Skip to main content

Advertisement

SpringerLink
Log in

How to Treat Erectile Dysfunction in Men with Diabetes: from Pathophysiology to Treatment

  • Microvascular Complications—Neuropathy (D Ziegler, Section Editor)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Erectile dysfunction (ED) is highly prevalent affecting at least 50 % of men with diabetes mellitus (DM). DM may cause ED through a number of pathophysiological pathways. These include neuropathy, endothelial dysfunction, cavernosal smooth muscle structural/functional changes, and hormonal changes. Lifestyle changes, diabetes control, and treatment of hypogonadism are important as the first step in ED management since there is no curative treatment for ED. Phosphodiesterase type 5 inhibitors (PDE5i) are the first-line treatment option. Intracavernous administration of vasoactive drugs is commonly used as a second-line medical treatment when PDE5i have failed. Alprostadil is the most widely used drug in this second-line setting. The combination of papaverine, phentolamine, and alprostadil represents the most efficacious intracavernous pharmacologic treatment option that may save non-responders to alprostadil. Penile prosthesis implantation can be considered in treatment refractory cases, with excellent functional and safety results in the properly informed patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lindau ST, Gavrilova N. Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ. 2010;340:c810. doi:10.1136/bmj.c810.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57(5):804–14. doi:10.1016/j.eururo.2010.02.020.

    Article  PubMed  Google Scholar 

  3. Papaharitou S, Athanasiadis L, Nakopoulou E, Kirana P, Portseli A, Iraklidou M, et al. Erectile dysfunction and premature ejaculation are the most frequently self-reported sexual concerns: profiles of 9,536 men calling a helpline. Eur Urol. 2006;49(3):557–63. doi:10.1016/j.eururo.2005.09.023.

    Article  PubMed  Google Scholar 

  4. Kirana PS, Rosen R, Hatzichristou D. Subjective well-being as a determinant of individuals’ responses to symptoms: a biopsychosocial perspective. Int J Clin Pract. 2009;63(10):1435–45. doi:10.1111/j.1742-1241.2009.02183.x.

    Article  PubMed  Google Scholar 

  5. Aytac IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999;84(1):50–6.

    Article  Google Scholar 

  6. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol. 2000;163(2):460–3.

    Article  CAS  PubMed  Google Scholar 

  7. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537–44.

    Article  CAS  PubMed  Google Scholar 

  8. Bacon CG, Hu FB, Giovannucci E, Glasser DB, Mittleman MA, Rimm EB. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care. 2002;25(8):1458–63.

    Article  PubMed  Google Scholar 

  9. Hatzimouratidis K, Hatzichristou D. Erectile dysfunction and diabetes mellitus. Insulin. 2009;4(2):114–22.

    Article  Google Scholar 

  10. Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res. 2005;17(1):39–57. doi:10.1038/sj.ijir.3901250.

    Article  CAS  PubMed  Google Scholar 

  11. Guay A, Jacobson J. The relationship between testosterone levels, the metabolic syndrome (by two criteria), and insulin resistance in a population of men with organic erectile dysfunction. J Sex Med. 2007;4(4 Pt 1):1046–55. doi:10.1111/j.1743-6109.2007.00530.x.

    Article  CAS  PubMed  Google Scholar 

  12. Fedele D, Coscelli C, Santeusanio F, Bortolotti A, Chatenoud L, Colli E, et al. Erectile dysfunction in diabetic subjects in Italy. Gruppo Italiano Studio Deficit Erettile nei Diabetici. Diabetes Care. 1998;21(11):1973–7.

    Article  CAS  PubMed  Google Scholar 

  13. Fedele D, Coscelli C, Cucinotta D, Forti G, Santeusanio F, Viaggi S, et al. Incidence of erectile dysfunction in Italian men with diabetes. J Urol. 2001;166(4):1368–71.

    Article  CAS  PubMed  Google Scholar 

  14. Grover SA, Lowensteyn I, Kaouache M, Marchand S, Coupal L, DeCarolis E, et al. The prevalence of erectile dysfunction in the primary care setting: importance of risk factors for diabetes and vascular disease. Arch Intern Med. 2006;166(2):213–9. doi:10.1001/archinte.166.2.213.

