Erectile Dysfunction In Diabetic Patients Research Articles

Pharmacological Treatments for Erectile Dysfunction in Diabetic Patients: Efficacy, Safety, and Emerging Therapies

Men with diabetes mellitus, particularly those with type 2 diabetes (T2DM), are known to experience erectile dysfunction (ED), a condition whose prevalence has risen to 75% in recent years. The pathophysiology of ED in diabetic patients involves vascular impairment, neuropathy, hormonal dysregulation, and chronic hyperglycemia, all of which contribute to endothelial dysfunction, reduced nitric oxide availability, and nerve damage. Phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, tadalafil, and vardenafil, are the first-line pharmacological treatments for ED, though their efficacy is reduced in diabetic patients due to the extent of vascular and neurological damage. Other treatments, including testosterone replacement therapy (TRT), intracavernosal injections, and vacuum erection devices (VEDs), provide alternatives for patients unresponsive to PDE5 inhibitors. Emerging therapies such as low-intensity extracorporeal shockwave therapy (LI-ESWT) and regenerative medicine approaches, including stem cell and platelet-rich plasma (PRP) injections, show potential in improving erectile function in diabetic patients. Glycemic control plays a critical role in both preventing ED and enhancing the efficacy of treatments by improving vascular function and reversing nerve damage. This review was conducted through an extensive analysis of current literature on pharmacological and emerging treatments for ED in diabetic patients. In conclusion, integrating traditional pharmacotherapy with emerging treatments and emphasizing glycemic control holds promise for optimizing ED management in diabetic patients. Keywords: Erectile Dysfunction (ED), Diabetes Mellitus (T2DM), Phosphodiesterase Type 5 (PDE5) Inhibitors, Testosterone Replacement Therapy (TRT), Glycemic Control

Treatment Options for Erectile Dysfunction in Diabetics

Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain a penile erection suitable for sexual intercourse. This condition is common with diabetic males. This article comprehensively reviews various treatment options for Erectile Dysfunction (ED) in diabetic men, with a specific focus on the potential of Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT). Persistent hyperglycemia may decrease nitric oxide (NO) generation, the cycloguanosine monophosphate (cGMP) pathway, reactive free radical levels, the RhoA/Rho kinase pathway, and nerve function, all of which may be contributing factors to ED in diabetic patients. Elevated AGE expression in diabetes individuals' corpus cavernosum may result in structural alterations to the tissue, including thicker arterial walls, decreased flexibility, endothelial dysfunction, and atherosclerosis. Chronic hyperglycemia can produce nerve injury that affects both autonomic and other sensory patterns. The following are existing treatment options for ED; oral phosphodiesterase type 5 (PDE5) inhibitor, intracavernosal injection therapy, Intraurethral PGE1 suppository (IUS), Vacuum Erection Device (VED) and penile prosthesis or penile implant. Low-Intensity Extracorporeal Shockwave therapy (LI-ESWT), the treatment options for ED is a non-invasive procedure that focuses on address the root causes of ED. The mechanism underlying the efficacy of shock wave treatment is vasodilation and angiogenesis leading to improved blood flow to the penis by upregulating vascular endothelial growth factor (VEGF), nitric oxide synthase (NOS) and proliferating cell nuclear antigen. The review unveiled the success potential of (LI-ESWT) in treating diabetic impotence.

A comparative Study of Tadalafil versus Tadalafil combined with Alpha Lipoic Acid in the treatment of Erectile Dysfunction in Diabetic Patients

A comparative Study of Tadalafil versus Tadalafil combined with Alpha Lipoic Acid in the treatment of Erectile Dysfunction in Diabetic Patients

Assessment of the results of treatment erectile dysfunction in diabetic patients by tadalafil 20mg once every there days

