The mechanistic study on Wa medicine Niang-Mu-Liang medicinal liquor mitigating diabetes mellitus erectile dysfunction in rats by inhibiting ferroptosis

Background:This study aims to investigate the therapeutic effect of Wa medicine Niang-Mu-Liang medicinal liquor(NML)on rats with diabetes mellitus erectile dysfunction(DMED)and its impact on the ferroptosis signaling pathway.Methods:Thirty Sprague-Dawley rats were randomly divided into three groups:Control,DMED,and NML.After establishing the DMED model,treatments were administered for 8 weeks.After the administration,apomorphine hydrochloride tests were conducted to measure the mass and organ index of testes and epididymides,sperm concentration and viability in each group.Penile corpus cavernosum tissues were stained with hematoxylin and eosin.Nitric oxide and cyclic guanosine monophosphate levels in the penile corpus cavernosum tissues were determined using biochemical kits and enzyme-linked immunosorbent assay,while the expression of proteins related to the ferroptosis signaling pathway was measured by Western blot.Results:Compared to the DMED group,the DMED rats treated with NML showed significantly increased erection frequency,testicular and epididymal mass and index,sperm count and viability,along with noticeable improvement in the pathological morphology of penile corpus cavernosum.The content of nitric oxide and cyclic guanosine monophosphate,and the expression of ferritin heavy chain,ferritin light chain,and glutathione peroxidase 4 proteins in penile corpus cavernosum tissue were elevated,while the expression of transferrin and STEAP3 proteins was reduced.Conclusion:NML can improve erectile function in DMED rats by inhibiting the ferroptosis signaling pathway.

Pathogenesis and treatment of diabetes mellitus-related erectile dysfunction: current therapies and potential challenges

Erectile dysfunction(ED)is one of the important complications of diabetes,which is very common in diabetic patients,affecting more than half of male patients,and the incidence of the disease is about 3.5 times that of the normal population.The pathogenesis of diabetic erectile dysfunction(DMED)is complex,involving nerve,vascular,endocrine,muscular and psychological aspects.At present,the therapeutic approaches of DMED include drug therapy,surgery,physical therapy and so on.This article provides a review of current research on the pathogenesis and treatment of DMED.Further elucidation of the pathogenesis of DMED and the development of new therapeutic approaches are of great significance for the prevention and treatment of DMED.

Mechanism of the Xuefu Zhuyu decoction in treating diabetes mellitus erectile dysfunction based on the CaSR/Gq-PLC-PKC pathway

Background:To investigate the mechanism of Xuefu Zhuyu decoction in the treatment of diabetes mellitus erectile dysfunction.Methods:Rats with diabetes mellitus erectile dysfunction were developed using streptozocin and randomly assigned into model,low-dose herbal,and high-dose herbal groups.All rats were administered normal saline or the corresponding drugs by oral gavage for 4 weeks.The related indices were detected using enzyme-linked immunosorbent assays,immunohistochemistry,western blotting,and transmission electron microscopy.Results:The levels of lectin-like oxidized low-density protein receptor-1,endothelin-1,NADH oxidase,vascular cell adhesion molecule-1,and intercellular adhesion molecule-1 in the model group were significantly higher than they were in the mock group but lower than they were in the herbal treatment group.The level of nitric oxide was lower in the model group than was in the mock group but higher than the level in the herbal treatment group.The calcium-sensitive receptor,phospho-protein kinase Cδ/protein kinase Cδ,phosphorylated c-Jun amino-terminal kinase/c-Jun amino-terminal kinase,and phospho-P38 mitogen-activated protein kinase/P38 mitogen-activated protein kinase expression levels in the model group were higher than were in the mock group but lower than were in the herbal treatment group.The structures of the Corpus cavernosum penis endothelial cells were significantly improved in the herbal treatment group than they did in the model group.Conclusion:Xuefu Zhuyu decoction can decrease injury to the endothelium,improve vascular endothelial diastolic and contractive function,and inhibit vascular fibrosis in rats with diabetes mellitus erectile dysfunction.This mechanism may be related to the CaSR/Gq-PLC-PKC pathway.

