Abstract
Erectile disorders in men with diabetes mellitus (DM) in combination with autonomic neuropathy are diagnosed and rehabilitation methods of patients with erectile dysfunction (ED) are detected. Thirty patients with DM were examined (15 patients with diabetes mellitus type 1 and 15 patients with diabetes mellitus type 2 respectively). Patients with DM had ED mainly of severe form (IIEF-5 from 6 to 16 points). According to the examination results, the patients were assigned conservative therapy, including phosphodiesterase inhibitors of type V, anticholinesterase drugs, thioctic acid drugs. Conservative therapy was combined with shock wave therapy in the area of the penis. The comparison group consisted of 15 healthy men (volunteers) without ED signs (IIEF-5 21–22 points). The immune-enzyme analysis was used for detection of sex hormone status. Ultrasound, dopplergraphic and X-ray methods were used for conduction of angiography of pool vessels of internal pudendal artery (IPA). Electroneuromyography of penis nerves was made. According to the obtained results, patients with DM were diagnosed with cavernous fibrosis, angiosclerosis of IPA and penis vessels in 100% of cases. Axonopathy of motor and sensory penis nerves was detected in 100 % of cases; stenosis and occlusion changes in IPA were detected in 42.9 % of cases causing disorder and insufficiency in arterial perfusion in the IPA pool. Denervation changes in sensory and motor penis nerves and hemodynamicly significant perfusion disorders in the IPA pool were the principal pathogenetic ED factors in patients with DM. A decrease of the IPA reaction to the pharmological stimulation was noted in patients with DM, which was caused by angiosclerosis and arterial wall elasticity loss. The inefficiency of conservative therapy in patients with DM and severe ED was revealed.
Highlights
Цель исследования – диагностика эректильных нарушений у мужчин с диабетической автономной нейропатией и определение тактики медицинской реабилитации пациентов с эректильной дисфункцией (ЭД) на фоне сахарного диабета (СД)
According to the results of conducted examination the patients were prescribed the course of conservative therapy including hosphodiesterase in hibitors of type V, anticholinesterase drugs, drugs of thioctic acid
Ultrasound, dopplerographic and X-ray methods were used for conduction of angiography of pool vessels of internal pudendal artery (IPA)
Summary
У больных отмечалась ЭД преимущественно тяжелой степени (Международный индекс эректильной функции (МИЭФ-5) – от 6 до 16 баллов). Гормональный статус определяли с помощью иммуноферментного анализа, ультразвукового и допплерографического методов исследования, выполняли ангиографическое исследование сосудов бассейна внутренней половой артерии (ВПА) и электронейромиографическое исследование нервов полового члена. У 100 % пациентов с СД был диагностирован кавернозный фиброз, регистрировались признаки ангиосклероза сосудов полового члена и ВПА. Во всех случаях была выявлена аксонопатия моторных и сенсорных порций нервов полового члена, в 42,9 % – стенозо-окклюзионные изменения ВПА, обусловливающие нарушение и недостаточность артериальной перфузии в бассейне ВПА. Денервационные изменения сенсорных и моторных порций нервов полового члена и гемодинамически значимые перфузионные нарушения в бассейне ВПА у пациентов с СД являлись ведущими патогенетическими факторами ЭД. Отмечалась неэффективность консервативной терапии у пациентов с СД и ЭД тяжелой степени. Ключевые слова: сахарный диабет, нейропатия, эректильная дисфункция, ультразвуковое исследование, электронейромиография, ангиография
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