Вестник урологии (Mar 2017)
TREATMENT OF NEUROGENIC ERECTILE DYSFUNCTION IN PATIENTS WITH TYPE I DIABETES
Abstract
Introduction. The urogenital form of autonomic diabetic polyneuropathy is a specific lesion of the autonomic nervous system in diabetic patients. It is main pathogenetic cause of sexual disorders in this category of patients. The most common violation of sexual function in patients with diabetes is erectile dysfunction (ED).Objective. Diagnosis of peripheral neuropathy with ED caused by type I diabetes and assessment of the effectiveness phosphodiesterase type 5 inhibitor (PDE5-I) in its treatment.Materials and methods. The study included 40 patients with ED due to type 1 diabetes at the age of 25.7 ± 6.1. The duration of type 1 diabetes was 18 ± 9.7 years. All 40 patients, initially and after the course of therapy with the PDE5-Is, underwent a neuromyographic study with the determination of the excitation propagation rate for nervus peroneus and nervus pudendus, endothelial function evaluation on the EndoPat ™ device, and the questionnaire on the international index of erectile function (IIEF-5) scale.Results. In 30 (75.0%) men, endothelial dysfunction was determined according to EndoPat ™. In the range of the gray zone of reactive hyperemia index (RHI) was detected in 7 men (16.6%). Normal function of the endothelium was revealed in 3 cases (8.4%). In the control study, the following data were found: endothelial dysfunction was detected in 6 patients (16.6%) according to Endo Pat ™, in 14 patients (33.4%) in the range of gray zone of RHI, endothelial function was normalized in 20 patients (50.0%). According to the neuromyographic study, initially all patients had diabetic neuropathy in both the distal and urogenital forms. After therapy, significant positive dynamics were shown. Based on the results of the questionnaire on the scale of IIEF-5, initially all patients showed ED of varying severity. With the control questionnaire after therapy, there was an improvement in erectile function.Conclusions. Given the high incidence of endothelial dysfunction and its generalized nature in patients with ED due to diabetes, it is advisable for all patients with diabetes to study the state of the endothelium in conjunction with a neuromyographic study. Medicine from the PDE5-I group with individual taking course are highly effective in restoring vascular endothelial function, and also have a neuroprotective effect, which is especially important for patients with type 1 diabetes.
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