    Article  PubMed  Google Scholar 

  15. Montorsi P, Ravagnani PM, Galli S, Rotatori F, Veglia F, Briganti A, et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J. 2006;27(22):2632–9. doi:10.1093/eurheartj/ehl142.

    Article  PubMed  Google Scholar 

  16. Miner M, Seftel AD, Nehra A, Ganz P, Kloner RA, Montorsi P, et al. Prognostic utility of erectile dysfunction for cardiovascular disease in younger men and those with diabetes. Am Heart J. 2012;164(1):21–8. doi:10.1016/j.ahj.2012.04.006. This is a review showing that identification of ED, particularly in men <60 years old and those with diabetes, is important in early cardiovascular risk detection and reduction.

    Article  PubMed  Google Scholar 

  17. Kloner RA. Erectile dysfunction and cardiovascular risk factors. Urol Clin North Am. 2005;32(4):397-402, v. doi:10.1016/j.ucl.2005.08.005.

  18. Romeo JH, Seftel AD, Madhun ZT, Aron DC. Sexual function in men with diabetes type 2: association with glycemic control. J Urol. 2000;163(3):788–91.

    Article  CAS  PubMed  Google Scholar 

  19. Fonseca V, Jawa A. Endothelial and erectile dysfunction, diabetes mellitus, and the metabolic syndrome: common pathways and treatments? Am J Cardiol. 2005;96(12B):13M–8. doi:10.1016/j.amjcard.2005.07.005.

    Article  PubMed  Google Scholar 

  20. Esposito K, Giugliano F, Martedi E, Feola G, Marfella R, D’Armiento M, et al. High proportions of erectile dysfunction in men with the metabolic syndrome. Diabetes Care. 2005;28(5):1201–3.

    Article  PubMed  Google Scholar 

  21. Esposito K, Giugliano F, Maiorino MI, Giugliano D. Dietary factors, Mediterranean diet and erectile dysfunction. J Sex Med. 2010;7(7):2338–45. doi:10.1111/j.1743-6109.2010.01842.x.

    PubMed  Google Scholar 

  22. Burke JP, Jacobson DJ, McGree ME, Nehra A, Roberts RO, Girman CJ, et al. Diabetes and sexual dysfunction: results from the Olmsted County study of urinary symptoms and health status among men. J Urol. 2007;177(4):1438–42. doi:10.1016/j.juro.2006.11.059.

    Article  PubMed  Google Scholar 

  23. Dunsmuir WD, Holmes SA. The aetiology and management of erectile, ejaculatory, and fertility problems in men with diabetes mellitus. Diabet Med. 1996;13(8):700–8. doi:10.1002/(SICI)1096-9136(199608)13:8<700::AID-DIA174>3.0.CO;2-8.

    Article  CAS  PubMed  Google Scholar 

  24. Cellek S, Cameron NE, Cotter MA, Muneer A. Pathophysiology of diabetic erectile dysfunction: potential contribution of vasa nervorum and advanced glycation endproducts. Int J Impot Res. 2013;25(1):1–6. doi:10.1038/ijir.2012.30.

    Article  CAS  PubMed  Google Scholar 

  25. Saenz DeTejada I, Angulo J, Cellek S, Gonzalez-Cadavid NF, Heaton J, Pickard R, et al. Physiology of erectile function and pathophysiology of erectile dysfunction. In: Lue TF, Basson R, Rosen R, Giuliano F, Khoury S, Montorsi F, editors. Sexual medicine: sexual dysfunctions in men and women. Paris: Health Publications; 2007. p. 287–344.

    Google Scholar 

  26. Hecht MJ, Neundorfer B, Kiesewetter F, Hilz MJ. Neuropathy is a major contributing factor to diabetic erectile dysfunction. Neurol Res. 2001;23(6):651–4. doi:10.1179/016164101101198965.

