision rules yielded a 63% misclassification of the two groups. Possible explanations for the lack of discriminative power of the MMPI with this sample of diabetic males were discussed in relation to previous findings. The power of nocturnal penile tumescence to classify men as having primary organic or primary psychogenic impotence was examined with reference to other vascular and endocrine variables.
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PMID:An evaluation of the Minnesota Multiphasic Personality Inventory as a discriminator of primary organic and primary psychogenic impotence in diabetic males. 271 88

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

A personal series of 256 cases of acromegaly/gigantism seen over a 20-year period from 1963 is described. The insidious nature of the condition resulted in delay in diagnosis which was often made by a doctor when seeing the patient for an unrelated problem. Other features which commonly led to the diagnosis being made were headache, change in appearance, carpal tunnel syndrome, amenorrhoea and diabetes. The Hardy system for grading the radiological appearance of the pituitary tumour was used. Widely invasive tumours were not common but tended to occur in patients with younger age of onset and high GH levels. The occurrence of various symptoms and clinical features was noted and the changes resulting from reducing the GH level to normal. The incidence of hypertension, but not of coronary artery disease, is increased and the blood pressure may be reduced following successful treatment. The effects on the upper and lower respiratory tract are reported as well as sleep apnoea and problems associated with anaesthesia. Skin manifestations included sweating, pigmented skin tags, acanthosis nigricans and cutis verticis gyrata. In the skeletal system the incidence of kyphoscoliosis and osteoarthritis especially of the hip is reported: the question of hip replacement is discussed. Diabetes mellitus disappeared in most cases if the acromegaly was cured. In men but not in women the incidence of colloid nodular goitre was increased as was hyperthyroidism in middle-aged women. In two patients a parathyroid adenoma was present: hypercalcaemia was present in five additional patients, but the cause was not determined. The common occurrence of amenorrhoea in the younger women was noted, it was not always associated with hyperprolactinaemia, and often responded to successful treatment of the acromegaly. The association of acromegaly with hirsutism and galactorrhoea is confirmed. The incidence of impotence and loss of libid in the men is discussed: in a proportion of those in whom the acromegaly was cured, potency returned, but in a number depression occurred and what was believed to be psychogenic impotence persisted. Hyperprolactinaemia was found in 49 out of 151 patients with active acromegaly in whom the prolactin level was measured. Previous reports have indicated a doubling of death rates in acromegalics. In this series there were 47 deaths observed compared to 37.2 expected. The increased death rate was in women of all ages and in men under the age of 55, The increased deaths in the women were from cardiovascular and cerebrovascular causes and from breast cancer.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acromegaly. 330 90

The diagnosis of sexual dysfunctions (SD) in diabetic male patients is usually based on interviews about the sexual behavior of the patients themselves. The absence of a standardized procedure may explain the discrepancies in the prevalence reported in previous papers. In this work, we show a rational procedure to assess the presence and the type of SD in a group of 128 diabetic men. By means of an appropriate questionnaire, SD were pointed out in 40% of insulin-dependent diabetics (IDD) and 52% of non-insulin-dependent diabetic patients (NIDD). Among the patients with SD, 28% had organic impotence, 11% psychogenic impotence and 8% reduction of libido. IDD with SD were older (p less than 0.01) and with a longer duration of diabetes (p less than 0.02) than IDD without SD. NIDD with and without SD had similar ages and known duration of diabetes. Both in IDD and in NIDD, the prevalence of SD was not affected by the quality of short-term metabolic control. In the patients in whom it was studied by a different technique, the predominant cause of organic impotence (76%) was a damage of parasympathetic nervous system, as evaluated by non-invasive tests. In 12% of the cases with organic impotence, a reduced penile flow alone was observed, while hormonal parameters were similar in patients with and without organic impotence.
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PMID:Prevalence and type of sexual dysfunctions in diabetic males: a standardized clinical approach. 350 58


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