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Male Erectile Failureand Diabetes

By Clara Bradley,2014-07-01 03:11
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Male Erectile Failureand Diabetes

    Male Erectile Failureand Diabetes

Vo1.2.NO.3June.

    ;MaleErectileFailure

    ;andDiabetes

    ;Erectilefailureisparticularly(x)n’~loninmenwithdiabetes:it

    ;affectsupto30%.andtheprevalenceincreasesfurtherwith ;age.durationofdiabetes,andthepresenceofmic130vascularand ;ll’kgCiovascularcomphcations.Itcanbedistressingforboththe

    ;manandhispartxler.Thereisnowincreasingawarenessofthe ;imi~rtaDceoftheproblem.andtheincreasedefficacyandavail

    ;abihtyoftreatmentmakesitcorrectableinmolethan80%of ;Whyiserectiledysfunctionsocommonin

    ;menwithdiabetes?

    ;Normalerectilefunctionisphysiologi(‘allycomplex.

    ;on:

    ;Itdepends

    ;.normalpsychologicalandendocrinestatusforlibidoand ;arousal

    ;.neuralintegrity

    ;.normallyresponsivecorporaoaverl’Klsalsmoothmuscle

    ;.adequatearterialinflow

    ;.adequateveno-occlusivemechanisms.

    ;Thesefactorsareallvulnerableindiabetesanditscomplications. ;?Diabetesrmyo~3usepsychol0ealproblems,andconcomitant ;endocrineandotherdiso~lerscanalsoreducelibidoandarousa1. ;?Poormeta~hccontrol,autonomicneuropathy,peripheral ;vasculardiseaseandca/~ova,scixlarriskfactorssuchassmoking ;anddyshpidaemiamayallcontribute.

    ;?Hypertensionis(x)n’~lonintype2diabetesand,togetherwith

    ;increasinglyintensiveantihypertensivedrugi~gi133ens,maydis

    ;turberectilefunction.

    ;?Corporaoavem(~lsmoothmusclemaybedirectlyaffectedby ;microvasollardiseaseandimpairedendothehalce~atedre

    ;laxation.

    ;?Otherprimarypenileproblems(e.g.balanifis, ;Peyronie’sdisease)rmybeassociatedwithdiabetes.

    ;Awareness,assessmentandinvestigation

    ;phinrtsis,

    ;Diabetesserviceprovidersshouldscreenhighriskmen,orshould

    ;atleasthavepostersondisplayandinformationleafletsavailable,

;tomakemenawareofthefactthattheteamiscognizantofeFec

    ;Will~mDAle.lderisConsultantPhysicianattheWesternGeneral ;Hospital,Edinburgh,UKHequalifiedrnStThomas’Hospital,London

    ;andwasaoonsultantphysicianatQBnlry’sHospital,Sidcup.His

    ;interestsaleclinicalaspectsofdiabetescaredservicedelivery.andthe

    ;rrer~toferectilefailureinmenwithdiabetes.

    ;M]ICINE

    ;tiledysfunctionandcanofferhelp

    ;Historyendexamination

    ;Historyandexaminationaleessentia1.Cliniciansshouldascertain ;theextentandlikelycausesoftheproblem,toenablethemto ;giveaninfomaedexplanationandconstructiveadvicetopatients, ;andtodeterminetheappropriatetreatment.111ehistoryandex

    ;amination(whichmustincludethegenitalia)shoulddetermine ;thepatient’sgeneralhealth,degreeofmeta~hccontroland

    ;complicationstatus,andtherelevanceofassociatedconditions. ;111esexualhistoryshouldaimtoanswerthefollowingClUes

    ;tions.

    ;?Whatexactlyistheproblem?

    ;?Whyisitaproblem?

    ;?Whatisthepartner’sattitude?

    ;?Whatdoesthepatientand/orpartnerwanttobedoneabout ;theproblem?