    Article  CAS  PubMed  Google Scholar 

  27. Yamanaka M, Shirai M, Shiina H, Tanaka Y, Tsujimura A, Matsumiya K, et al. Diabetes induced erectile dysfunction and apoptosis in penile crura are recovered by insulin treatment in rats. J Urol. 2003;170(1):291–7. doi:10.1097/01.ju.0000060564.31122.2a.

    Article  CAS  PubMed  Google Scholar 

  28. Saenz de Tejada I, Blanco R, Goldstein I, Azadzoi K, de las Morenas A, Krane RJ, et al. Cholinergic neurotransmission in human corpus cavernosum. I. Responses of isolated tissue. Am J Physiol. 1988;254(3 Pt 2):H459–67.

    CAS  PubMed  Google Scholar 

  29. Azadzoi KM, Saenz de Tejada I. Diabetes mellitus impairs neurogenic and endothelium-dependent relaxation of rabbit corpus cavernosum smooth muscle. J Urol. 1992;148(5):1587–91.

    CAS  PubMed  Google Scholar 

  30. Cartledge JJ, Eardley I, Morrison JF. Nitric oxide-mediated corpus cavernosal smooth muscle relaxation is impaired in ageing and diabetes. BJU Int. 2001;87(4):394–401.

    Article  CAS  PubMed  Google Scholar 

  31. Cellek S, Rodrigo J, Lobos E, Fernandez P, Serrano J, Moncada S. Selective nitrergic neurodegeneration in diabetes mellitus - a nitric oxide-dependent phenomenon. Br J Pharmacol. 1999;128(8):1804–12. doi:10.1038/sj.bjp.0702981.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Musicki B, Burnett AL. Endothelial dysfunction in diabetic erectile dysfunction. Int J Impot Res. 2007;19(2):129–38. doi:10.1038/sj.ijir.3901494.

    Article  CAS  PubMed  Google Scholar 

  33. Bivalacqua TJ, Usta MF, Champion HC, Kadowitz PJ, Hellstrom WJ. Endothelial dysfunction in erectile dysfunction: role of the endothelium in erectile physiology and disease. J Androl. 2003;24(6 Suppl):S17–37.

    CAS  PubMed  Google Scholar 

  34. Singh R, Barden A, Mori T, Beilin L. Advanced glycation end-products: a review. Diabetologia. 2001;44(2):129–46. doi:10.1007/s001250051591.

    Article  CAS  PubMed  Google Scholar 

  35. Sullivan ME, Dashwood MR, Thompson CS, Muddle JR, Mikhailidis DP, Morgan RJ. Alterations in endothelin B receptor sites in cavernosal tissue of diabetic rabbits: potential relevance to the pathogenesis of erectile dysfunction. J Urol. 1997;158(5):1966–72.

    Article  CAS  PubMed  Google Scholar 

  36. Takahashi K, Ghatei MA, Lam HC, O’Halloran DJ, Bloom SR. Elevated plasma endothelin in patients with diabetes mellitus. Diabetologia. 1990;33(5):306–10.

    Article  CAS  PubMed  Google Scholar 

  37. Wang H, Eto M, Steers WD, Somlyo AP, Somlyo AV. RhoA-mediated Ca2+ sensitization in erectile function. J Biol Chem. 2002;277(34):30614–21. doi:10.1074/jbc.M204262200.

    Article  CAS  PubMed  Google Scholar 

  38. Bivalacqua TJ, Champion HC, Usta MF, Cellek S, Chitaley K, Webb RC, et al. RhoA/Rho-kinase suppresses endothelial nitric oxide synthase in the penis: a mechanism for diabetes-associated erectile dysfunction. Proc Natl Acad Sci U S A. 2004;101(24):9121–6. doi:10.1073/pnas.0400520101.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Ming XF, Viswambharan H, Barandier C, Ruffieux J, Kaibuchi K, Rusconi S, et al. Rho GTPase/Rho kinase negatively regulates endothelial nitric oxide synthase phosphorylation through the inhibition of protein kinase B/Akt in human endothelial cells. Mol Cell Biol. 2002;22(24):8467–77.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Simopoulos DN, Gibbons SJ, Malysz J, Szurszewski JH, Farrugia G, Ritman EL, et al. Corporeal structural and vascular micro architecture with X-ray micro computerized tomography in normal and diabetic rabbits: histopathological correlation. J Urol. 2001;165(5):1776–82.