ABSTRACT Introduction Tadalafil (a PDE5 inhibitor) is used to treat erectile dysfunction (ED), which can be dosed on-demand or daily. Tadalafil has a long half-life, so it has a long-lasting effect. Men with ED also have a preference for a treatment that is time-independent Aim To evaluate the efficacy and safety of tadalafil 20 mg with a dose of one tablet every three days in the treatment of erectile dysfunction among diabetic patients. Material and methods A prospective study was carried out on 22 men with diabetes who were examined with symptoms of erectile dysfunction satisfying the selection criteria at Center for Andrology and Sexual Medicine - VietDuc University Hospital from June 2020 to June 2021. These patients were treated with tadalafil 20 mg once every three days. Results There were 22 patients included in the study, mean age was 52.1 years old. The baseline degree of erectile dysfunction was mainly mild to moderate (accounting for 73%). The average IIEF-5 score before and after treatment was 12.2 and 19.3, respectively. The improvement of IIEF-5 score was statistically significant (p <0.05). Headache was the most common side effect, accounting for 13.6%, followed by facial flushing, nasal congestion, myalgia and back pain with 9.1%, palpitations and digestive disorders with 4.5%. Conclusion tadalafil 20mg dosed one tablet every three days for the treatment of erectile dysfunction among diabetic patients has a statistically significant effect; hopefully, providing an additional option for the safe treatment of erectile dysfunction in diabetic patients. Disclosure Work supported by industry: no.

Low-intensity extracorporeal shock wave therapy for erectile dysfunction: Myths and realities.

To review the evidence of clinical efficacy of low-intensity extracorporeal shock wave therapy (Li-ESWT) for the treatment of erectile dysfunction (ED). A search on PubMed using Medical Subject Headings terms [((low intensity extracorporeal shockwave therapy) OR (Li-ESWT)) AND (erectile dysfunction)] was conducted in August 2022, to obtain studies on the use of Li-ESWT for the treatment of ED. Its success rate in terms of International Index of Erectile Function-5 (IIEF-5) score and Erection Hardness Score (EHS) improvement was recorded and analysed. A total of 139 articles were reviewed. Overall, 52 studies were included in the final review. 17 studies were on vasculogenic ED, 5 on post pelvic surgery ED, 4 specifically on ED in diabetic patients, 24 on non-specified origin ED and 2 on mixed pathophysiological origin ED. The mean age of patients was 55.87±7.91 (standard deviation) years and the duration of ED was 4.36±2.08 years. The mean IIEF-5 score went from 12.04±2.67 at baseline to 16.12±5.72, 16.30±3.26 and 16.85±1.63 respectively at 3, 6 and 12 months. The mean EHS went from 2.00±0.46 at baseline to 2.58±0.60, 2.75±0.46 and 2.87±0.16 respectively at 3, 6 and 12 months. Li-ESWT may be a safe and efficacy option for the treatment and cure of ED. Further studies are needed to assess which patients are more suitable for this procedure and which Li-ESWT protocol can lead to the best outcomes.

Efficacy Evaluation of Plant Products in the Treatment of Erectile Dysfunction Related to Diabetes.

Erectile dysfunction affects more than 50% of diabetic male patients, with a higher prevalence compared with the general population. Age, clinical factors, and lifestyle habits have been suggested to contribute to the pathophysiology and worsening of erectile dysfunction in diabetic patients. First- and second-line standard treatments are represented by phosphodiesterase type 5 (PDE5) inhibitors and alprostadil, respectively. However, natural compounds have been suggested to ameliorate this clinical condition. This study aims to preclinically characterize the potential synergism among plant-derived products for the improvement of erectile dysfunction in the diabetic condition. The effects of a nutritional supplement composed of Panax ginseng, Moringa oleifera and rutin, as single agents or as a mixture, were evaluated in a streptozotocin (STZ)-induced diabetic rat model with erectile dysfunction. The treatment efficacy was evaluated by measuring sexual-related parameters (i.e., mount and intromission latencies, the mount and intromission frequencies and the ejaculation latency). Results showed that only the mixture was able to significantly reduce the diabetes-related delay in mount latency (p < 0.01). Substantial similar effects were observed by measuring the intromission latency and the mean number of mounts was very similar between rats treated with the mixture and controls. Single agent treatments showed very low effects in terms of intromission frequency, whereas the mixture was able to increase this parameter. Additionally, a statistically significant reduced ejaculation latency was observed in rats treated with the mixture compared with the STZ control. These results are in agreement with the available literature and suggest that the study mixture may ameliorate sexual behavior compared with the administration of the study natural compounds as single agents in diabetic rats. Further preclinical and clinical studies are needed to perform a more comprehensive evaluation of the efficacy and safety of the study mixture.