Prevalence and Factors Associated with Erectile Dysfunction in Diabetic Patients at the National University Hospital Center Hubert Koutoukou Maga in Cotonou

Erectile dysfunction was one of the most common complications in diabetic patients. According to several studies, its prevalence was two to three times higher in diabetics than in the general population. But it has often been overlooked despite the fact that it seriously affects the quality of life. The aim of this study was to determine the prevalence of erectile dysfunction and its associated factors in diabetics’ patients. This was a cross-sectional analysis study of 76 male diabetic patients who consulted by the Department of Endocrinology from June 22, 2019 to September 25, 2019. Erectile dysfunction was diagnosed by calculating the IIEF score. Statistical comparisons were made between patients without and with Erectile dysfunction chi-square test with a significance level p Conclusion: This study showed a high prevalence of erectile dysfunction in diabetics. Significant concomitant factors were hypertension, diabetes imbalance and the duration of diabetes. It was, therefore, important to include systematic screening for erectile dysfunction at least annually, as well as other complications of diabetes.

Epidemio-Clinical Aspects of Ecrectile Dysfunction in Type 2 Diabetics at Abeche Chu

Introduction: Erectile dysfunction (ED) is a frequent complication of diabetes and more frequently affects type 2 diabetics. It is often unrecognised or its management is delayed because it is often overshadowed by other complications. The aim of our study was to describe the epidemiological and clinical aspects of ED. Patients and Method: This was a descriptive cross-sectional study over an 8-month period from April to December 2021, of type 2 diabetic subjects with erectile dysfunction (ED) seen at the University Hospital of Abeche. Erectile function was assessed using the International Index of Erectile Function (IIEFS5). Results: Out of a total of 112 patients with type 2 diabetes, 64 agreed to take part in the study. Only 40 patients correctly completed the survey form. Of these, 34 (85%) had erectile dysfunction. On average, our patients were over 49.4 years old, and 55.9% of them had had diabetes for more than 10 years. Erectile dysfunction had affected the social life of 21 patients (61.76% of cases) and 28 (82.35%) had not been informed by a healthcare professional. Most of them, 31 cases or 91.17%, had never told their GP about their erectile dysfunction. The patients who thought that diabetes had an influence on their erectile dysfunction represented 74%. Diabetes was poorly controlled in 22 patients (64.70%). According to the International Index of Erectile Function (IIEF5), 85% of diabetic patients suffer from erectile dysfunction, including 28.6% with severe erectile dysfunction, 35.7% with moderate erectile dysfunction and 14.3% with mild erectile dysfunction. Erectile dysfunction was significantly more frequent in diabetics with arterial hypertension and poor diabetic control. Conclusion: The hospital prevalence of erectile dysfunction in our patients is high. Early detection of this disorder therefore remains a challenge to be met in order to organise better psychological and drug treatment.

Correlates of Erectile Dysfunction in Nigerian Men with Type 2 Diabetes Mellitus: Experience from a Tertiary Health Center