    Article  CAS  PubMed  Google Scholar 

  41. Wessells H, Teal TH, Engel K, Sullivan CJ, Gallis B, Tran KB, et al. Fluid shear stress-induced nitric oxide production in human cavernosal endothelial cells: inhibition by hyperglycaemia. BJU Int. 2006;97(5):1047–52. doi:10.1111/j.1464-410X.2006.06059.x.

    Article  CAS  PubMed  Google Scholar 

  42. Seftel AD, Vaziri ND, Ni Z, Razmjouei K, Fogarty J, Hampel N, et al. Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology. 1997;50(6):1016–26. doi:10.1016/S0090-4295(97)00512-8.

    Article  CAS  PubMed  Google Scholar 

  43. Usta MF, Bivalacqua TJ, Yang DY, Ramanitharan A, Sell DR, Viswanathan A, et al. The protective effect of aminoguanidine on erectile function in streptozotocin diabetic rats. J Urol. 2003;170(4 Pt 1):1437–42. doi:10.1097/01.ju.0000077557.45582.f3.

    Article  CAS  PubMed  Google Scholar 

  44. Chang S, Hypolite JA, Velez M, Changolkar A, Wein AJ, Chacko S, et al. Downregulation of cGMP-dependent protein kinase-1 activity in the corpus cavernosum smooth muscle of diabetic rabbits. Am J Physiol Regul Integr Comp Physiol. 2004;287(4):R950–60. doi:10.1152/ajpregu.00639.2003.

    Article  CAS  PubMed  Google Scholar 

  45. Corona G, Mannucci E, Petrone L, Ricca V, Balercia G, Mansani R, et al. Association of hypogonadism and type II diabetes in men attending an outpatient erectile dysfunction clinic. Int J Impot Res. 2006;18(2):190–7. doi:10.1038/sj.ijir.3901391.

    Article  CAS  PubMed  Google Scholar 

  46. Kapoor D, Aldred H, Clark S, Channer KS, Jones TH. Clinical and biochemical assessment of hypogonadism in men with type 2 diabetes: correlations with bioavailable testosterone and visceral adiposity. Diabetes Care. 2007;30(4):911–7. doi:10.2337/dc06-1426.

    Article  CAS  PubMed  Google Scholar 

  47. Bansal TC, Guay AT, Jacobson J, Woods BO, Nesto RW. Incidence of metabolic syndrome and insulin resistance in a population with organic erectile dysfunction. J Sex Med. 2005;2(1):96–103. doi:10.1111/j.1743-6109.2005.20120.x.

    Article  PubMed  Google Scholar 

  48. Cellek S, Foxwell NA, Moncada S. Two phases of nitrergic neuropathy in streptozotocin-induced diabetic rats. Diabetes. 2003;52(9):2353–62.

    Article  CAS  PubMed  Google Scholar 

  49. Wessells H. Insights and interventions in diabetes associated erectile dysfunction. J Urol. 2013;190(1):15–6. doi:10.1016/j.juro.2013.04.041.

    Article  PubMed  Google Scholar 

  50. Lue TF, Giuliano F, Montorsi F, Rosen RC, Andersson KE, Althof S, et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med. 2004;1(1):6–23. doi:10.1111/j.1743-6109.2004.10104.x.

    Article  PubMed  Google Scholar 

  51. Giugliano D, Giugliano F, Esposito K. Sexual dysfunction and the Mediterranean diet. Public Health Nutr. 2006;9(8A):1118–20. doi:10.1017/S1368980007668542.

    Article  PubMed  Google Scholar 

  52. Esposito K, Giugliano F, Di Palo C, Giugliano G, Marfella R, D’Andrea F, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978–84. doi:10.1001/jama.291.24.2978.