The Effect of Intracavernosal Injection of Stem Cell in the Treatment of Erectile Dysfunction in Diabetic Patients: A Randomized Single-blinded Clinical Trial.

The prevalence of erectile dysfunction in men is increasing. As well, the prevalence of diabetes, as one of the causes of sexual dysfunction, is rising in many countries. Due to the failure of common therapies in some patients with sexual dysfunction, it is necessary to develop an effective alternative treatment, such as stem cell therapy, for this problem. In this randomized single-blinded clinical trial, 20 diabetic patients with erectile dysfunction, who were resistant to common treatments, were selected and divided into two groups of intervention and control (n=10 per group). Autologous mesenchymal stem cells (MSCs) were extracted from oral mucosa and then infused via intracavernosal injection (50-60 ×106 cells) to the participants of the intervention group. Normal saline was injected in the control group. The patients were followed up with the International Index of Erectile Function (IIEF5) questionnaire, as well as color Doppler duplex ultrasound. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were determined three and six months after the interventions. The mean IIEF5 scores in the intervention group were 7.2 ± 2.1, 9.2 ± 3.4, and 10.6 ± 4.7 before, three months, and six months after the injection, respectively, showing a significant ascending trend (P = 0.01). Comparing the intervention and control groups, there was a significant difference in the IIEF5 score change during six months after the injection (P = 0.02). Regarding the PSV and RI of penis vessels, there were no statistically significant differences between the two groups. However, these parameters showed upward and improving trends in the intervention group. Intracavernosal injection of stem cells improved sexual function and PSV and RI indices of penile arteries in diabetic patients.

Erectile Dysfunction in Diabetic Patients: From Etiology to Management

Diabetes mellitus (DM) is a widespread chronic disease with a prevalence that is expected to further increase in the near future. The classical management of DM includes the normalization of the glycometabolic profile and the evaluation of cardiac and cerebral vascular health by the intervention of an array of different specialists. However, so far, sexual dysfunctions are still a neglected complication in patients with DM, although there is an elevated prevalence of this long-term complication in male and female patients. Furthermore, some of them may represent a sign of vascular alteration and/or hypogonadism and require timely management to prevent the onset of major adverse cardiac events. This narrative review briefly summarizes the current evidence on epidemiology, pathogenesis, diagnosis, and therapy of erectile dysfunction in male patients with DM to support diabetologists in clinical practice.

Effect of physical exercise combined with shockwave therapy on erectile dysfunction in diabetic patients.

The aim of the study was to evaluate whether physical exercise (PE) in addition to extracorporeal shockwave therapy (ESWT) is more effective in improving erectile function as compared to ESWT and PE alone in diabetic patients with erectile dysfunction (ED). Forty-five patients with type 2 diabetes mellitus (DM) and ED were divided into three equal groups: group 1 (ESWT group) received treatment with ESWT twice weekly for 6 weeks, comprising 3000 shockwaves at an energy density of 0.25 mJ/mm2 and an emission frequency of 6 Hz; group 2 (PE group) received treatment with physical exercise three times per week for 12 weeks; and group 3 (combined group) was treated using physical exercise in the form of the program followed by the PE group, plus ESWT in the form of the same parameter and protocol as that of the ESWT group. Treatment outcomes were measured by International Index of Erectile Function-5 (IIEF-5) score variations recorded at 4 and 12 weeks after the end of treatment with respect to the baseline. The mean IIEF-5 scores significantly improved in all groups at the 4-week follow-up without intergroup differences. At the 12-week follow-up, the mean IIEF-5 improvement and durability were significantly higher among patients in combined groups. The combined approach of ESWT and PE provides significant advantages in erectile dysfunction improvement and durability as compared to ESWT or PE alone in diabetic patients with ED.

