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

糖尿病的病理生理学是多因素的，没有单个病原学在最前线。在糖尿病的病人的可勃起的机能障碍(编辑)的建议机制包括提高的先进 glycation 结束产品(年龄)和氧自由基的增加的层次，损害氮的氧化物(没有)合成，增加的 endothelin B 受体绑定地点和极端结构的变化在调整 RhoA/Rho-kinase 小径上面，没有依赖的选择 nitrergic 神经退化和损害周期的海鸟粪正弦单音的磷酸盐( cGMP )依赖者 kinase-1 ( PKG-1 )。糖尿病的编辑的治疗是多模式的。内在的多糖症和 comorbidities 的治疗具有最大的重要性阻止或停住疾病的前进。外围地行动口头的磷酸二酯酶打 5 (PDE5 ) 禁止者是在糖尿病患者的编辑的口头的麦克匪特斯氏疗法的支柱。真空勃起设备作为一种非侵略的治疗选择是另外的治疗。经由尿道的栓剂或体内注射的血管作用的药的本地管理能与最小的副作用是有效的。有可勃起的机制的不可逆的损坏的病人是阴茎培植的候选人。在编辑的治疗的进化的未来策略针对与适当向量改正或对待编辑的内在的机制，研究人员们对有象神经营养的因素和氮的氧化物 synthase (NOS ) 那样的代理人的 transfect 糖尿病患者动物有能力。在基因治疗的进一步的研究被需要充分在人查明它的安全和用途。

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.

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

类型 5 phosphodiesterase 禁止者(PDE5Is ) 是众所周知的经由氮的氧化物和周期的 guanosine monophosphate (NO-cGMP ) 小径是有效的并且广泛地在糖尿病的可勃起的机能障碍(编辑) 的治疗被使用。然而，另外的小径是否可以与 PDE5Is 涉及糖尿病的编辑的处理，是不清楚的。这研究的目的是通过 PDE5Is 的长期的管理在糖尿病的编辑治疗澄清抗氧化剂的角色。三组 Sprague-Dawley 老鼠被利用：组 N，正常控制；组 D， streptozotocin (STZ ) 作为控制导致了糖尿病的老鼠；并且组织 D&#x0002b； T，导致 STZ 的糖尿病的老鼠收到了 tadalafil 的口头的管理 8 个星期。可勃起的功能被 intracavernous 压力(ICP ) 和吝啬的动脉的压力(地图) 在无痛苦的死亡前在多孔的神经的电的刺激期间估计。malondialdehyde (MDA ) 的层次， superoxide dismutase (草皮) 和多孔的织物的 mitochondrial 膜潜力(MMP ) 被生物化学的分析估计。线粒体的形态学被电子显微镜学观察。ICP/MAP 比率在组 D&#x0002b 是更高的； T 比在组 D (P&#x0003c； 0.05 ) 。MDA 的层次减少了，草皮的活动在组 D&#x0002b 增加了；与组 D 比较的 T (P&#x0003c； 0.05 ) 。在糖尿病的老鼠的多孔的组织的 mitochondrial 膜潜力水平被 tadalafil 治疗部分恢复 8 个星期。线粒体的形态学变化显著地也在组 D&#x0002b 被改善； T。一起，在糖尿病的老鼠的 tadalafil 的长期的管理部分经由一条本地抗氧化的压力小径减少了阴茎的氧化压力损害。一旦每日的开始，在糖尿病的发作可以帮助阻止老鼠开发糖尿病的编辑后不久，给的 tadalafil 的长期的剂量。

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.

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

可勃起的机能障碍(编辑) 是糖尿病 mellitus 的主要复杂并发症。Icariin 被显示了通过它的 bioactive 形式提高可勃起的功能， icarisid II。这研究经由对先进 glycosylation 结束的评价与编辑和它的潜在的机制在糖尿病的老鼠上调查 icarisid II 的效果产品(年龄) ， autophagy， mTOR 和 NO-cGMP 小径。Icarisid II 被一个酶的方法从 icariin 提取。在控制和糖尿病的编辑组，老鼠被管理正常盐；在 icarisid II 组，老鼠 intragastrically 是管理 icarisid II。可勃起的功能被测量 intracavernosal 压力 / 平均数评估动脉的压力(ICP/MAP ) 。年龄集中，氮的氧化物 synthase (NOS ) 活动和 cGMP 集中被酶免疫分析估计。房间增长被分析使用甲基 thiazolyl tetrazolium 试金和流动 cytometry。Autophagosomes 被传播电子显微镜学， monodansylcadaverine 染色和 GFP-LC3 本地化观察。在 autophagy 的 NOS isoforms 和关键蛋白质的表示被西方的污点检验。我们的结果证明了 Icarisid II 增加了 ICP/MAP 价值，光滑的肌肉房间(SMC ) 生长曲线， S 阶段和 SMC/collagen 纤丝(SMC/CF ) 比例和减少的 Beclin 1 (P&#x0003c； 0.05 ) 。Icarisid II 显著地增加了 proliferative 索引和 p-p70S6K (Thr389 ) 层次并且减少 autophagosomes 的数字和 LC3-II 的层次(P&#x0003c； 0.01 ) 。Icarisid II 减少了年龄集中和增加的 cGMP 集中， NOS 活动(P&#x0003c； 0.05 ) 并且 cNOS 层次(P&#x0003c； 0.01 ) 在糖尿病的编辑组。因此， Icarisid II 组成有希望的混合物因为糖尿病的编辑和力量涉及 SMC 增长和 NO-cGMP 小径和年龄， autophagy 和 mTOR 小径的 downregulation 的 upregulation。

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.

Application of pudendal evoked potentials in diagnosis of erectile dysfunction

Aim: Extensive neurophysiological investigations were carried out in I00 healthy subjects and 84, patients with penile erectile dysfunction.

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.

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.

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.

Transplantation of endothelial progenitor cells transfected with VEGF165 to restore erectile function in diabetic rats

现在的学习调查了移植 endothelial 祖先细胞(EPC ) 的效果有进有糖尿病的可勃起的机能障碍(编辑) 的老鼠的阴茎海绵体的脉管的 endothelial 生长因素基因(VEGF165 ) 的 transfected。糖尿病的编辑的一个老鼠模型经由 streptozotocin 的 intraperitoneal 注射被构造。在 streptozotocin 治疗以后，预先对待从每三组老鼠的 EPC 被移植进他们的阴茎海绵体。我们的结果，监视的后面的 intracavernosal 压力(ICP ) ，看了在试用组在老鼠之中显著地增加的那 ICP 什么时候在基础条件和电的刺激期间与从在 blank-plasmid 和控制的老鼠的结果相比组织(P < 0.01 为两比较) 。组织学的检查在试用组在老鼠的阴茎海绵体揭示了广泛的 neovascularisation。荧光显微镜学在熬过的试用组移植 EPC 显示了那许多，区分了房间进 endothelial 并且集成于 neovascularisation 的地点。基于这研究的结果，我们断定进有糖尿病的编辑的老鼠的阴茎海绵体的 VEGF165-transfected EPC 的移植恢复可勃起的功能。