    Article  CAS  PubMed  Google Scholar 

  53. Dusing R. Sexual dysfunction in male patients with hypertension: influence of antihypertensive drugs. Drugs. 2005;65(6):773–86.

    Article  PubMed  Google Scholar 

  54. Wassmann S, Hilgers S, Laufs U, Bohm M, Nickenig G. Angiotensin II type 1 receptor antagonism improves hypercholesterolemia-associated endothelial dysfunction. Arterioscler Thromb Vasc Biol. 2002;22(7):1208–12.

    Article  CAS  PubMed  Google Scholar 

  55. Gruenwald I, Shenfeld O, Chen J, Raviv G, Richter S, Cohen A, et al. Positive effect of counseling and dose adjustment in patients with erectile dysfunction who failed treatment with sildenafil. Eur Urol. 2006;50(1):134–40. doi:10.1016/j.eururo.2006.01.042.

    Article  PubMed  Google Scholar 

  56. Nehra A, Jackson G, Miner M, Billups KL, Burnett AL, Buvat J, et al. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87(8):766–78. doi:10.1016/j.mayocp.2012.06.015.

    Article  PubMed Central  PubMed  Google Scholar 

  57. Kostis JB, Jackson G, Rosen R, Barrett-Connor E, Billups K, Burnett AL, et al. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol. 2005;96(2):313–21. doi:10.1016/j.amjcard.2005.03.065.

    Article  PubMed  Google Scholar 

  58. Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group. JAMA. 1999;281(5):421–6.

    Article  CAS  PubMed  Google Scholar 

  59. Boulton AJ, Selam JL, Sweeney M, Ziegler D. Sildenafil citrate for the treatment of erectile dysfunction in men with Type II diabetes mellitus. Diabetologia. 2001;44(10):1296–301. doi:10.1007/s001250100656.

    Article  CAS  PubMed  Google Scholar 

  60. Stuckey BG, Jadzinsky MN, Murphy LJ, Montorsi F, Kadioglu A, Fraige F, et al. Sildenafil citrate for treatment of erectile dysfunction in men with type 1 diabetes: results of a randomized controlled trial. Diabetes Care. 2003;26(2):279–84.

    Article  CAS  PubMed  Google Scholar 

  61. Goldstein I, Young JM, Fischer J, Bangerter K, Segerson T, Taylor T. Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care. 2003;26(3):777–83.

    Article  CAS  PubMed  Google Scholar 

  62. Safarinejad MR. Oral sildenafil in the treatment of erectile dysfunction in diabetic men: a randomized double-blind and placebo-controlled study. J Diabetes Complicat. 2004;18(4):205–10. doi:10.1016/S1056-8727(03)00056-4.

    Article  PubMed  Google Scholar 

  63. Fonseca V, Seftel A, Denne J, Fredlund P. Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials. Diabetologia. 2004;47(11):1914–23. doi:10.1007/s00125-004-1549-6.

    Article  CAS  PubMed  Google Scholar 

  64. Ziegler D, Merfort F, van Ahlen H, Yassin A, Reblin T, Neureither M. Efficacy and safety of flexible-dose vardenafil in men with type 1 diabetes and erectile dysfunction. J Sex Med. 2006;3(5):883–91. doi:10.1111/j.1743-6109.2006.00295.x.

    Article  CAS  PubMed  Google Scholar 

  65. Hatzichristou D, Gambla M, Rubio-Aurioles E, Buvat J, Brock GB, Spera G, et al. Efficacy of tadalafil once daily in men with diabetes mellitus and erectile dysfunction. Diabet Med. 2008;25(2):138–46. doi:10.1111/j.1464-5491.2007.02338.x.

    Article  CAS  PubMed  Google Scholar 

  66. Park HJ, Choi HK, Ahn TY, Park JK, Chung WS, Lee SW, et al. Efficacy and safety of oral mirodenafil in the treatment of erectile dysfunction in diabetic men in Korea: a multicenter, randomized, double-blind, placebo-controlled clinical trial. J Sex Med. 2010;7(8):2842–50. doi:10.1111/j.1743-6109.2010.01888.x.