Effect of low-intensity extracorporeal shock wave therapy on diabetic erectile dysfunction: Randomised control trial.

This study aimed to assess the effectiveness of low-intensity extracorporeal shockwave therapy (Li-ESWT) in the management of erectile dysfunction in diabetic patients with mixed vasculogenic and neurogenic causes as confirmed by nerve conduction and Doppler studies. This randomised controlled trial included 42 patients 41-55years of age with a confirmed diagnosis of erectile dysfunction and diabetic polyneuropathy. They were randomly allocated to one of two groups: shock wave group (n=21) treated with Li-ESWT plus pelvic floor muscle training and control Group (n=21) treated with pelvic floor muscle exercise and sham therapy by a shock wave. The erectile function was scored according to the five-item version of the International Index of Erectile Function (IIEF-5). Colour-coded duplex sonography was used for the evaluation of penile perfusion of the two cavernous arteries. The assessment was done before and three months after treatment. IIEF-EF increased significantly in the study group (p<.001), but not in the control group (p=.194). Peak systolic velocity increased significantly in the two groups; however, the post-treatment peak systolic velocity was significantly higher in the study group compared to the control group (p<.001, for both arteries).

The relationship between serum irisin levels and erectile dysfunction in diabetic men (irisin and erectile dysfunction in diabetic patients)

Irisin is an exercise-induced myokine that alleviates endothelial dysfunction and reduces insulin resistance in type 2 diabetes mellitus. We conducted this cross-sectional prospective study to determine the association of serum irisin levels and erectile dysfunction in type 2 diabetic patients. We compared 34 diabetic patients with erectile dysfunction with 30 diabetic patients without erectile dysfunction. In our study, serum irisin levels were found to be statistically significantly higher in diabetic patients without erectile dysfunction compared to those with erectile dysfunction (p=.016) and according to correlation analysis, irisin levels had a significantly negative correlation with the serum HbA1C value (r=-.294, p=.018). Based on the results of our study, we think that this molecule can be used in the diagnosis or treatment of erectile dysfunction in diabetic patients, if these findings are supported by larger studies.

Early Detection of Vasculogenic ED in Diabetic Patients by Assessment of Platelet Indices

Background: The permanent incompetence to attain or preserve an erection is erectile dysfunction (ED). ED impacts a lot of men all over the world. Vasculogenic, hormonal, neurogenic, anatomical, drug-induced and psychogenic factors are included in ED pathophysiology. A significant pathophysiological factor underlying vasculogenic erectile dysfunction is endothelial dysfunction (EDys). Platelet Indices are significant biomarkers for platelet activation and pathophysiology of atherothrombsis, including average volume of platelets, width of platelet distribution and count of platelets. Measurement of Platelet indexes in diabetic males can detect erectile dysfunction early on. Objectives: The purpose of this research is to measure the PIs with ED in diabetic men and to associate among PIs and ED and also to associate among PIs and vasculogenic ED. Patients and Methods: The research was performed on 90 persons who were split into 3 groups: Group A: 30 diabetic male patients with ED, Group B: 30 diabetic male patients without ED, Group C: 30 healthy individuals as control. Results: A significant relationship among platelet indices, ED, and DM was shown in the present research. A statistically substantial increase was found in PIs (MPV, PDW) and HbA1C in ED with DM than DM and control groups. A statistically substantial decrease in PIs (PC) was also found in ED with DM than DM without and control groups. Conclusion: A substantial correlation in DM among platelet indices and ED. In patients with diabetes with ED, particularly those with vasculogenic pathology, PIs have increased.

