Top

Published in:

01-11-2014 | Microvascular Complications—Neuropathy (D Ziegler, Section Editor)

How to Treat Erectile Dysfunction in Men with Diabetes: from Pathophysiology to Treatment

Authors: Konstantinos Hatzimouratidis, Dimitrios Hatzichristou

Published in: Current Diabetes Reports | Issue 11/2014

Abstract

Erectile dysfunction (ED) is highly prevalent affecting at least 50 % of men with diabetes mellitus (DM). DM may cause ED through a number of pathophysiological pathways. These include neuropathy, endothelial dysfunction, cavernosal smooth muscle structural/functional changes, and hormonal changes. Lifestyle changes, diabetes control, and treatment of hypogonadism are important as the first step in ED management since there is no curative treatment for ED. Phosphodiesterase type 5 inhibitors (PDE5i) are the first-line treatment option. Intracavernous administration of vasoactive drugs is commonly used as a second-line medical treatment when PDE5i have failed. Alprostadil is the most widely used drug in this second-line setting. The combination of papaverine, phentolamine, and alprostadil represents the most efficacious intracavernous pharmacologic treatment option that may save non-responders to alprostadil. Penile prosthesis implantation can be considered in treatment refractory cases, with excellent functional and safety results in the properly informed patients.

Lindau ST, Gavrilova N. Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ. 2010;340:c810. doi:10.1136/bmj.c810.PubMedCentralPubMedCrossRef

Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57(5):804–14. doi:10.1016/j.eururo.2010.02.020.PubMedCrossRef

Papaharitou S, Athanasiadis L, Nakopoulou E, Kirana P, Portseli A, Iraklidou M, et al. Erectile dysfunction and premature ejaculation are the most frequently self-reported sexual concerns: profiles of 9,536 men calling a helpline. Eur Urol. 2006;49(3):557–63. doi:10.1016/j.eururo.2005.09.023.PubMedCrossRef

Kirana PS, Rosen R, Hatzichristou D. Subjective well-being as a determinant of individuals’ responses to symptoms: a biopsychosocial perspective. Int J Clin Pract. 2009;63(10):1435–45. doi:10.1111/j.1742-1241.2009.02183.x.PubMedCrossRef

Aytac IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999;84(1):50–6.CrossRef

Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol. 2000;163(2):460–3.PubMedCrossRef

Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537–44.PubMedCrossRef

Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care. 2002;25(8):1458–63.PubMedCrossRef

Hatzimouratidis K, Hatzichristou D. Erectile dysfunction and diabetes mellitus. Insulin. 2009;4(2):114–22.CrossRef

10.

Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17(1):39–57. doi:10.1038/sj.ijir.3901250.PubMedCrossRef

11.

Guay A, Jacobson J. The relationship between testosterone levels, the metabolic syndrome (by two criteria), and insulin resistance in a population of men with organic erectile dysfunction. J Sex Med. 2007;4(4 Pt 1):1046–55. doi:10.1111/j.1743-6109.2007.00530.x.PubMedCrossRef

12.

Fedele D, Coscelli C, Santeusanio F, Bortolotti A, Chatenoud L, Colli E, et al. Erectile dysfunction in diabetic subjects in Italy. Gruppo Italiano Studio Deficit Erettile nei Diabetici. Diabetes Care. 1998;21(11):1973–7.PubMedCrossRef

13.

Fedele D, Coscelli C, Cucinotta D, Forti G, Santeusanio F, Viaggi S, et al. Incidence of erectile dysfunction in Italian men with diabetes. J Urol. 2001;166(4):1368–71.PubMedCrossRef

14.

Grover SA, Lowensteyn I, Kaouache M, Marchand S, Coupal L, DeCarolis E, et al. The prevalence of erectile dysfunction in the primary care setting: importance of risk factors for diabetes and vascular disease. Arch Intern Med. 2006;166(2):213–9. doi:10.1001/archinte.166.2.213.PubMedCrossRef

15.

Montorsi P, Ravagnani PM, Galli S, Rotatori F, Veglia F, Briganti A, et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J. 2006;27(22):2632–9. doi:10.1093/eurheartj/ehl142.PubMedCrossRef

16.•

Miner M, Seftel AD, Nehra A, Ganz P, Kloner RA, Montorsi P, et al. Prognostic utility of erectile dysfunction for cardiovascular disease in younger men and those with diabetes. Am Heart J. 2012;164(1):21–8. doi:10.1016/j.ahj.2012.04.006. This is a review showing that identification of ED, particularly in men <60 years old and those with diabetes, is important in early cardiovascular risk detection and reduction.PubMedCrossRef

17.

