Erectile dysfunction in men with diabetes (literature review). Part 2
Keywords:diabetes mellitus, man, erectile dysfunction, testosterone, phosphodiesterase type 5 inhibitors
The second part of review article highlights modern views on the diagnosis and treatment of erectile dysfunction (ED) in men with diabetes mellitus (DM). Google Scholar and PubMed databases were used to search for literature sources. The role of comorbid diseases in the development of ED in men with diabetes mellitus has been shown. The generalized data on the main clinical manifestations of erectile dysfunction, methods of its diagnosis and treatment are given. A number of epidemiological studies over the past 20 years have found that erectile dysfunction in men with diabetes may be an early marker of cardiovascular complications. Thus, in the algorithm for the diagnosis of ED in patients with diabetes it is necessary to conduct a thorough examination of the cardiovascular system. The article describes modern therapeutic and surgical methods of ED treatment. Numerous literature sources indicate an important role of the correction of androgen deficiency in men with type 2 diabetes to enhance the effectiveness of phosphodiesterase type 5 (PDE5) inhibitors. The literature review shows the data on the emergence of new PDE5 inhibitors, which have a higher selectivity compared to existing ones that provides a better therapeutic effect and reduces the frequency and severity of side effects. The modern algorithm for the treatment of ED in men involves the sequential stages of using different treatments. The last link of therapy, in case of inefficiency of the previous ones, is penile prosthesis. Implantation of three-piece penile prosthesis is an effective method of ED treatment. The use of this method in patients with severe forms of ED on the background of diabetes, in case of ineffectiveness of PDE5 inhibitors and intracavernous injections of vasoactive drugs, is considered promising.
Perelman MA. The history of sexual medicine. In: Tolman DL, Diamond LM, Bauermeister JA, George WH, Pfaus JG, Ward LM, editors. APA handbook of sexuality and psychology, Vol 2 - Contextual approaches. Washington DC; American Psychological Association: 2014. pp. 137-179. https://doi.org/10.1037/14194-005.
Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. A prospective study of risk factors for erectile dysfunction. J Urol. 2006 Jul;176(1):217-21. doi: 10.1016/S0022-5347(06)00589-1.
Martin SA, Atlantis E, Lange K, Taylor AW, O'Loughlin P, Wittert GA; Florey Adelaide Male Ageing Study. Predictors of sexual dysfunction incidence and remission in men. J Sex Med. 2014 May;11(5):1136-47. doi: 10.1111/jsm.12483.
Nehra A, Jackson G, Miner M, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012 Aug;87(8):766-78. doi: 10.1016/j.mayocp. 2012.06.015.
He J, Li X, Dai HH, et al. The safety and efficacy of PDE5-inhibitors-vardenafil on treating diabetes mellitus erectile dysfunction: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2019 Dec;98(51):e18361. doi: 10.1097/MD.0000000000018361.
Goldstein I, McCullough AR, Jones LA, et al. A randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of avanafil in subjects with erectile dysfunction. J Sex Med. 2012 Apr;9(4):1122-33. doi: 10.1111/j.1743-6109.2011.02629.x.
Glina S, Fonseca GN, Bertero EB, et al. Efficacy and tolerability of lodenafil carbonate for oral therapy of erectile dysfunction: a phase III clinical trial. J Sex Med. 2010 May;7(5):1928-36. doi: 10.1111/j.1743-6109.2010.01711.x.
Kim BH, Lim HS, Chung JY, et al. Safety, tolerability and pharmacokinetics of udenafil, a novel PDE-5 inhibitor, in healthy young Korean subjects. Br J Clin Pharmacol. 2008 Jun;65(6):848-54. doi: 10.1111/j.1365-2125.2008.03107.x.
Porst H, Rajfer J, Casabé A, et al. Long-term safety and efficacy of tadalafil 5 mg dosed once daily in men with erectile dysfunction. J Sex Med. 2008 Sep;5(9):2160-9. doi: 10.1111/j.1743-6109. 2008.00935.x.
Sun L, Peng FL, Yu ZL, Liu CL, Chen J. Combined sildenafil with vacuum erection device therapy in the management of diabetic men with erectile dysfunction after failure of first-line sildenafil monotherapy. Int J Urol. 2014 Dec; 21(12):1263-7. doi: 10.1111/iju.12564.
McCullough AR, Hellstrom WG, Wang R, Lepor H, Wagner KR, Engel JD. Recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral alprostadil versus sildenafil citrate. J Urol. 2010 Jun;183(6):2451-6. doi: 10.1016/j.juro.2010.01.062.
Alexandre B, Lemaire A, Desvaux P, Amar E. Intracavernous injections of prostaglandin E1 for erectile dysfunction: patient satisfaction and quality of sex life on long-term treatment. J Sex Med. 2007 Mar;4(2):426-31. doi: 10.1111/j.1743-6109.2006. 00260.x.
Tsertsvadze A, Fink HA, Yazdi F, et al. Oral phosphodiesterase-5 inhibitors and hormonal treatments for erectile dysfunction: a systematic review and meta-analysis. Ann Intern Med. 2009 Nov 3;151(9):650-61. doi: 10.7326/ 0003-4819-151-9-200911030-00150.
Khera M, Adaikan G, Buvat J, et al. Diagnosis and treatment of testosterone deficiency: recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med. 2016 Dec;13(12):1787-804. doi: 10.1016/j.jsxm.2016.10.009.
Corona G, Maseroli E, Rastrelli G, et al. Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf. 2014 Oct;13(10):1327-51. doi: 10.1517/ 14740338.2014.950653.
Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010 Jun;95(6):2536-59. doi: 10.1210/jc.2009-2354.
Morgentaler A, Zitzmann M, Traish AM, et al. Fundamental concepts regarding testosterone deficiency and treatment: International Expert Consensus Resolutions. Mayo Clin Proc. 2016 Jul;91(7):881-96. doi: 10.1016/j.mayocp.2016.04.007.
Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015 Feb;90(2):224-51. doi: 10.1016/j.mayocp. 2014.10.011.
Muraleedharan V, Marsh H, Kapoor D, Channer KS, Jones TH. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Eur J Endocrinol. 2013 Oct 21;169(6):725-33. doi: 10.1530/EJE-13-0321.
Dhindsa S, Ghanim H, Batra M, et al. Insulin resistance and inflammation in hypogonadotropic hypogonadism and their reduction after testosterone replacement in men with type 2 diabetes. Diabetes Care. 2016 Jan;39(1):82-91. doi: 10.2337/dc15-1518.
Bettocchi C, Palumbo F, Spilotros M, et al. Patient and partner satisfaction after AMS inflatable penile prosthesis implant. J Sex Med. 2010 Jan;7(1 Pt 1):304-9. doi: 10.1111/j.1743-6109.2009. 01499.x.
Phé V, Rouprêt M. Erectile dysfunction and diabetes: a review of the current evidence-based medicine and a synthesis of the main available therapies. Diabetes Metab. 2012 Feb;38(1):1-13. doi: 10.1016/ j.diabet.2011.09.003.
Luchytskyy V, Tronko M, Luchytskyy E. Aspects of Testosterone Replacement Therapy in Men With Type 2 Diabetes Mellitus and Testosterone Deficiency. International Journal of Endocrinology (Ukraine). 2019;15(2):99-105. doi:10.22141/2224-0722.214.171.1249.166099.
How to Cite
Copyright (c) 2021 Е.V. Luchytskiy, V.E. Luchytskiy
This work is licensed under a Creative Commons Attribution 4.0 International License.