Introduction: Erectile dysfunction (ED) is a common complication of diabetes mellitus (DM) that is associated with poor quality of life and can be present in type 2 diabetics at the time of diagnosis. There are common risk factors associated with erectile dysfunction in type 2 diabetic subjects. Some of these are potentially treatable or reversible. The risk factors evaluated by this study included glycaemic control, duration of diabetes, obesity, peripheral artery disease (PAD), hypertension and antihypertensive medications use. Materials and Methods: This study was a cross sectional one carried out over a period of six months (June-November, 2016) at the diabetes clinic of the Nnamdi Azikiwe University Teaching Hospital, Nnewi and involved 124 subjects with type 2 diabetes mellitus. A convenience sampling method was used. A detailed physical examination, blood pressure and anthropometric measurements and vascular assessment with a hand-held doppler ultrasound were carried out. Data was collected using a study proforma. Erectile dysfunction was diagnosed with the International Index of Erectile Function questionnaire while anxiety and depression were diagnosed with the Hospital Anxiety and Depression questionnaires. Subjects that had anxiety/depression or hypogonadism were excluded from the study. Results: A total of 124 subjects were studied, 48.4% of whom had erectile dysfunction. Glycaemic control was significantly associated with ED among the subjects (OR = 0.198, 95% CI = 0.081 - 0.483, P < 0.001). Similarly, peripheral artery disease (PAD) was significantly associated with ED in the subjects (OR = 2.867, 95% CI = 1.360 - 6.044, P = 0.006). However, no significant correlation was found between ED and obesity, duration of diabetes mellitus, antihypertensive medications use and duration of hypertension among the subjects (P > 0.05). Conclusion: Poor glycaemic control and presence of PAD significantly increase the risk of ED in male subjects with type 2 DM, thus underscoring the need for an early screening and treatment of these predictors of erectile dysfunction.

Pathophysiology and treatment of diabetic erectile dysfunction

The pathophysiology of diabetes is multifactorial and no single etiology is at the forefront. The proposed mechanisms of erectile dysfunction （ED） in diabetic patients includes elevated advanced glycation end-products （AGEs） 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 （cGMP）-dependent kinase-1 （PKG-1）. The treatment of diabetic ED is multimodal. Treatment of the underlying hyperglycemia and comorbidities is of utmost importance to prevent or halt the progression of the disease. The peripherally acting oral phosphodiesterase type 5 （PDE5） inhibitors are the mainstay of oral medical treatment of ED in diabetics. Vacuum erection devices are an additional treatment as a non-invasive treatment option. Local administration of vasoactive medication via urethral suppository or intracorpora! injection can be effective with minimal side-effects. Patients with irreversible damage of the erectile mechanism are candidates for penile implantation. Future strategies in the evolution of the treatment of ED are aimed at correcting or treating the underlying mechanisms of ED. With an appropriate vector, researchers have been able to transfect diabetic animals with agents such as neurotrophic factors and nitric oxide synthase （NOS）. Further studies in gene therapy are needed to fully ascertain its safety and utility in humans.

Effect of icarisid II on diabetic rats with erectile dysfunction and its potential mechanism via assessment of AGEs, autophagy, roTOR and the NO-cGMP pathway

Erectile dysfunction （ED） is a major complication of diabetes mellitus. Icariin has been shown to enhance erectile function through its bioactive form, icarisid Ih This study investigates the effects of icarisid Ⅱ on diabetic rats with ED and its potential mechanism viathe assessment of advanced glycosylation end products （AGEs）, autophagy, mTOR and the NO-cGMP pathway. Icarisid Ⅱ was extracted from icariin by an enzymatic method. In the control and diabetic ED groups, rats were administered normal saline; in the icarisid Ⅱ group, rats were administered icarisid Ⅱ intragastrically. Erectile function was evaluated by measuring intracavernosal pressure/mean arterial pressure （ICP/MAP）. AGE concentrations, nitric oxide synthase （NOS） activity and cGMP concentration were assessed by enzyme immunoassay. Cell proliferation was analysed using methyl thiazolyl tetrazolium assay and flow cytometry. Autophagosomes were observed by transmission electron microscopy, monodansylcadaverine staining and GFP-LC3 Iocalisation. The expression of NOS isoforms and key proteins in autophagy were examined by western blot. Our results have shown that Icarisid Ⅱ increased ICP/MAP values, the smooth muscle cell （SMC） growth curve, S phase and SMC/collagen fibril （SMC/CF） proportions and decreased Beclin 1 （P〈0.05）. Icarisid Ⅱ significantly increased the proliferative index and p-p70S6K（Thr389） levels and decreased the numbers of autophagosomes and the levels of LC3-11 （P〈0.01）. Icarisid Ⅱ decreased AGE concentrations and increased cGMP concentration, NOS activity （P〈0.05） and cNOS levels （P〈0.01） in the diabetic ED group. Therefore, Icarisid Ⅱ constitutes a promising compound for diabetic ED and might be involved in the upregulation of SMC proliferation and the NO-cGMP pathway and the downregulation of AGEs, autophagy and the mTOR pathway.

