Abstract
The aim of our study was to evaluate functional alterations of the corpus cavernusum and its correlation with the lack of response to treatment with PDE5i in eugonadal patients with Type 2 Diabetes Mellitus and Erectile Dysfunction. In this prospective randomized study we included 157 patients. All were treated with 5 mg tadalafil daily and 100 mg sildenafil on demand and the response to treatment was assessed in 6 month by dividing them into 2 groups: G1: Good response. Significative improvement of erectile function according to IIEF-5, and G2: There was not an improvement with the treatment. At the end of the treatment we performed neurological and vascular studies to both groups. Also we performed CC-EMG in order to evaluate penile autonomic neuropathy. 82 patients were included in G1 and 75 in G2. The time evolution of the ED was 1.5 years for G1 and 5 years for G2. Average fasting glucose and glycosilated hemoglobin values were significantly higher in G2 than in G1. Also we observed significant differences in penile vascular parameters between both groups. Peripheral neuropathy parameters did not show differences between both groups. Cavernous smooth muscle electromyography showed asynchronous and asymetric potentials in G1 (minimal autonomic neuropathy) and denervation potentials in G2 characteristic of severe CC damage. It is concluded that vascular and autonomic alterations are causes of severe CC damage and lack of response to treatment with PDE5i in this population. Peripheral neuropathy is not part of this process.
Highlights
Erectile Disfunction (ED) is the most frequent cause of sexual dysfunction in diabetic male patients with an estimated incidence of 35% - 75% [1] [2].ED is defined as the inability to achieve or maintain an adequate erection to allow a satisfactory sexual intercourse
All patients were treated with 5 mg tadalafil daily and 100 mg sildenafil on demand and the response to treatment was assessed in 6 months by dividing them into 2 groups: Group 1 (G1): Good response
average fasting glucose (AFG) and HbA1c values were significantly higher in group 2 (G2) than in G1 (Figure 1 and Figure 2) showing that this first group of patients have poor response to antidiabetic therapy or bad controls
Summary
ED is defined as the inability to achieve or maintain an adequate erection to allow a satisfactory sexual intercourse. This situation should be evident for several months and should occur in at least half of the attempts [3]. ED is a generalized vascular disease marker and early diagnosis in patients with type II diabetes mellitus (DM) prevents cardiovascular events such as myocardial infarction [4] [5]. Diabetic patients have comorbid factors such as hypertension and chronic renal failure that predispose to ED [1] [6]
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