Эректильная дисфункция у пациентов с автономной диабетической нейропатией

Abstract

Objective: diagnostics of erectile disorders within men with diabetic autonomic neuropathy and detection of rehabilitation methods of patients with erectile dysfunction (ED) affected diabetes mellitus (DM). Materials and methods . Thirty patients with DM were examined (15 patients with type 1 and 15 patients with type 2 respectively). Patients with DM had ED mainly of severe form (IIEF-5  from 6 to 16 points). According to the results of conducted examination the patients were prescribed the course of conservative therapy including hosphodiesterase in hibitors of type V, anticholinesterase drugs, drugs of thioctic acid. Conservative therapy was combined with shock wave therapy in the area of the penis. The group for comparison consisted of 15 healthy men (volunteers) without signs of ED (IIEF-5 21–22 points). Immune-enzyme analysis was used for detection of sex hormone status. Ultrasound, dopplerographic and X-ray methods were used for conduction of angiography of pool vessels of internal pudendal artery (IPA). Electroneuromyography of penis nerves was conducted. Results. According to the conducted research patients with DM were diagnosed with cavernous fibrosis, angiosclerosis of IPA and penis vessels in 100 % cases. Axonopathy of motor and sensory nerves of penis was detected in 100 % cases, stenosis and occlusion changes in IPA were detected in 42.9 % cases causing disorder and insufficiency in arterial perfusion in IPA pool. Conclusion. Denervation changes in sensory and motor nerves of penis and hemodynamicly significant perfusion disorders in IPA pool were principal pathogenetic factors of ED within the patients with DM. Decrease of reaction of IPA to the pharmacological stimulation was noted within patients with DM, which was caused by the angiosclerosis and loss of arterial wall elasticity. There was noted inefficiency of conservative therapy within patients with DM and ED at severe stage.