The effects of long-term administration of tadalafil on STZ-induced diabetic rats with erectile dysfunction via a local antioxidative mechanism

Type 5 phosphodiesterase inhibitors （PDE51s） are well known being effective via the nitric oxide and cyclic guanosine monophosphate （NO-cGMP） pathway and are widely used in the treatment of diabetic erectile dysfunction （ED）. However, it is unclear whether other pathways may be involved in the treatment of diabetic ED with PDE51s. The purpose of this study was to clarify the role of antioxidants in diabetic ED treatment through the long-term administration of PDE51s. Three groups of Sprague-Dawley rats were utilized： Group N, the normal control; Group D, streptozotocin （STZ）-induced diabetic rats as a control; and Group D＋T, STZ-induced diabetic rats who received oral administration of tadalafil for 8 weeks. Erectile function was assessed by intracavernous pressure （ICP） and mean arterial pressure （MAP） during electrical stimulation of the cavernous nerve before euthanasia. The levels of malondialdehyde （MDA）, superoxide dismutase （SOD） and mitochondrial membrane potential （MMP） of cavernous tissue were assessed by biochemical analysis. The morphology of mitochondria was observed by electron microscopy. The ICP/MAP ratio was higher in Group D＋T than in Group D （P〈O.05）. The levels of MDA decreased and the activities of SOD increased in Group D＋T in comparison with Group D （P〈O.05）. The mitochondrial membrane potential level of cavernous tissue in diabetic rats was partially recovered by tadalafil treatment for 8 weeks. The morphology changes of mitochondria were also remarkably ameliorated in Group D＋T. Collectively, the long-term administration of tadalafil in diabetic rats partially reduced oxidative stress lesions of the penis via a local antioxidative stress pathway. Long-term dosages of tadalafil given once daily beginning soon after the onset of diabetes may aid in preventing rats from developing diabetic ED.

Stem cell therapy and diabetic erectile dysfunction:A critical review

Erectile dysfunction(ED)has been identified as one of the most frequent chronic complications of diabetes mellitus(DM).The prevalence of ED is estimated to be about 67.4%in all DM cases worldwide.The pathophysiological process leading to ED involves endothelial,neurological,hormonal,and psychological factors.In DM,endothelial and neurological factors play a crucial role.Damages in the blood vessels and erectile tissue due to insulin resistance are the hallmark of ED in DM.The current treatments for ED include phosphodiesterase-5 inhibitors and penile prosthesis surgery.However,these treatments are limited in terms of just relieving the symptoms,but not resolving the cause of the problem.The use of stem cells for treating ED is currently being studied mostly in experimental animals.The stem cells used are derived from adipose tissue,bone,or human urine.Most of the studies observed an improvement in erectile quality in the experimental animals as well as an improvement in erectile tissue.However,research on stem cell therapy for ED in humans remains to be limited.Nevertheless,significant findings from studies using animal models indicate a potential use of stem cells in the treatment of ED.

