Abstract
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.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Benneff PH, Rewers MJ, Knowler WC . Epidemiology of diabetes mellitus. In: Porte D, Sherwin R (eds). Ellenberg & Rifkin's Diabetes Mellitus, 5th edn. Appleton & Lange: Stanford, CT, 1998, pp 373–385.
Hakim LS, Goldstein J . Diabetic sexual dysfunction. Endocr Metab Clin North Am 1996; 25: 379–400.
Koppiker N, Boolell M, Price D . Recent advances in the treatment of erectile dysfunction in patients with diabetes mellitus. Endocr Pract 2003; 9: 52–63.
De Berardis G et al. Erectile dysfunction and quality of life in type 2 diabetic patients. Diabetes Care 2003; 25: 284–291.
De Berardis G et al. Identifying patients with type 2 diabetes with a higher likelihood of erectile dysfunction: the role of the interaction between clinical and psychological factors. J Urol 2003; 169: 1422–1428.
Price DE et al. The management of impotence in diabetic men by vacuum tumescence therapy. Diabetes Med 1991; 8: 964–967.
Bodansky HJ . Treatment of male erectile dysfunction using the active vacuum assist device. Diabetes Med 1994; 11: 410–412.
Bell DS, Cutter GR, Hayne VB, Lloyd LK . Factors predicting efficacy of phentolamine-papaverine intracorporeal injection for treatment of erectile dysfunction in diabetic males. Urology 1992; 40: 36–69.
Segenreich E et al. Comparative evaluation of treatment of 452 patients suffering from various forms of erectile dysfunction with vasoactive agents injected intracorporally. Harefuah 1998; 134: 673–678.
Lipshultz LJ, Kim ED . Treatment of erectile dysfunction in men with diabetes. JAMA 1999; 281: 465–470.
Boulton AJM, Selam JL, Sweeney M, Ziegler D . Sildenafil citrate for the treatment of erectile dysfunction in men with type II diabetes mellitus. Diabetologia 2001; 44: 1296–1301.
Brock GB et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol 2002; 163: 1332–1336.
Goldstein I et al. The Vardenafil Diabetes Study Group: Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes. Diabetes Care 2003; 26: 777–783.
Chen J, Mabjeesh NJ, Greenstein A . Sildenafil versus the vacuum erection device: patient preference. J Urol 2001; 166: 1779–1781.
McMahon CG, Samali R, Johnson H . Treatment of intracorporeal injection nonresponse with sildenafil alone or in combination with triple agent intracorporeal injection therapy. J Urol 1999; 162: 1992–1997.
Carson CC, Mulcahy JJ, Govier FE, AMS 700 CX Study Group. Efficacy, safety and patient satisfaction outcomes of the AMS 700 CX inflatable penile prosthesis: results of a long-term multicenter study. Urology 2000; 164: 376–380.
Cappelleri JC et al. Diagnostic evaluation of the erectile function domain of the International Index of Erectile Function. Urology 1999; 54: 346–351.
Segenreich E, Israilov SR, Shmueli J, Servadio C . Can the vacuum test be used as a diagnostic method for determining the degree of severity of erectile dysfunction. Int J Impotence Res 1994; 6: 99–166.
DeBusk R et al. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of the Princeton Consensus Panel. Am J Cardiol 2000; 86: 175–181.
Bland M . An Introduction to Medical Statistics. Oxford University Press: Oxford, 1989, pp 22–104.
Carson CC, Burnett AL, Levine LA, Nehra A . The efficacy of sildenafil citrate (Viagra®) in clinical populations: an update. Urology 2002; 60: 12–27.
Levine LA, Dimitrou RJ . Vacuum constriction and external erection devices in erectile dysfunction. Urol Clin North Am 2001; 28: 335–341.
Sarteschi LM et al. Cavernous arterial and arteriolar circulation in patients with erectile dysfunction: a power Doppler study. J Urol 1998; 159: 428–432.
Wilson SK, Carson CC, Cleves MA, Delk II JR . Quantifying risk of penile prosthesis infection with elevated glycosylated hemoglobin. J Urol 1998; 159: 1537–1540.
Grunwald JE, Metelitsina T, Grunwald L . Effect of sildenafil citrate (Viagra) on retinal blood vessel diameter. Am J Ophthalmol 2002; 133: 809–812.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Israilov, S., Shmuely, J., Niv, E. et al. Evaluation of a progressive treatment program for erectile dysfunction in patients with diabetes mellitus. