Abstract
Nocturnal electrobioimpedance volumetric assessment (NEVA) is a procedure that can measure penile volume changes together with the number and duration of nocturnal erectile events. This study was conducted to evaluate the different NEVA patterns in diabetic patients with erectile dysfunction (ED), and demonstrate the extent to which tadalafil may affect the characteristics of nocturnal penile erections in these patients. Therefore, 38 patients with noninsulin-dependent diabetes and ED participated in this study. They were assessed with history intake including evaluation by the abridged five-item version of International Index of Erectile Function, clinical and psychiatric assessment and NEVA for three consecutive nights where placebo was given on the second night and tadalafil on the third night. In all, 14 potent males were taken as a control group. Data were analyzed using t-test. Results showed normal patterns in only six (16%) patients (central organic group), while abnormal patterns were observed in the remaining 32 (84%) patients (peripheral organic group). These abnormal patterns showed significant decrease in both the number (P=0.0001) and duration (P=0.03) of erectile events compared to those of controls. The percentage of penile blood volume change over baseline also decreased significantly (P=0.0002) relative to controls. Veno-occlusive dysfunction was the main pathology (23 patients, 72%) as suggested by NEVA. Tadalafil did not significantly change basal nocturnal penile tumescence results in either the central organic or control groups, but it did so significantly in the peripheral organic group (P=0.02 for duration change and P=0.01 for % blood volume change). In conclusion, NEVA may suggest some evidence about the pathophysiology of an underlying vasculogenic cause, thus directing towards the next specific step needed for a precise diagnosis. Tadalafil improves nocturnal erections in diabetic patients with peripheral but not central organic impotence.
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References
Sartca K et al. Multidisciplinary approach of diabetic impotence. Eur Urol 1994; 26: 314–318.
Bennett AE, Melman A . The epidemiology of erectile dysfunction. Urol Clin N Am 1995; 22: 699–709.
Karacan I . Clinical value of nocturnal erection in the prognosis and diagnosis of impotence. Med Aspects Hum Sexual 1970; 4: 27–34.
Barry JM, Blank BH, Boileau M . Nocturnal penile tumescence monitoring with stamps. Urology 1980; 15: 171–172.
Anders EK, Bradley WE, Krane RJ . Nocturnal penile rigidity measured by the snap-gauge band. J Urol 1983; 129: 964–966.
Bradley WE et al. New method for continuous measurement of nocturnal penile tumescence and rigidity. Urology 1985; 26: 4–9.
Knoll LD, Abrams JH . Application of nocturnal electrobioimpedance volumetric assessment: a feasibility study in men without erectile dysfunction. J Urol 1999; 161: 1137–1140.
Knoll LD, Abrams JH . Nocturnal electrobioimpedance volumetric assessment of patients with erectile dysfunction. Urology 1999; 53: 1200–1204.
Lindsey I, Cunningham C, George BD, Mortensen NJM . Nocturnal penile tumescence is diminished but not ablated in postprostatectomy impotence. Dis Colon Rectum 2003; 46: 14–20.
Rosen RC, McKenna KE . PDE-5 inhibition and sexual response: pharmacological mechanisms and clinical outcomes. Annu Rev Sex Res 2002; 13: 36–88.
Padma-Nathan H et al. Tadalafil (IC 351) provides prompt response and extended period of responsiveness for the treatment of men with erectile dysfunction. In: Proceedings of the 96th Annual Meeting of the American Urological Association. Anaheim, 2001; 224pp.
Rosen RC et al. Development and evaluation of an abridged, 5-item version of the international index of erectile function (IIEF) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11: 319–326.
Davis-Joseph B, Tiefer L, Melman A . Accuracy of the initial history and physical examination to establish the etiology of erectile dysfunction. Urology 1995; 45: 498–502.
Sachs BD . The false organic-psychogenic distinction and related problems in the classification of erectile dysfunction. Int J Impot Res 2003; 15: 72–78.
Veves A et al. Aetiopathogenesis and management of impotence in diabetic males: four year experience from a combined clinic. Diabetic Med 1995; 12: 77–82.
Watkins SE, Williams P, Ryder RE, Bowshier W . Psychometric assessment of diabetic impotence. Br J Psychiatry 1993; 162: 840–842.
Hatch JP, De La Pefia AM, Fisher JG . Psychometric differentiation of psychogenic and organic erectile disorders. J Urol 1987; 138: 781–783.
Abel GG et al. Differential diagnosis of impotence in diabetics: the validity of sexual sympatomatology. Neurourol Urodyn 1982; 1: 57–61.
Karacan I, Williams RL, Thornby JL . Sleep related tumescence as a function of age. Am J Psychiatry 1975; 132: 932–937.
Wang CJ et al. Penile blood flow study in diabetic impotence. Urol Int 1993; 50: 209–212.
Kader GA, Griffin PT . Reevaluation of the phenomena of the first night effect. Sleep 1983; 6: 67–71.
Klein R, Klein BE, Lee KE, Moss SE . Prevalence of self reported erectile dysfunction in people with long term insulin dependent diabetes mellitus. Diabetes Care 1996; 19: 135–141.
Deutsch S, Sherman L . Previously unrecognized diabetes mellitus in sexually impotent men. JAMA 1980; 244: 2430–2432.
Allen RP, Engel RM, Smolev JK, Brendler CB . Comparison of duplex ultrasonography and nocturnal penile tumescence in evaluation of impotence. J Urol 1994; 151: 1525–1529.
Colakoglu Z et al. Autonomic nerve involvement and venous leakage in diabetic men with impotence. BJU Int 1999; 83: 453–456.
Lehmen TB, Jacob JA . Etiology of diabetic impotence. J Urol 1983; 129: 291–293.
Jevtich MJ et al. Vascular factors in erectile failure among diabetics. Urology 1983; 19: 163–168.
Gilbert HW, Gingell JC . Tunical compliance and venous incompetence. J Urol 1993; 149: 286A.
Shabsigh R et al. Intracavernous alprostadil alfadex is more efficacious, better tolerated and preferred over intraurethral alprostadil plus optional actis: a comparative, randomized, cross over, multicenter study. Urology 2000; 55: 109–113.
Lue TL . Physiology of erection and pathophysiology of impotence. In: Walsh PC, Retik AB, Stamy TA, Vaughan Jr ED (eds) Cambell's Urology, 8 edn WB Saunders Company: Philadelphia, 1992, pp 709–728.
Heaton JPW . Editorial comment. Int J Impot Res 1998; 10: 151.
Karacan I, Karates M . Erectile dysfunction in sleep apnea and response to GPAAP. J Sex Marital Ther 1995; 21: 239–247.
Acknowledgements
Some of the early results of this work were presented at the Sixth Congress of the European Federation of Sexology, Limassol, Cyprus, June 16–20, 2002 and the Seventh Asian Congress of Sexology, Raffles City, Singapore, November 14–17, 2002.
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Salama, N. Nocturnal electrobioimpedance volumetric assessment in diabetic men with erectile dysfunction before and after tadalafil intake. Int J Impot Res 16, 441–447 (2004). https://doi.org/10.1038/sj.ijir.3901203
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DOI: https://doi.org/10.1038/sj.ijir.3901203
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