Relationship between Gut Microbiota and Type 2 Diabetic Erectile Dysfunction in Sprague-Dawley Rats

In order to investigate the relationship between gut microbiota and type 2 diabetic erectile dysfunction（T2DED）, we analyzed the characteristics of gut microbiota in the Sprague-Dawley（SD） rats with T2DED. Thirty-five SD rats were randomly divided into two groups： control group（n=15） with normal diet, and experimental group（n=20） with construction of T2D model. Faecal and serum samples were collected at 2nd and 8th week after establishment of T2D model, respectively. Faecal samples were used for analysis of gut microbiota, and serum samples for detection of trimethylamine N-oxide（TMAO）, lipopolysaccharide（LPS）, and inflammatory factors like interleukin-1（IL-1）, IL-2, IL-10, and monocyte chemoattractantprotein-1（MCP-1）. The main compositions of gut microbiota were Bacteroidetes, Proteobacteria and Firmicutes at the phylum level, and Oscillospira, Allobaculum, Bacteroides, Ruminococcus, SMB53, Prevotella, Coprococcus, Sutterella and Blautia at the genus level with relatively higher abundance in all SD rats. The relative abundance of Enterococcus, Corynebacterium, Aerococcus, Facklamia（opportunistic pathogens in most case） increased, and that of Allobaculum, Bifidobacterium, Eubacterium, Anaerotruncus（beneficial bacteria） decreased in T2DED group as compared with that at 2nd week after establishment of T2D model（T2D2 group）. The serum contents of TMAO, LPS, IL-1, IL-2, IL-10 and MCP-1 in T2DED group were significantly higher than those in control group. The gut microbiota of T2DED rats was inhibited. The gut microbiota of T2DED rats had changed, as the relative abundance of beneficial bacterium was decreased while that of opportunistic pathogens was increased. The variations of gut microbiota might lead to inflammation and prompt the emergence of erectile dysfunction in the rats with T2D. TMAO might play an important role in the formation of T2DED.

Progress and prospect of stem cell therapy for diabetic erectile dysfunction

Diabetic erectile dysfunction(DED)is a common complication of diabetes mellitus,significantly impairing the quality of life of patients.The conventional clinical treatment still has limitations.Stem cells(SCs),as a type of cells with multidirectional or directional differentiation capability and sustainable selfrenewal potential,are widely used in regenerative medicine and tissue engineering.With the continuous update of regenerative medicine theory and the success of animal experiments,SCs as a treatment for male erectile dysfunction,especially DED,have attracted widespread attention because of curable possibility.This review focus on the current progress in the clinical application of SC treatment for DED.Moreover,we summarize the development prospects of SCs in the field of DMED therapy.

Erectile Dysfunction among Diabetic Men in Two Medical Centers in Burkina Faso: Epidemiological, Diagnosis and Therapeutic Aspects

Objective: To study erectile dysfunction in diabetic patients seen in two clinics in the city of Bobo-Dioulasso, Burkina Faso. Materials and Methods: A prospective cross-sectional descriptive study was conducted at the Souro Sanou Teaching Hospital (CHUSS) and the Saint Leopold clinic in Bobo-Dioulasso, from March 1 to September 1, 2012. A total of 107 patients data were collated and analysed, which was then grouped into two: the ED group, designating patients with erectile dysfunction and the NED group consisting of those patients without. The sample comprised of 61 patients with types 1 and 2 diabetesand were aged between 25-70 years. The IIEF-5 was used to evaluate erectile dysfunction. Results: The prevalence of erectile dysfunction was 57%. The average age of patients was 54.4 ± 8.3 years. All patients with ED had type 2 diabetes. The mean disease duration of diabetes was 7.2 ± 6 years. Erectile dysfunction was severe in 32.8% of cases, moderate in 31.1% of cases and mild in 36.1%. Its severity was significantly associated with glycated hemoglobin, triglycerides and BMI. Phosphodiesterase types 5 (PDE5) inhibitors were found to be effective in the treatment of erectile dysfunction with a satisfactory therapeutic response in 77.4% of users. Conclusion: Erectile dysfunction is a common complication in diabetic patients. Its occurrence and severity are influenced by several factors. The potential presence of this disorder should be assessed due to its negative impact on quality of life. Phosphodiesterase type 5 inhibitors are an effective treatment modality in diabetic patients.

