title: How to treat erectile dysfunction in men with diabetes: from pathophysiology to treatment.
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.
authors.affiliation: Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Hatzimouratidis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Hatzichristou
mesh_terms: D048909:Diabetes Complications / Q000503:physiopathology* / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D007172:Erectile Dysfunction / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007006:Hypogonadism / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D010353:Patient Education as Topic; D019935:Penile Implantation / Q000379:methods*; D015917:Penile Prosthesis; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D014665:Vasodilator Agents