Kloner RA. Erectile dysfunction and cardiovascular risk factors. Urol Clin North Am. 2005;32(4):397-402, v. doi:10.1016/j.ucl.2005.08.005.

18.

Romeo JH, Seftel AD, Madhun ZT, Aron DC. Sexual function in men with diabetes type 2: association with glycemic control. J Urol. 2000;163(3):788–91.PubMedCrossRef

19.

Fonseca V, Jawa A. Endothelial and erectile dysfunction, diabetes mellitus, and the metabolic syndrome: common pathways and treatments? Am J Cardiol. 2005;96(12B):13M–8. doi:10.1016/j.amjcard.2005.07.005.PubMedCrossRef

20.

Esposito K, Giugliano F, Martedi E, Feola G, Marfella R, D’Armiento M, et al. High proportions of erectile dysfunction in men with the metabolic syndrome. Diabetes Care. 2005;28(5):1201–3.PubMedCrossRef

21.

Esposito K, Giugliano F, Maiorino MI, Giugliano D. Dietary factors, Mediterranean diet and erectile dysfunction. J Sex Med. 2010;7(7):2338–45. doi:10.1111/j.1743-6109.2010.01842.x.PubMed

22.

Burke JP, Jacobson DJ, McGree ME, Nehra A, Roberts RO, Girman CJ, et al. Diabetes and sexual dysfunction: results from the Olmsted County study of urinary symptoms and health status among men. J Urol. 2007;177(4):1438–42. doi:10.1016/j.juro.2006.11.059.PubMedCrossRef

23.

Dunsmuir WD, Holmes SA. The aetiology and management of erectile, ejaculatory, and fertility problems in men with diabetes mellitus. Diabet Med. 1996;13(8):700–8. doi:10.1002/(SICI)1096-9136(199608)13:8<700::AID-DIA174>3.0.CO;2-8.PubMedCrossRef

24.

Cellek S, Cameron NE, Cotter MA, Muneer A. Pathophysiology of diabetic erectile dysfunction: potential contribution of vasa nervorum and advanced glycation endproducts. Int J Impot Res. 2013;25(1):1–6. doi:10.1038/ijir.2012.30.PubMedCrossRef

25.

Saenz DeTejada I, Angulo J, Cellek S, Gonzalez-Cadavid NF, Heaton J, Pickard R, et al. Physiology of erectile function and pathophysiology of erectile dysfunction. In: Lue TF, Basson R, Rosen R, Giuliano F, Khoury S, Montorsi F, editors. Sexual medicine: sexual dysfunctions in men and women. Paris: Health Publications; 2007. p. 287–344.

26.

Hecht MJ, Neundorfer B, Kiesewetter F, Hilz MJ. Neuropathy is a major contributing factor to diabetic erectile dysfunction. Neurol Res. 2001;23(6):651–4. doi:10.1179/016164101101198965.PubMedCrossRef

27.

Yamanaka M, Shirai M, Shiina H, Tanaka Y, Tsujimura A, Matsumiya K, et al. Diabetes induced erectile dysfunction and apoptosis in penile crura are recovered by insulin treatment in rats. J Urol. 2003;170(1):291–7. doi:10.1097/01.ju.0000060564.31122.2a.PubMedCrossRef

28.

Saenz de Tejada I, Blanco R, Goldstein I, Azadzoi K, de las Morenas A, Krane RJ, et al. Cholinergic neurotransmission in human corpus cavernosum. I. Responses of isolated tissue. Am J Physiol. 1988;254(3 Pt 2):H459–67.PubMed

29.

Azadzoi KM, Saenz de Tejada I. Diabetes mellitus impairs neurogenic and endothelium-dependent relaxation of rabbit corpus cavernosum smooth muscle. J Urol. 1992;148(5):1587–91.PubMed

30.

Cartledge JJ, Eardley I, Morrison JF. Nitric oxide-mediated corpus cavernosal smooth muscle relaxation is impaired in ageing and diabetes. BJU Int. 2001;87(4):394–401.PubMedCrossRef

31.