Erectile Dysfunction in a Cohort of Eugonodal Type 2 Diabetic Men Attending a Tertiary Healthcare Facility: Prevalence and Correlation with Testicular Volume

Background: Erectile dysfunction (ED) is a very common complication of diabetes mellitus. The prevalence of ED in diabetic patients, especially those with type 2 diabetes mellitus (T2DM) is very high compared with their non-diabetic counterparts. There are few studies on ED and its correlation with testicular volume in eugonadal type 2 diabetics globally and especially in sub-Saharan Africa. Objective: To access the prevalence and correlation of ED with testicular volume in T2DM patients attending the diabetes outpatient clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi in South-eastern Nigeria. Materials and Methods: This was a cross sectional prevalence study comprising 124 subjects with T2DM and 62 non diabetic controls. Data collection was done using a study protocol. Hospital Anxiety and Depression Scale (HADS) and the International Index of Erectile function (IIEF) questionnaires were used for diagnosis of anxiety/depression and erectile dysfunction respectively. Testicular volumes for the study subjects were estimated using Prader-orchidometer. Serum total testosterone, follicle stimulating hormone and luteinizing hormone levels were determined. Participants who had anxiety, depression or hypogonadism were excluded from the study. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 20. Results: The mean age of the subjects was 58.29 ± 10.02 while that of the controls was 56.48 ± 10.58 (P = 0.255). 48.4% of the subjects had ED while 4.8% of the controls had erectile dysfunction (P &lt; 0.001). Of the subjects that had ED, 26.7% had mild, 11.7% had moderate while 61.7% had severe erectile dysfunction. Severe ED was more associated with subjects (χ2= 7.230, P = 0.027). IIEF score has significant positive correlation with the mean testicular volume. Conclusion: Prevalence of ED in men with T2DM in Nigeria is high and there is a significant positive correlation between ED and testicular volume in this group of subjects.

Estradiol correlates with erectile dysfunction and its severity in type 2 diabetic patients.

Erectile dysfunction (ED) is a frequent microvascular complication of type 2 diabetes mellitus (T2DM). Hormonal derangements such as hypogonadism and hyperestrogenism are common in T2DM. Our aim was to investigate the relationship between estrogens and ED in diabetic patients. We performed a retrospective study on 57 patients with T2DM suffering from ED. ED was assessed with the International Index of Erectile Function questionnaire (IIEF-5) and penile color-doppler ultrasound (PCDU). Blood tests included glycated hemoglobin, lipid profile, total testosterone (T), and estradiol (E2). E2 was negatively correlated with IIEF-5 score after correction for age, diabetes duration, BMI, HbA1c, LDL- and HDL-cholesterol, T and PSA (r = -0.457, p < 0.01). Patients in the higher E2 quartile, had statistically higher probability of severe ED (61.5%). In the same patients, the PCDU demonstrated a statistically longer Acceleration Time (120.0 ± 24.5, p = 0.048) indicating an impaired arterial flow. In diabetic patients, higher E2 is associated with worse erectile function and impaired cavernous arterial flow. Diabetic patients with high E2 are more prone to severe ED. It could be suggested to include estradiol measurement in the hormonal assessment of ED in patients with T2DM.

Erectile dysfunction in diabetes mellitus: A review

The International Diabetes Federation estimates that globally there are 425 million people with diabetes. Estimates of the prevalence of erectile dysfunction (ED) in men with diabetes range from 20% to 85% in different studies. Among men with ED, those with diabetes are likely to experience the problem 10–15 years earlier than men without diabetes. This review aims to provide an update of the epidemiology, pathophysiology and management of ED in diabetes patients in India. The proposed mechanisms of ED in diabetic patients include elevated advanced glycation end-products and increased levels of oxygen-free radicals, impaired nitric oxide (NO) synthesis, increased endothelin B receptor binding sites and ultrastructural changes, upregulated RhoA/Rho-kinase pathway, NO-dependent selective nitrergic nerve degeneration and impaired cyclic guanosine monophosphate-dependent kinase-1. Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome and excessive alcohol consumption. Therefore, the promotion of healthful lifestyles would yield great benefits in reducing the burden of ED. The treatment of diabetic ED is multimodal. The treatment of the underlying hyperglycaemia and comorbidities is of utmost importance to prevent the progression of the disease. The peripherally acting oral phosphodiesterase type 5 inhibitors are the mainstay of oral medical treatment of ED in diabetics. Vacuum erection devices are an additional a non-invasive treatment option. The local administration of vasoactive medication through urethral suppository or intracorporal injection can be effective with minimal side-effects.