    Article  CAS  PubMed  Google Scholar 

  67. du Moon G, Yang DY, Lee CH, Ahn TY, Min KS, Park K, et al. A therapeutic confirmatory study to assess the safety and efficacy of Zydena (udenafil) for the treatment of erectile dysfunction in male patients with diabetes mellitus. J Sex Med. 2011;8(7):2048–61. doi:10.1111/j.1743-6109.2011.02268.x.

    Article  CAS  Google Scholar 

  68. Goldstein I, Jones LA, Belkoff LH, Karlin GS, Bowden CH, Peterson CA, et al. Avanafil for the treatment of erectile dysfunction: a multicenter, randomized, double-blind study in men with diabetes mellitus. Mayo Clin Proc. 2012;87(9):843–52. doi:10.1016/j.mayocp.2012.06.016.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  69. Hatzimouratidis K, Hatzichristou DG. A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient? Drugs. 2005;65(12):1621–50.

    Article  CAS  PubMed  Google Scholar 

  70. Price DE, Cooksey G, Jehu D, Bentley S, Hearnshaw JR, Osborn DE. The management of impotence in diabetic men by vacuum tumescence therapy. Diabet Med. 1991;8(10):964–7.

    Article  CAS  PubMed  Google Scholar 

  71. Sidi AA, Becher EF, Zhang G, Lewis JH. Patient acceptance of and satisfaction with an external negative pressure device for impotence. J Urol. 1990;144(5):1154–6.

    CAS  PubMed  Google Scholar 

  72. Padma-Nathan H, Hellstrom WJ, Kaiser FE, Labasky RF, Lue TF, Nolten WE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med. 1997;336(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  73. Padma-Nathan H, Yeager JL. An integrated analysis of alprostadil topical cream for the treatment of erectile dysfunction in 1732 patients. Urology. 2006;68(2):386–91. doi:10.1016/j.urology.2006.02.027.

    Article  PubMed  Google Scholar 

  74. Williams G, Abbou CC, Amar ET, Desvaux P, Flam TA, Lycklama a Nijeholt GA, et al. Efficacy and safety of transurethral alprostadil therapy in men with erectile dysfunction. MUSE Study Group. Br J Urol. 1998;81(6):889–94.

    Article  PubMed  Google Scholar 

  75. Buvat R, Fernando Y, Damaj B, Moncada I, Frank D, Burger M. Clinically significant approvement of erectile function following treatment with alprostadil cream (Vitaros®) in 1652 patients with erectile dysfunction. J Sex Med. 2012;9 suppl 5:384. abstract P-01-086.

    Google Scholar 

  76. Heaton JP, Lording D, Liu SN, Litonjua AD, Guangwei L, Kim SC, et al. Intracavernosal alprostadil is effective for the treatment of erectile dysfunction in diabetic men. Int J Impot Res. 2001;13(6):317–21.

    Article  CAS  PubMed  Google Scholar 

  77. Perimenis P, Konstantinopoulos A, Perimeni PP, Gyftopoulos K, Kartsanis G, Liatsikos E, et al. Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction. Asian J Androl. 2006;8(2):219–24. doi:10.1111/j.1745-7262.2006.00095.x.

    Article  CAS  PubMed  Google Scholar 

  78. Porst H. The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. J Urol. 1996;155(3):802–15.

    Article  CAS  PubMed  Google Scholar 

  79. Tal R, Mulhall JP. Intracavernosal injections and fibrosis: myth or reality? BJU Int. 2008;102(5):525–6. doi:10.1111/j.1464-410X.2008.07738.x.

    Article  PubMed  Google Scholar 

  80. Simmons M, Montague DK. Penile prosthesis implantation: past, present and future. Int J Impot Res. 2008;20(5):437–44. doi:10.1038/ijir.2008.11.