Cellek S, Rodrigo J, Lobos E, Fernandez P, Serrano J, Moncada S. Selective nitrergic neurodegeneration in diabetes mellitus - a nitric oxide-dependent phenomenon. Br J Pharmacol. 1999;128(8):1804–12. doi:10.1038/sj.bjp.0702981.PubMedCentralPubMedCrossRef

32.

Musicki B, Burnett AL. Endothelial dysfunction in diabetic erectile dysfunction. Int J Impot Res. 2007;19(2):129–38. doi:10.1038/sj.ijir.3901494.PubMedCrossRef

33.

Bivalacqua TJ, Usta MF, Champion HC, Kadowitz PJ, Hellstrom WJ. Endothelial dysfunction in erectile dysfunction: role of the endothelium in erectile physiology and disease. J Androl. 2003;24(6 Suppl):S17–37.PubMed

34.

Singh R, Barden A, Mori T, Beilin L. Advanced glycation end-products: a review. Diabetologia. 2001;44(2):129–46. doi:10.1007/s001250051591.PubMedCrossRef

35.

Sullivan ME, Dashwood MR, Thompson CS, Muddle JR, Mikhailidis DP, Morgan RJ. Alterations in endothelin B receptor sites in cavernosal tissue of diabetic rabbits: potential relevance to the pathogenesis of erectile dysfunction. J Urol. 1997;158(5):1966–72.PubMedCrossRef

36.

Takahashi K, Ghatei MA, Lam HC, O’Halloran DJ, Bloom SR. Elevated plasma endothelin in patients with diabetes mellitus. Diabetologia. 1990;33(5):306–10.PubMedCrossRef

37.

Wang H, Eto M, Steers WD, Somlyo AP, Somlyo AV. RhoA-mediated Ca2+ sensitization in erectile function. J Biol Chem. 2002;277(34):30614–21. doi:10.1074/jbc.M204262200.PubMedCrossRef

38.

Bivalacqua TJ, Champion HC, Usta MF, Cellek S, Chitaley K, Webb RC, et al. RhoA/Rho-kinase suppresses endothelial nitric oxide synthase in the penis: a mechanism for diabetes-associated erectile dysfunction. Proc Natl Acad Sci U S A. 2004;101(24):9121–6. doi:10.1073/pnas.0400520101.PubMedCentralPubMedCrossRef

39.

Ming XF, Viswambharan H, Barandier C, Ruffieux J, Kaibuchi K, Rusconi S, et al. Rho GTPase/Rho kinase negatively regulates endothelial nitric oxide synthase phosphorylation through the inhibition of protein kinase B/Akt in human endothelial cells. Mol Cell Biol. 2002;22(24):8467–77.PubMedCentralPubMedCrossRef

40.

Simopoulos DN, Gibbons SJ, Malysz J, Szurszewski JH, Farrugia G, Ritman EL, et al. Corporeal structural and vascular micro architecture with X-ray micro computerized tomography in normal and diabetic rabbits: histopathological correlation. J Urol. 2001;165(5):1776–82.PubMedCrossRef

41.

Wessells H, Teal TH, Engel K, Sullivan CJ, Gallis B, Tran KB, et al. Fluid shear stress-induced nitric oxide production in human cavernosal endothelial cells: inhibition by hyperglycaemia. BJU Int. 2006;97(5):1047–52. doi:10.1111/j.1464-410X.2006.06059.x.PubMedCrossRef

42.

Seftel AD, Vaziri ND, Ni Z, Razmjouei K, Fogarty J, Hampel N, et al. Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology. 1997;50(6):1016–26. doi:10.1016/S0090-4295(97)00512-8.PubMedCrossRef

43.

Usta MF, Bivalacqua TJ, Yang DY, Ramanitharan A, Sell DR, Viswanathan A, et al. The protective effect of aminoguanidine on erectile function in streptozotocin diabetic rats. J Urol. 2003;170(4 Pt 1):1437–42. doi:10.1097/01.ju.0000077557.45582.f3.PubMedCrossRef

44.

Chang S, Hypolite JA, Velez M, Changolkar A, Wein AJ, Chacko S, et al. Downregulation of cGMP-dependent protein kinase-1 activity in the corpus cavernosum smooth muscle of diabetic rabbits. Am J Physiol Regul Integr Comp Physiol. 2004;287(4):R950–60. doi:10.1152/ajpregu.00639.2003.PubMedCrossRef

45.

