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

Erectile dysfunction is a common feature in men with diabetes. The efficacy and acceptability of a new battery-powered vacuum assist device, the 'Active' was assessed over 6 months in 19 diabetic men, median age 59 (38-66) years, of whom 9 had ECG evidence of autonomic neuropathy. Their pre-treatment duration of impotence was 24 (12-168) months and their expectation of restored sexual activity was 8 (1-28) times per month. The effect of the device was assessed using visual analogue scales (range 1-10) at 3 and 6 months. Eleven patients continued to use their device over 6 months. Self-assessment values for sexual satisfaction, partners's sexual satisfaction, and self-esteem significantly increased over 6 months. In those continuing to use the device, it was considered highly effective, painless in use and not embarrassing. Despite wearing a constriction ring to maintain their erection, ejaculation was satisfactory. The device was used four times per month on average.
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PMID:Treatment of male erectile dysfunction using the active vacuum assist device. 808 16

In the literature the importance of the neurological factor in the etiology of erectile dysfunction in patients with diabetes mellitus is subject to debate. We report on the findings of neurophysiological investigations in 27 impotent and 30 potent diabetic patients, as well as 102 impotent nondiabetic patients. Additionally, hormonal and vascular evaluations were done. The neurophysiological evaluations consisted of assessment of somatic as well as autonomic sensory nerves, by measuring the latencies of somatosensory evoked potentials of the posterior tibial and pudendal nerves, and of the bulbocavernosus and urethro-anal reflexes. The results show a higher incidence of more severe peripheral and autonomic sensory neuropathy in impotent diabetic men. Also, a preponderance of abnormal intracavernous pharmacological tests, suggesting vasculogenic impotence, was found in impotent diabetic patients. No important endocrinological differences were found among the 3 groups under investigation. Significant differences occurred for plasma glucose and glycosylated hemoglobin. We conclude that diabetic urogenital sensory neuropathy has a crucial role in the etiology of diabetic impotence. Angiopathy seems to be of secondary importance. The results show that poor diabetes regulation is associated with diabetic impotence.
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PMID:Erectile dysfunction in diabetic men: the neurological factor revisited. 812 17

The direct evaluation of the autonomic nervous system to detect the neurogenic component of erectile dysfunction in men is not possible. Biothesiometry, a vibration perception test, is a simple method for the assessment of the penile somato-afferent system. A nomogram for the evaluation of somato-afferent system has been developed utilizing the biothesiometer in healthy men. This nomogram was used to compare the biothesiometric values of potent and impotent diabetic patients. According to our data, the radix penis is selectively damaged by diabetes mellitus in the first stage of the disease, whereas the glans penis is damaged later on when the disease reaches the stage of impotence.
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PMID:The effects of diabetes on penile somato-afferent system. 819 92

It is of some interest to diagnose polyneuropathy and/or sacral neuropathy in diabetic males with erectile dysfunction. Non-invasive electrophysiological measurements with surface electrodes, which are widely available, have been applied to determine the diagnostic yield of several electrophysiologic parameters for assessing polyneuropathy including the pudendal nerve in impotent diabetics. Latencies of the bulbocavernosus reflex and the pudendal somatosensory evoked potentials were measured in a group of 28 diabetic patients with an erectile dysfunction as their main complaint, as well as in a group of 20 potent males without systemic disease. In diabetic patients motor conduction measurements of one median and peroneal nerve and sensory conduction measurements of one median and sural nerve were also performed. In 15 patients abnormalities of the peripheral nerve conduction were demonstrated whereas abnormalities of the bulbocavernosus reflex and/or cortical somatosensory evoked potentials were demonstrated in eight. Five patients had both types of abnormalities. In the patient group no differences could be demonstrated between those with Type 1 or Type 2 diabetes. The only significant clinical/neurophysiological correlation was found between the absence of the bulbocavernosus reflex on clinical examination and its prolonged latencies on electrophysiological measurement. The study showed that a bigger yield of abnormal results was obtained when pudendal nerve function parameters were included in the evaluation of diabetics with erectile dysfunction. Considered separately, however, the battery of electrophysiological tests evaluating limb nerve function seems more sensitive in diagnosing neuropathy than electrophysiological assessment of pudendal nerve function alone.
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PMID:Pudendal versus limb nerve electrophysiological abnormalities in diabetics with erectile dysfunction. 834 11

The treatment of arteriogenic erectile dysfunction with revascularization techniques has been controversial both in terms of its use and the type of surgical repair. Success rates reported in the literature are based almost exclusively on patient testimonial, without the use of objective post-operative criteria. At our institution from 7/88 through 8/91, 18 patients were treated for arteriogenic impotence using microsurgical penile revascularization. The patient population ranged in age from 23 to 64 years, and each patient underwent a complete history and physical examination, serum hormone testing, psychological evaluation of patient and partner, biothesiometry, penile plethysmography, nocturnal penile tumescence/rigidity testing with a Rigiscan device, and selective pudendal arteriography. One patient was status post a pelvic fracture, 2 lacked identifiable risk factors, 2 had diabetes, 6 were heavy smokers, and 7 had hypertension. Pre-operatively each patient had a suspicious medical history, abnormal plethysmography, abnormal Rigiscan testing, and a hemodynamically significant lesion on angiography. Revascularization was done by anastomosing the inferior epigastric artery to the deep dorsal veing and dorsal artery, or the deep dorsal vein alone if both arteries were atretic. Postoperatively, all 18 patients underwent a personal interview, repeat penile plethysmography, and repeat Rigiscan testing. Six patients reports successful coitus and an additional four were having coitus with the aid of intracavernous pharmacotherapy. Seventy-eight percent (14/18) had improved tracings on penile plethysmography, and 56% (10/18) had normal erectile capability by Rigiscan testing.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The success of microsurgical penile revascularization in treating arteriogenic impotence. 834 13