    Article  CAS  PubMed  Google Scholar 

  81. Henry GD, Wilson SK. Updates in inflatable penile prostheses. Urol Clin North Am. 2007;34(4):535–47. doi:10.1016/j.ucl.2007.08.015. vi.

    Article  PubMed  Google Scholar 

  82. Carson CC. Penile prosthesis implantation: surgical implants in the era of oral medication. Urol Clin North Am. 2005;32(4):503–9. doi:10.1016/j.ucl.2005.09.002. vii.

    Article  PubMed  Google Scholar 

  83. Chen Y, Dai Y, Wang R. Treatment strategies for diabetic patients suffering from erectile dysfunction. Expert Opin Pharmacother. 2008;9(2):257–66. doi:10.1517/14656566.9.2.257.

    Article  CAS  PubMed  Google Scholar 

  84. Moore CR, Wang R. Pathophysiology and treatment of diabetic erectile dysfunction. Asian J Androl. 2006;8(6):675–84. doi:10.1111/j.1745-7262.2006.00223.x.

    Article  PubMed  Google Scholar 

  85. Mulhall JP, Ahmed A, Branch J, Parker M. Serial assessment of efficacy and satisfaction profiles following penile prosthesis surgery. J Urol. 2003;169(4):1429–33. doi:10.1097/01.ju.0000056047.74268.9c.

    Article  PubMed  Google Scholar 

  86. Bishop JR, Moul JW, Sihelnik SA, Peppas DS, Gormley TS, McLeod DG. Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections. J Urol. 1992;147(2):386–8.

    CAS  PubMed  Google Scholar 

  87. Carson 3rd CC, Mulcahy JJ, Harsch MR. Long-term infection outcomes after original antibiotic impregnated inflatable penile prosthesis implants: up to 7.7 years of followup. J Urol. 2011;185(2):614–8.

    Article  PubMed  Google Scholar 

  88. Mulcahy JJ, Carson 3rd CC. Long-term infection rates in diabetic patients implanted with antibiotic-impregnated versus nonimpregnated inflatable penile prostheses: 7-year outcomes. Eur Urol. 2011;60(1):167–72. doi:10.1016/j.eururo.2011.01.046.

    Article  PubMed  Google Scholar 

  89. Gruenwald I, Appel B, Kitrey ND, Vardi Y. Shockwave treatment of erectile dysfunction. Ther Adv Urol. 2013;5(2):95–9. doi:10.1177/1756287212470696. This is a thorough review of the role of shockwave therapy in the treatment of erectile dysfunction including men with diabetes.

    Article  PubMed Central  PubMed  Google Scholar 

  90. Qiu X, Lin G, Xin Z, Ferretti L, Zhang H, Lue TF, et al. Effects of low-energy shockwave therapy on the erectile function and tissue of a diabetic rat model. J Sex Med. 2013;10(3):738–46. doi:10.1111/jsm.12024.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  91. Gruenwald I, Appel B, Vardi Y. Low-intensity extracorporeal shock wave therapy—a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhibitor therapy. J Sex Med. 2012;9(1):259–64. doi:10.1111/j.1743-6109.2011.02498.x.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Dr. Hatzimouratidis reports personal fees from Lilly, Jannsen, and Menarini during the conduct of the study.

Dr. Hatzichristou reports personal fees from Lilly, Menarini, Bayer, and grants and personal fees from GSK and Medispec during the conduct of the study.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

Author information

Authors and Affiliations

  1. Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Konstantinos Hatzimouratidis & Dimitrios Hatzichristou

  2. 77 Mitropoleos str., 54622, Thessaloniki, Greece

    Dimitrios Hatzichristou

Authors
  1. Konstantinos Hatzimouratidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitrios Hatzichristou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dimitrios Hatzichristou.

Additional information

This article is part of the Topical Collection on Microvascular Complications—Neuropathy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hatzimouratidis, K., Hatzichristou, D. How to Treat Erectile Dysfunction in Men with Diabetes: from Pathophysiology to Treatment. Curr Diab Rep 14, 545 (2014). https://doi.org/10.1007/s11892-014-0545-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-014-0545-6

Keywords

Search

Navigation