Corona G, Mannucci E, Petrone L, Ricca V, Balercia G, Mansani R, et al. Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Int J Impot Res. 2006;18(2):190–7. doi:10.1038/sj.ijir.3901391.PubMedCrossRef

46.

Kapoor D, Aldred H, Clark S, Channer KS, Jones TH. Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care. 2007;30(4):911–7. doi:10.2337/dc06-1426.PubMedCrossRef

47.

Bansal TC, Guay AT, Jacobson J, Woods BO, Nesto RW. Incidence of metabolic syndrome and insulin resistance in a population with organic erectile dysfunction. J Sex Med. 2005;2(1):96–103. doi:10.1111/j.1743-6109.2005.20120.x.PubMedCrossRef

48.

Cellek S, Foxwell NA, Moncada S. Two phases of nitrergic neuropathy in streptozotocin-induced diabetic rats. Diabetes. 2003;52(9):2353–62.PubMedCrossRef

49.

Wessells H. Insights and interventions in diabetes associated erectile dysfunction. J Urol. 2013;190(1):15–6. doi:10.1016/j.juro.2013.04.041.PubMedCrossRef

50.

Lue TF, Giuliano F, Montorsi F, Rosen RC, Andersson KE, Althof S, et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med. 2004;1(1):6–23. doi:10.1111/j.1743-6109.2004.10104.x.PubMedCrossRef

51.

Giugliano D, Giugliano F, Esposito K. Sexual dysfunction and the Mediterranean diet. Public Health Nutr. 2006;9(8A):1118–20. doi:10.1017/S1368980007668542.PubMedCrossRef

52.

Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D’Andrea F, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978–84. doi:10.1001/jama.291.24.2978.PubMedCrossRef

53.

Dusing R. Sexual dysfunction in male patients with hypertension: influence of antihypertensive drugs. Drugs. 2005;65(6):773–86.PubMedCrossRef

54.

Wassmann S, Hilgers S, Laufs U, Bohm M, Nickenig G. Angiotensin II type 1 receptor antagonism improves hypercholesterolemia-associated endothelial dysfunction. Arterioscler Thromb Vasc Biol. 2002;22(7):1208–12.PubMedCrossRef

55.

Gruenwald I, Shenfeld O, Chen J, Raviv G, Richter S, Cohen A, et al. Positive effect of counseling and dose adjustment in patients with erectile dysfunction who failed treatment with sildenafil. Eur Urol. 2006;50(1):134–40. doi:10.1016/j.eururo.2006.01.042.PubMedCrossRef

56.

Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87(8):766–78. doi:10.1016/j.mayocp.2012.06.015.PubMedCentralPubMedCrossRef

57.

Kostis JB, Jackson G, Rosen R, Barrett-Connor E, Billups K, Burnett AL, et al. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol. 2005;96(2):313–21. doi:10.1016/j.amjcard.2005.03.065.PubMedCrossRef

58.

Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group. JAMA. 1999;281(5):421–6.PubMedCrossRef

59.

Boulton AJ, Selam JL, Sweeney M, Ziegler D. Sildenafil citrate for the treatment of erectile dysfunction in men with Type II diabetes mellitus. Diabetologia. 2001;44(10):1296–301. doi:10.1007/s001250100656.PubMedCrossRef

60.

Stuckey BG, Jadzinsky MN, Murphy LJ, Montorsi F, Kadioglu A, Fraige F, et al. Sildenafil citrate for treatment of erectile dysfunction in men with type 1 diabetes: results of a randomized controlled trial. Diabetes Care. 2003;26(2):279–84.PubMedCrossRef

61.

Goldstein I, Young JM, Fischer J, Bangerter K, Segerson T, Taylor T. Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care. 2003;26(3):777–83.PubMedCrossRef

62.

Safarinejad MR. Oral sildenafil in the treatment of erectile dysfunction in diabetic men: a randomized double-blind and placebo-controlled study. J Diabetes Complicat. 2004;18(4):205–10. doi:10.1016/S1056-8727(03)00056-4.PubMedCrossRef

63.

Fonseca V, Seftel A, Denne J, Fredlund P. Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials. Diabetologia. 2004;47(11):1914–23. doi:10.1007/s00125-004-1549-6.PubMedCrossRef

64.

Ziegler D, Merfort F, van Ahlen H, Yassin A, Reblin T, Neureither M. Efficacy and safety of flexible-dose vardenafil in men with type 1 diabetes and erectile dysfunction. J Sex Med. 2006;3(5):883–91. doi:10.1111/j.1743-6109.2006.00295.x.PubMedCrossRef

65.