Cavernous electromyography was first introduced by Wagner and Gerstenberg in 1989. The authors developed a refined method of cavernous electromyography by means of single potential analysis in introduced this method into clinical Urology as a diagnostic procedure for the evaluation of patients presenting with erectile dysfunction. To date, our experience with single potential analysis of cavernous electrical activity (SPACE) includes more than 500 patients with erectile dysfunction of various etiologies and 92 normal control subjects. Several technical modifications and refinements have been adopted during the last 4 years. In normal control subjects, SPACE shows a regular pattern of activity with long phases of electrical silence at the usual amplification interrupted by synchronous low frequency, high amplitude potentials. In patients with disruption of the peripheral autonomic supply, typical asynchronous potentials with higher frequencies and irregular shape are observed. In complete spinal cord lesions, abnormal as well as normal electrical activity is found. In patients with a long history of insulin-dependent diabetes and presumably cavernous smooth muscle degeneration, SPACE recordings show irregular potentials with low amplitudes and slow depolarization speed. Synchronization of electrical activity is usually absent. Recent studies on patients with venous leakage show that SPACE provides independent clinical information about the cavernous smooth musculature. The recording of cavernous electrical activity is possible and reproductible. In the future, a new software for one-line date processing, storage and interpretation of SPACE signals will be available.
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PMID:Single potential analysis of cavernous electrical activity (SPACE). Experiences, limitations and perspectives. 835 74

In arteriogenic erectile dysfunction, representing about 80 percent of all organic forms of impotence, a purely arteriogenic impotence is distinguished from a venous leakage. The former can be treated with promising results by means of arterial revascularization. In this respect it is worth mentioning that this form of impotence may also occur following pelvic surgery. Furthermore, diabetes mellitus at an early stage may be responsible for erectile dysfunction. A venous leakage, however, is not a disease of the veins but of the cavernous tissue. In most cases ischemic diseases are due to arterial lesions. In our experience have found that this disease can be treated with the chance of good results by means of our technique of arterial revascularization combined with penile banding.
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PMID:[Revascularization of the penis in cases of male impotence of vascular origin]. 835 75

Pudenal somatosensory evoked potential (PSEP) and bulbocavernosus reflex (BCR) testing have been reported to be useful in the evaluation of erectile dysfunction and neurogenic bladder. 461 patients with sexual dysfunction were studied to determine the usefulness of the above tests. Abnormality of PSEP was found significantly in upper motor neuron (UMN) type spinal cord patients and average prolonged P1 latency was 47.4 +/- 9.8 msec. Lower motor neuron (LMN) type spinal cord patients revealed great abnormality in BCR latency with an average value of 44.9 +/- 14.5 msec on the right and 44.2 +/- 15.6 msec on the left. Additionally significant differences were obtained in patients with diabetes mellitus, pelvic trauma and spinal cord lesion of the UMN type in the study of PSEP. There was also a significant difference in the patients with diabetes mellitus, pelvic trauma and spinal cord lesion of the LMN type in the BCR study. The findings of our study suggest that PSEP together with BCR study is useful in assessing the integrity of the sacral reflex arc and the central afferent pathway, in differentiating the lesion site and in providing basic data for the management plan in sexual rehabilitation. Furthermore, because erection is under the influence of both the somatic and autonomic nervous system, BCR study and PSEP combined with currently studied electrical activity of the corpus cavernosum would provide a more accurate evaluation of the neurogenic erectile dysfunction patients.
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PMID:Pudendal somatosensory evoked potential and bulbocavernosus reflex testing in erectile dysfunction. 837 85

We report on our experience with autoinjection therapy in 72 patients with erectile dysfunction. We analysed factors that have an impact on the outcome of autoinjection therapy, and we focused on psychological, sexological and relational issues. In 53 (74%) patients an organic aetiological factor was found. Although with the aid of injection 82% of the men were able to achieve an erection adequate for penetration, only 39% continued treatment beyond one year. Lowest drop-out rates were encountered among patients with diabetes mellitus and men without organic aetiology (50% and 53% respectively). The most important reason for discontinuation was lack of acceptance of autoinjection therapy by the partner. Other reasons were prolonged erection, haematomas, ineffectiveness and fear of self-injection. Although autoinjection provides a safe and effective long-term method for the treatment of erectile dysfunction, the drop-out rate is strikingly high. Apparently, the acceptance of the partner is the most important determinant of the result of autoinjection therapy. Therefore, the partner should be involved in the counselling and treatment from the beginning.
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PMID:[Experiences with intracavernous auto-injection for the treatment of erection disorders]. 847 74

Testing of the autonomic cardiovascular reflexes (single breath beat-to-beat variation and orthostatic blood pressure change) was performed in 542 patients with erectile dysfunction who were grouped according to aetiological factors and their response to visual sexual stimulation and the papaverine test. Age-related normal values for autonomic tests were determined in the group of 124 patients with psychogenic impotence. Abnormal cardiovascular reflexes were associated with ageing and organic impotence, indicating autonomic dysfunction as a major contribution to impotence. Single breath beat-to-beat variation, as a simple non-invasive test, is useful in the clinical evaluation of impotence, especially in patients with diabetes and a history of alcohol abuse.
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PMID:Cardiovascular reflexes in the neurological evaluation of impotence. 846 55


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