Document Detail


Pathophysiology and treatment of diabetic erectile dysfunction.
MedLine Citation:
PMID:  16892168     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 intracorporal 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.
Authors:
Charles R Moore; Run Wang
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Publication Detail:
Type:  Journal Article; Review     Date:  2006-08-04
Journal Detail:
Title:  Asian journal of andrology     Volume:  8     ISSN:  1008-682X     ISO Abbreviation:  Asian J. Androl.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-11-22     Completed Date:  2007-01-08     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  100942132     Medline TA:  Asian J Androl     Country:  China    
Other Details:
Languages:  eng     Pagination:  675-84     Citation Subset:  IM    
Affiliation:
Department of Urology, University of Texas Health Science Center and MD Anderson Cancer Center, 6431 Fannin Street, Suite 6.018, Houston, Texas 77030, USA.
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MeSH Terms
Descriptor/Qualifier:
Alprostadil / administration & dosage,  therapeutic use
Cyclic GMP-Dependent Protein Kinases / physiology
Diabetes Complications / physiopathology*
Diabetic Neuropathies / physiopathology
Erectile Dysfunction / etiology*,  physiopathology,  therapy*
Glycosylation End Products, Advanced / physiology
Humans
Male
Nitric Oxide / physiology
Penile Erection
Penile Prosthesis
Penis / blood supply
Phosphodiesterase Inhibitors / therapeutic use
Receptor, Endothelin B / physiology
Suppositories
Vacuum
Chemical
Reg. No./Substance:
0/Glycosylation End Products, Advanced; 0/Phosphodiesterase Inhibitors; 0/Receptor, Endothelin B; 0/Suppositories; 10102-43-9/Nitric Oxide; 745-65-3/Alprostadil; EC 2.7.11.12/Cyclic GMP-Dependent Protein Kinases

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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