Hatzichristou D, Gambla M, Rubio-Aurioles E, Buvat J, Brock GB, Spera G, et al. Efficacy of tadalafil once daily in men with diabetes mellitus and erectile dysfunction. Diabet Med. 2008;25(2):138–46. doi:10.1111/j.1464-5491.2007.02338.x.PubMedCrossRef

66.

Park HJ, Choi HK, Ahn TY, Park JK, Chung WS, Lee SW, et al. Efficacy and safety of oral mirodenafil in the treatment of erectile dysfunction in diabetic men in Korea: a multicenter, randomized, double-blind, placebo-controlled clinical trial. J Sex Med. 2010;7(8):2842–50. doi:10.1111/j.1743-6109.2010.01888.x.PubMedCrossRef

67.

du Moon G, Yang DY, Lee CH, Ahn TY, Min KS, Park K, et al. A therapeutic confirmatory study to assess the safety and efficacy of Zydena (udenafil) for the treatment of erectile dysfunction in male patients with diabetes mellitus. J Sex Med. 2011;8(7):2048–61. doi:10.1111/j.1743-6109.2011.02268.x.CrossRef

68.

Goldstein I, Jones LA, Belkoff LH, Karlin GS, Bowden CH, Peterson CA, et al. Avanafil for the treatment of erectile dysfunction: a multicenter, randomized, double-blind study in men with diabetes mellitus. Mayo Clin Proc. 2012;87(9):843–52. doi:10.1016/j.mayocp.2012.06.016.PubMedCentralPubMedCrossRef

69.

Hatzimouratidis K, Hatzichristou DG. A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient? Drugs. 2005;65(12):1621–50.PubMedCrossRef

70.

Price DE, Cooksey G, Jehu D, Bentley S, Hearnshaw JR, Osborn DE. The management of impotence in diabetic men by vacuum tumescence therapy. Diabet Med. 1991;8(10):964–7.PubMedCrossRef

71.

Sidi AA, Becher EF, Zhang G, Lewis JH. Patient acceptance of and satisfaction with an external negative pressure device for impotence. J Urol. 1990;144(5):1154–6.PubMed

72.

Padma-Nathan H, Hellstrom WJ, Kaiser FE, Labasky RF, Lue TF, Nolten WE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med. 1997;336(1):1–7.PubMedCrossRef

73.

Padma-Nathan H, Yeager JL. An integrated analysis of alprostadil topical cream for the treatment of erectile dysfunction in 1732 patients. Urology. 2006;68(2):386–91. doi:10.1016/j.urology.2006.02.027.PubMedCrossRef

74.

Williams G, Abbou CC, Amar ET, Desvaux P, Flam TA, Lycklama a Nijeholt GA, et al. Efficacy and safety of transurethral alprostadil therapy in men with erectile dysfunction. MUSE Study Group. Br J Urol. 1998;81(6):889–94.PubMedCrossRef

75.

Buvat R, Fernando Y, Damaj B, Moncada I, Frank D, Burger M. Clinically significant approvement of erectile function following treatment with alprostadil cream (Vitaros®) in 1652 patients with erectile dysfunction. J Sex Med. 2012;9 suppl 5:384. abstract P-01-086.

76.

Heaton JP, Lording D, Liu SN, Litonjua AD, Guangwei L, Kim SC, et al. Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men. Int J Impot Res. 2001;13(6):317–21.PubMedCrossRef

77.

Perimenis P, Konstantinopoulos A, Perimeni PP, Gyftopoulos K, Kartsanis G, Liatsikos E, et al. Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction. Asian J Androl. 2006;8(2):219–24. doi:10.1111/j.1745-7262.2006.00095.x.PubMedCrossRef

78.

Porst H. The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. J Urol. 1996;155(3):802–15.PubMedCrossRef

79.

Tal R, Mulhall JP. Intracavernosal injections and fibrosis: myth or reality? BJU Int. 2008;102(5):525–6. doi:10.1111/j.1464-410X.2008.07738.x.PubMedCrossRef

80.

Simmons M, Montague DK. Penile prosthesis implantation: past, present and future. Int J Impot Res. 2008;20(5):437–44. doi:10.1038/ijir.2008.11.PubMedCrossRef

81.