    ;IrT?stigatia_1s

    ;Investigationsalenecessaryonlywhenthehistoryorexamination ;suggestsaspecificcause(e.g.endocrine)orfi.1l~lerasse~ment ;ofassociatedconditions(particularlyoal~diovasc111ardiseaseand ;riskfactors)ismqui.Manypossiblepenileinvestigationsare ;listedinthehtemture(e.g.nocturnaltulnesP~neetests.cavern

    ;osography),buttheirresultsdonotinfluenceinitialmedical ;treatmentandtheycanbereservedforreseamhorfu~erassess

    ;mentbeforesuIcalcorrectivetreatment.

    ;Management

    ;Somemenaresatisfiedwithjustanexplanationoftheirerectile ;failure,butmanywanttreatmenttocorrecttheproblem.Some ;nlenregainnormalfun6tionafterregularphysicaltIeannents. ;Counselling

    ;Generalcounsellingisanimt~rtantadjuncttoalltr朗加lents,to

    ;helpthepatientovercoii~anxietyandunderstandanyrelationship ;problems.Itishelpfulifthepatient’spartnerispresentatthe

    ;discussion.

    ;Partnercormnunicationandperformanceanxietymaybehelped ;bydiscussingthemodifiedMastersandJohnson’sensatefocus

    ;ing’technique.

;P!1Jaltt1apy

    ;Innmenwithdiabetes.erectiledysfunctionhasano,~ic ;basisandpsychosexualtherapyalonehaslittleplaceineat

    ;ment.However,itshouldbeconsideredessentialinmenwith ;generalpsychologicalorrelationshipproblemsofwhicherectile ;dysfunctionisiustapart.(Physicaltreatmentscanbeofmajor ;benefitinmenwithpredominantlypsychologicalcallsesoferectile ;dysfunction.)

    ;(sildenafilcilrate)

    ;Untilrecently,resultsoftreatmentwithtabletsand/ortopical ;crearnshavebeendisappointing.Treatmenthasbeenrevolution

    ;izedbytheavailability.

    ;ofViagra.whichissuccessfulinH1O

    ;than60%ofiIlenwithtype1ortype2diabetesandisnowthe ;02002TheMedicinePublishingCompanyLtd

    ;

    ;Vo1.2.NO.3June.

    ;usualtreatmentofchoice.SildenafiliSaphosphodiesterase5in. ;}libitorthatrelativelyspecificallyincreasc~cyclicGMPactivity ;andtherebysmoothmusclerelaxationinthecorporaoavemosa.It ;requiressexualarousal,andthusactivationofthenitricoxide ;pathway,tobeeffective.Menshoul~lstal~withadoseof50nag, ;butmostrequire100mgtable~.Sideeffectsofdyspe~ia,flush.

    ;ingordizzinessausuallyminirea1.Concomitantuseofnitrates ;iSanabsolutecontraindication.butinsomenlendiscontinuingor ;replacingthemcanbeconsidered.Thepresenceofcardiovascular ;diseaseormultipleriskfactorsiSnotacontraindicationtouseof ;Viagra.Viagrashouldbetriedonatleastsixoccasionsbeforeit ;isabandonedasineffective.

    ;Ott1eragents

    ;Otheroralandtopicalagents,includingneweragentssuchas ;apomorphine,remaindisappointingindiabetesrelatederectile

    ;dysfunction.Newerphosphodiesteraseinhibitorsareunderdevel

    ;1,Self-injectiontreatmentoferectilefailure.

    ;MDICINE

    ;opment.

    ;2Caverject

    ;DualGb

    ;injectic~device.

    ;InI-ooIoIselfinjectiontherapy

    ;[ntracorporealself-injectiontherapy(Figures1and2)continues ;tobeausefulandeffectivesecond.1inetreatment.ItiSwelltol

    ;crated,andiSeasyandnlesstoadminister.Menshouldbe ;carefullytaughtthetechniqueandadvisedtouseonlythelowest

    ;effectivedose,topreventaprolongederection(>6hours)that ;mayrequireemergencyaspiration&tumescence.Complications ;3Someexamplesofvacuumdevices.

