Evaluation of a Progressive Treatment Program for Erectile Dysfunction in Patients with Diabetes Mellitus

S. Israilov; J. Shmuely; E. Niv; D. Engelstein; P. Livne; J. Boniel


Int J Impot Res. 2005;17(5):431-436. 

In This Article

Abstract and Introduction

The aim was to evaluate the effectiveness of a progressive program, starting with simple methods and, when not effective, moving to more complex methods, to treat erectile dysfunction (ED) in patients with diabetes mellitus. A total of 284 diabetic patients with ED entered into a 6-phase program starting with sildenafil citrate (Viagra). Those with contraindications, side effects, or negative response (erection insufficient for vaginal penetration) were switched to the vacuum erection device (VED), and then progressively (for failures) to intracavernous injection (ICI), sildenafil citrate+ICI, ICI+VED, and penile prosthesis. Patients were followed for 2 y. Of the 284 patients 276 patients were eligible for sildenafil citrate and 147 (53.3%) responded positively, but 25 (9.1%) patients stopped it soon due to adverse effects. Of 162 patients (129 nonresponders, eight noneligible for the sildenafil and 25 patients who dropped out due to adverse effects), treated with VED, 114 (70.4%) responded well, however, only 19 (11.7%) patients agreed to continue its use. Of the remaining 143 patients (nonresponders, noneligible for the previously mentioned treatments and patients who dropped out due to adverse effects), 103/143 (72%) responded to ICI, 27/40 (67.5%) to sildenafil+ICI, and 9/13 (69.2%) to ICI+VED. Four patients received a penile implant. At the 2 y follow-up, 81 of 284 patients who entered the study (28.5%) were still responding to sildenafil, seven (2.5%) to VED, 113 (39.8%) to ICI, 24 (8.5%) to sildenafil+ICI, two (0.7%) to ICI+VED; 15 (5.3%) had a penile implant. In all 17 (6%) patients reported spontaneous erections, 11 (3.9%) stopped the treatment due to family reasons and 14 (4.9%) failed the treatment. In conclusion, the progressive treatment program for ED seems to be very effective for diabetic patients, yielded a complete response for short-term and 91.2% rate of success at the end of 2 y follow-up.

Diabetes mellitus (DM) is one of most common diseases. Its prevalence in US varies from 1-2 to 6.6% of general population, depending on chosen criteria of DM.[1] DM is associated with erectile dysfunction (ED) in 25-75% of men, depending on age, duration of DM, glycemic control, presence of microvascular (retinopathy, nephropathy and neuropathy) and macrovascular (ischemic heart disease, peripheral vascular disease and cerebro-vascular disease) complications.[2,3,4,5]

The mechanism underlying ED in patients with DM is usually multifactorial. Neuropathy, atherosclerosis of big vessels, endothelial dysfunction of small vessels, hormonal imbalance, comorbid diseases, physiological stress and various medications may be involved in the pathogenesis of ED in patients with DM.[2,5] Of course, the usual causes of ED in general population, like depression, postsurgery, etc, may also play a role in patients with DM. All these factors need to be taken into account in treating ED in this population.

There are several methods currently available for the treatment of ED associated with DM, including the vacuum erection device (VED);[6,7] intracavernous injection (ICI) of vasoactive drugs;[8,9,10] oral phosphodiesterase inhibitors such as sildenafil citrate (Viagra),[11] tadalafil citrate (Cialis)[12] and vardenafil (Levitra);[13] combination of sildenafil with VED[14] or ICI of vasoactive drugs;[15] and penile prosthesis.[16]

However, the studies conducted so far have evaluated the success of each method of treatment alone. The aim, of the present study was to examine the effectiveness of a stepwise, progressive ED treatment program in a large cohort of patients with diabetes mellitus.