Henry GD, Wilson SK. Updates in inflatable penile prostheses. Urol Clin North Am. 2007;34(4):535–47. doi:10.1016/j.ucl.2007.08.015. vi.PubMedCrossRef

82.

Carson CC. Penile prosthesis implantation: surgical implants in the era of oral medication. Urol Clin North Am. 2005;32(4):503–9. doi:10.1016/j.ucl.2005.09.002. vii.PubMedCrossRef

83.

Chen Y, Dai Y, Wang R. Treatment strategies for diabetic patients suffering from erectile dysfunction. Expert Opin Pharmacother. 2008;9(2):257–66. doi:10.1517/14656566.9.2.257.PubMedCrossRef

84.

Moore CR, Wang R. Pathophysiology and treatment of diabetic erectile dysfunction. Asian J Androl. 2006;8(6):675–84. doi:10.1111/j.1745-7262.2006.00223.x.PubMedCrossRef

85.

Mulhall JP, Ahmed A, Branch J, Parker M. Serial assessment of efficacy and satisfaction profiles following penile prosthesis surgery. J Urol. 2003;169(4):1429–33. doi:10.1097/01.ju.0000056047.74268.9c.PubMedCrossRef

86.

Bishop JR, Moul JW, Sihelnik SA, Peppas DS, Gormley TS, McLeod DG. Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections. J Urol. 1992;147(2):386–8.PubMed

87.

Carson 3rd CC, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of followup. J Urol. 2011;185(2):614–8.PubMedCrossRef

88.

Mulcahy JJ, Carson 3rd CC. Long-term infection rates in diabetic patients implanted with antibiotic-impregnated versus nonimpregnated inflatable penile prostheses: 7-year outcomes. Eur Urol. 2011;60(1):167–72. doi:10.1016/j.eururo.2011.01.046.PubMedCrossRef

89.••

Gruenwald I, Appel B, Kitrey ND, Vardi Y. Shockwave treatment of erectile dysfunction. Ther Adv Urol. 2013;5(2):95–9. doi:10.1177/1756287212470696. This is a thorough review of the role of shockwave therapy in the treatment of erectile dysfunction including men with diabetes.PubMedCentralPubMedCrossRef

90.

Qiu X, Lin G, Xin Z, Ferretti L, Zhang H, Lue TF, et al. Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model. J Sex Med. 2013;10(3):738–46. doi:10.1111/jsm.12024.PubMedCentralPubMedCrossRef

91.

Gruenwald I, Appel B, Vardi Y. Low-intensity extracorporeal shock wave therapy—a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy. J Sex Med. 2012;9(1):259–64. doi:10.1111/j.1743-6109.2011.02498.x.PubMedCrossRef

Title: How to Treat Erectile Dysfunction in Men with Diabetes: from Pathophysiology to Treatment
Authors: Konstantinos Hatzimouratidis
Dimitrios Hatzichristou
Publication date: 01-11-2014
Publisher: Springer US
Published in: Current Diabetes Reports / Issue 11/2014
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI: https://doi.org/10.1007/s11892-014-0545-6

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits

Illustration of figure on mountain summit/© Orapun / Stock.adobe.com, STEP AAG HeroTeaserCollection image/© Tarek / Generated with AI / Stock.adobe.com, ACC 2024 Pediatric and Congenital Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Pulmonary Vascular Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 Valvular Heart Disease: Year in Review/© 2024 American College of Cardiology, ACC 2024 HF and Cardiomyopathies: Year in Review/© 2024 American College of Cardiology, Woman out walking/© Seventyfour / stock.adobe.com (symbolic image with model), Woman checking smartwatch /© saltdium / stock.adobe.com (symbolic image with model), Cardiac catheterization/© Damian / stock.adobe.com

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 11/2014

Fine Mapping of Type 2 Diabetes Susceptibility Loci

Role of B Lymphocytes in the Pathogenesis of Type 1 Diabetes

Good Cop, Bad Cop: Quality of Parental Involvement in Type 1 Diabetes Management in Youth

Beyond HbA1c and Glucose: the Role of Nontraditional Glycemic Markers in Diabetes Diagnosis, Prognosis, and Management

Assessing Premorbid Cognitive Ability in Adults With Type 2 Diabetes Mellitus—a Review With Implications for Future Intervention Studies

Insights into the Genetic Susceptibility to Type 2 Diabetes from Genome-Wide Association Studies of Glycaemic Traits

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

Highlights from the ACC 2024 Congress

ACC 2024 Congress Coverage