Magnitude and Factors Contributing to Erectile Dysfunction among Diabetic Men Attending the Diabetic Clinic at Debre Tabor Comprehensive and Specialized, Hospital in North West, Ethiopia 2020, Institutional Based Cross-Sectional Study

Background: Erectile dysfunction, which is defined as difficult to attain and maintain an erectile function enough to permit sufficient sexual performance, is accepted to be a big problem especially among diabetic patients. Objective To assess the Magnitude and factors contributing to Erectile Dysfunction Among Diabetic men attending the diabetic clinic in Debre Tabor Comprehensive and Specialized hospital, North West Ethiopia. Methods: Hospital based cross-sectional study was conducted on 362 participants in Debre Tabor Comprehensive and Specialized Hospital from August - December 2020 using systematic random sampling technique. Data were analyzed with SPSS Version 23. Binary and multivariable logistic regressions were done to identify factors which were contributing to erectile dysfunction. P-value < 0.05 and the corresponding 95% CI of odds ratios were considered to declare the result as statistically significant. Results: Three hundred sixty-two diabetes patients participating in the study with the mean age being 44.4 ± 14.47 (range: 18 - 78) years were interviewed. The majority (59.7% with CI: 54.4:64.6) of the diabetes patients suffered from erectile dysfunction and 13.3% (95% CI 17.8% - 26.8%) were found to have severe erectile dysfunction. Bi-variable analysis showed duration of diabetes (>10 years), type of diabetes (type II), physical exercise, drinking alcohol, BMI, blood glucose, and blood pressure were associated with erectile dysfunction at 5% level (p ≤ 0.05). Multiple logistic regression analysis revealed that duration of diabetes 10 years (AOR = 6.2, 95% CI: 2.78 - 13.85, p = 0.001), co-existing hypertension (AOR: 3.59, 95% CI: 1.58 - 8.19, p = 0.002), physically inactive (AOR = 2.87, 95% CI: 1.53 - 8.31, p = 0.003), unsafe level alcohol intake (AOR: 3.09;95% CI 1.45 - 6.59*, p = 0.003) and raised blood glucose (AOR: 15.26, 95% CI: 7.82 - 29.77, p = 0.004) were independent risk factors but no association was found with other variables. Conclusion: The magnitude of erectile dysfunction in this study population was 59.7% and associated with the type of diabetes;duration of diabetic, physical exercise, alcohol drinking, increase in blood pressure, and elevated blood glucose level were independently correlated with erectile dysfunction.

STUDY ON HEMODYNAMICS OF ERECTION IN DIABETIC ERECTILE DYSFUNCTION

To study the cavernosa hemodynamics in diabetic erectile dysfunction (ED).Methods 22 diabetic and 35 psychic ED patients were studied by intracavernosum injection of a mixture papaverine and phentolamine ( 30/ l mg ) to assess the hemodynamics changes of the corpus cavernosum by means of colour duplex ultrasonography. Results The average hemodynamics data of the diabetic ED patients vs that of the psychogenic ED patients in terms of peak flow velocity ( PFV) : 20. 06 + 7. 15cm/s vs 35. 82 +9.41cmfs, end diastolic velocity (EDV) : 8. 82 + 0. 35cmf s vs 5.51 + 0. 42cm/s, artery diameter (Ad) : 0. 78 + 0. 25cm vs 1. 01 + 0. 42cm,vein diameter (Vd) : 1.05 +0. 32mm vs 1.21 +0.45mm, resistance index(R1) : 0. 72 +0. 28 vs 0. 98 +0. 31 ,mean velocity of artery ( MV) :6. 71 +0. 27cm/s vs 10. 31 +3.32cmfs, dorsal deep vein flow( DDVF) ： 28. 81 +6. 32cm!s vs 25. 74 + 0. 58cm/s. Stasticstical differences existed in PFV, Ad,R1 and MV( P <0.01 ). The arterial wall is thick and rigid in diabetic ED patients. Conclusion Atheroscleorsis and veno-occlusive dysfunction of the corpus cavernosum are essential to the development of diabetic ED.