The Validity of using a Single-Question Self-Report of Erectile Dysfunction as a Screening Tool among Men with Type 2 Diabetes Mellitus

Background and objectiveThis study aimed to determine the validity of using a single-question self-report of erectile dysfunction (ED) as a screening tool among Saudi men with type 2 diabetes mellitus (T2DM). Materials and methodsA cross-sectional study was conducted using a single-question self-report questionnaire to determine the association between the risk of ED and poor glycemic control among men with T2DM. The study was conducted in a hospital-based diabetes clinic in Riyadh, Saudi Arabia. Married adults (aged >18 years) suffering from T2DM for at least 1 year were included in the study. All statistical analy-ses were performed using SAS version 9.2 and R software (Foundation for Statistical Computing, Vienna, Austria). ResultsWith 86% response rate, 293 participants were included in this study. Over half (53.9%) of the partic-ipants were below 60 years of age. More than half (55.3%) were suffering from uncontrolled diabetes (i.e., HbA1c > 7%). There was significant correlation between the International Index of Erectile Function (IIEF) and self-reported question in terms of duration of T2DM (p < 0.001), type of treatment (p = 0.004), income of the participants (p = 0.005), age (p < 0.001), education level (p = 0.032), and occupation (p < 0.001). However, there was no significant correlation between IIEF and self-reported question in terms of body mass index (p = 743) and smoking. Regarding overall diagnostic accuracy of IIEF score to predict self-reported ED, receiver operating characteristic curve showed area under curve as 89.4%, which is sta-tistically significant. ConclusionSingle-question self-report of ED is a valid and reliable tool to screen diabetic patients suffering from sexual problems. Such tool may help to identify ED in diabetic patients and warrant early management.

Pharmacodynamic Changes in Penile Color-Doppler Ultrasound of Diabetic Patients

AbstractBackground: Erectile dysfunction in diabetic patients leads to changes of intima, media, and Lumina of arteries resulting in atherosclerosis.Aims of Study: To determine the association between diabetes mellitus and penile Doppler ultrasonography changes in patients with erectile dysfunction. Also, the influence of duration, control of diabetes and diabetes complications on Doppler parameters.Settings and Design: Prospective cohort study, Andrology Unit of Dermatology, Venereology and Andrology Department, Tanta University Hospital.Material and Methods: Thirty diabetic patients with ED and 10 age matched healthy controls were enrolled. Patients underwent assessment with international index of erectile function score, cavernosal artery ultrasonography during flaccid state for measurement of internal diameter, intima media thickness and arterial wall mass index. Followed by ICI to measure peak systolic velocity, end diastolic velocity and resistive index.Statistical Analysis Used: Mean, standard deviation and Chi-square test by SPSS V.16.Results: Diabetic patients with ED showed statistically significant decrease in IIEF score and PSV, increase in IMT and AWMI compared to controls. Positive correlation between duration of diabetes, blood glucose level and IMT and AWMI, Negative correlation between duration of diabetes and IIEF, PSV and erectile response. Negative correlation between blood glucose level and IIEF, PSV. Negative correlation between IMT, AWMI with IIEF.Conclusions: Diabetic patients with ED have a higher prevalence of atherosclerosis represented as increased IMT and AWMI compared with controls. Diabetes was an inde-pendent risk factor associated with atherosclerosis. Cavernosal artery IMT and AWMI interpreted clinically as negative correlation with erectile function domain of IIEF. These new parameters give good prediction for atherosclerosis and could replace more invasive ICI.

Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Diabetic Patients.