    ;o2002TheMedicinePublishingCompanyLid

    ;

    ;Vo1.2.NO.3June,

    ;includebraising,fibrosis(urleo~n)anddiscomfortinthe ;erectpenis.Alprostadill~ainsthepreferreddrug,andisavail? ;ableaSCandV/fi&d.13othareavailableindua1.(?ham

    ;herinjectordevices:C~ectDudChomberisthesimplest ;preparationtouse.Otherdrugsandcombinations,includingpa

    ;paverine,phentolamineandvasoaetiveintestinalpeptide,(?allbe ;eonsi&red,butarenotcurrentlylicemed.

    ;IVledieatedurethralsystemforerection(MUSE)

    ;MUSEWaSdevelopedaSanaltemativetoiniectiontherapy.A ;high-dosealprostadilpe]let(500or100)isplacedintothe ;urethrausingaspecialintroducer,anddiffusesintotheeorl3ora ;eaverllosa.1histreatmentisnotveryeffectiveinmenwithdiabe

    ;tes.anddiseomfortand]aekofemeacvlimititsusefulness. ;VacuumtuIl,le~en(?edevices(Figure3)areeffectiveandwell ;tolerated.Acylinderwithanattachedvacuumpumpisplaced ;overthepenisandusedtocreatean’erectilestate’.Aretention

    ;bandisthenslippedoffthecylinderandontothebaseofthepe

    ;histomaintaintheerection.

    ;SurgicalBnBm

    ;Surgicalreferralfortheinsertionofapenileprosthesis(?allbe ;considered.butthisisnowusuallyreservedformenwhohave ;failedtorespondtomedicaltreatmentsorwhohavestructuralpe

    ;nileabnorrmlitiesrequitingsuchtreatment.Prosthesesmaybe ;semirigidorinflatable.

    ;M)ICINE

    ;Miel’ova,scalarrevaseularization

    ;perimenta1.

    ;techniquesremainlargelyex?

    ;?

    ;FURTHERRE!ADING

    ;AIexanclerWD.SexualFunctioninDiabeticMen.In:PickuPJ, ;WiIliamsG,eds.TextbookofDiabetes.Oxford:BlackwelI ;Science.195)7.

    ;(FurU-lercletaiIsofmaleerectilefailureindiabetes;thebookalSO ;containschaptersONfemalesexuaIdysfunction,andalIaspects ;ofdiabetesingenera1)

    ;EarctleyI.SethiaK,edsErectileDysfunction:Curront ;InvestigationandMina1em.London:Mosby-Wolfe,19?j8.

    ;(AusefuI,concise,well_illustratedandeasy-to-readbookONall ;aspectsoferectiledysfunction;coversbothmedicalandsurgical ;aspects.)

    ;GregoireA,PJ,edsIrr~tence:AnIntegratedApproachto ;CicalPractice.Ectinburgh:ChurchilILivinqstone,1993. ;(AJittleotJtdatedre~dingtreatrr~t.butremainsanexcellent ;bookcoveringalIaspectsoferectiledysfunction,includinga ;a?dhistoricalperspectiveandusefuIdetailsofsexua~history-

    ;takingandpsychologicalaspects.)

    ;JacksonG,BetterictqeJ,DeanJeta1.ASystematicApproachto ;ErectileDysfunctionintheCardiovascularPatient:AC_,orlsensus ;Statement./nf?CPract1999::44551.

    ;(UsefulinforrnationONcardiovascularcti~_.:qseandthesafetyof ;sexua~activityandtreatmentsforerectiledysfunction.) ;PriceD,AIexanclerW,eds.AoVanc~/nDiabetesSeries: ;Irr~tenceinDiabetesReading:HarwoodAcac~’nic.]01.

    ;(Adetailedaccountofthepathophysiologyandrnanac~nentof ;erectiledysfunctioninn1enwithdiabetes.)

    ;

    ;

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