Nitro-oleic acid ameliorates erectile dysfunction in a streptozotocin-induced rat model of diabetes by inhibiting oxidative stress and apoptosis and activating the NO/cGMP pathway

The major vascular complications associated with diabetes make the management of diabetic mellitus erectile dysfunction(DMED)a challenging endeavor.Notable factors contributing to DMED include oxidative stress,nitric oxide(NO)/cyclic guanosine monophosphate(cGMP)pathway activation,and apoptosis,while nitro-oleic acid(NO,-OA)has been shown to be beneficial in treating these aspects of this condition.We,herein,investigated the effects and possible mechanisms of NO,-OA on erectile function as assessed in a streptozotocin-induced rat model of diabetes.Our results revealed that the erectile function of DMED rats was significantly impaired compared with that of the control group.However,in response to 4 weeks of NO,-OA treatment,there was an improvement in erectile function.The expression of oxidative stress-related indicators was significantly increased and the NO/cGMP pathway was impaired in the DMED group.The expression of proapoptotic factors was increased,while that of antiapoptotic factors was decreased in the DMED group.Moreover,the cell morphology in the cavernous tissue of the DMED group also changed adversely.NO,-OA treatment significantly reversed all these changes observed in the DMED group.In conclusion,NO,-OA treatment partially improved erectile function in DMED rats through mechanisms that included inhibition of oxidative stress,activation of the NO/cGMP pathway,and a reduction in apoptosis.

Application of pudendal evoked potentials in diagnosis of erectile dysfunction

Aim: Extensive neurophysiological investigations were carried out in 100 healthy subjects and 84 patients with penileerectile dysfunction. Methods: Following examinations were performed, spinal and scalp somatosensory evoked poten-tials (SEPs) to stimulation of the dorsal nerve of penis, motor evoked potentials (MEPs) from bulbocavernosus (BC) inresponse to scalp and spinal root stimulation, and measurement of sacral reflex latency (SRL) from anal sphincter (AS).Results: In the healthy subjects, the mean sensory total conduction time (sensory TCT), as measured at the peak of thescalp P1 (P40) wave was 39.73 ms. The mean sensory central conduction time (sensory CCT = spinal-to-scalp conductiontime) was 28.98 ms. The mean peripheral conduction time (PCP) was 9.40 ins. Transcranial brain stimulation was per-formed by using a magnetic stimulator during voluntary contraction of the examined muscle. Spinal root stimulation wasperformed at rest. Motor total conduction time (motor TCT) to BC muscles was 20.48 ms. Motor central conductiontime (motor CCT) to sacral cord segments controlling BC muscles was 14.42 ms at rest. The mean SRL was 35.13 ms.Conclusion: Combined or isolated abnormalities of SEPs, MEPs, and SRL were found in patients with erectile dysfunc-tion. (Asian J Androl 1999 Sep; 1 : 145 - 150)

Erectile dysfunction in chronic kidney disease:From pathophysiology to management

Chronic kidney disease(CKD) is encountered in millions of people worldwide,with continuously rising incidence during the past decades,affecting their quality of life despite the increase of life expectancy in these patients.Disturbance of sexual function is common among men with CKD,as both conditions share common pathophysiological causes,such as vascular or hormonal abnormalities and are both affected by similar coexisting comorbid conditions such as cardiovascular disease,hypertension and diabetes mellitus.The estimated prevalence of erectile dysfunction reaches 70% in end stage renal disease patients.Nevertheless,sexual dysfunction remains under-recognized and under-treated in a high proportion of these patients,a fact which should raise awareness among clinicians.A multifactorial approach in management and treatment is undoubtedly required in order to improve patients' quality of life and cardiovascular outcomes.

Neurovascular Evaluation in Eugonadal Men with Type 2 Diabetes Mellitus and Erectile Disfunction:A Comparative Study between Responders and Not Responders to Phosphodiesterase 5 Inhibitors

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.