The cause of erectile dysfunction (ED) in diabetic patients is complex and involves both neurogenic and vasculogenic components and is often hard to treat. To study the effect of low-intensity extracorporeal shock wave therapy (Li-ESWT) therapy on a subgroup of diabetic patients with ED who are responders (PDE5I-R) and non-responders (PDE5I-NR) to phosphodiesterase 5 inhibitors (PDE5I). Analysis of pooled data from 5 double-blind, sham-controlled trials was performed. In this sub-analysis, of 350 patients in the PDE5I-R group and with vasculogenic ED, we found 61 patients with diabetes mellitus who underwent LI-ESWT. Another 48 patients (of 53) belonged to the PDE5I-NR group. Baseline efficacy was evaluated with the International Index of Erectile Function-Erectile Function domain questionnaire (IIEF-EF) for the PDE5I-R and with Erection Hardness Score, IIEF-EF, and flow-mediated dilation technique for the PDE5I-NR. Change in the IIEF-EF score after treatment of diabetes-induced ED with Li-ESWT in the PDE5i-R group vs the PDE5i-NR group. LI-ESWT therapy was found to be effective in both subgroups of diabetic patients. Minimally clinical important difference in IIEF-EF score was achieved in 50%, 79.5%, 77.3%, and 65.9% of the subjects in the active group in after the sixth shockwave (SW) treatment evaluation (just before initiating the seventh SW session) and at 1 month, 6 months, and 12 months after the last SW treatment, respectively. The difference among the groups was significant (P < .05) after the sixth treatment and in all the follow-up periods. In the PDE5I-NR group, 55% of the active group were converted to PDE5I-5-R after LI-ESWT. The difference between the active and sham groups was statistically significant in all the tested measures (P < .001). LI-ESWT is safe and effective for the treatment of ED in PDE5I-R and PDE5I-NR groups. Spivak L, Shultz T, Appel B, etal. Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Diabetic Patients. Sex Med Rev 2021;9:619-627.

Platelet Indices as a marker for early prediction of erectile dysfunction in diabetic patients.

Erectile dysfunction is one of the major concerns in diabetic patients. Platelet Indices including mean platelet volume, platelet count and platelet distribution width are important biomarkers for platelet activation and pathophysiology of atherothrombosis. Measurement of Platelet Indices may early predict erectile dysfunction in diabetic men. This study aimed to measure Platelet Indices in diabetic patients with erectile dysfunction and to correlate between them and erectile dysfunction especially of vasculogenic type. The study included 30 diabetic patients with diagnosed erectile dysfunction and 20 normal males as a control. Each patient was evaluated by history, International Index of Erectile Function-5, general and local examination, HbA1c, pharmaco-penile duplex ultrasonography and blood sample to measure Platelet Indices. Platelet distribution width and mean platelet volume were significantly higher in patients than controls (p<0.001). Their levels were significantly higher in vasculogenic erectile dysfunction than other types (p<0.001). No statistically significant association regards the platelet count (p>0.05). We concluded that Platelet Indices are high in diabetic patients with erectile dysfunction especially those with vasculogenic aetiology. They can predict erectile dysfunction in diabetic men early, and so they may be considered as cheap, available and useful biomarker for early diagnosis of vasculogenic erectile dysfunction in diabetic patients.

620 Detection of neurogenic erectile dysfunction in diabetic patients with Uroflowmetry

Aim was to estimate which of uroflowmetric parameters significantly correlate with neurogenic detrusor insufficiency and neurogenic erectile dysfunction in diabetics. 94 pts with diabetes mellitus (DM) were included in study ( cross sectional study ). Mean age of the pts were 53±13yrs, SD (range:23-77). The average duration of DM was 9,88± 6,95yrs, SD (range:0,2-31). The patients were divided due to severity of diabetic cystopathy (DC) and lower urinary tract symptoms. 43 pts suffered from incipient DC and had subclinical presentation of autonomic neuropathy, while 51 pts were with prominent DC( RU over 20% of bladder capacity, severely damaged sensibility, hypo or acontractile detrusor) and clinical presentation of autonomic neuropathy. All uroflowmetric parameters were determined during spontaneous uroflowmetry and pressure-flow-EMG study. As for ED the thorough interview with the pts was carried out, as well as laboratory analysis, penodynamic test, Duplex Doppler ultrasonography, EMG of lower extremities, Ewing-Clark test.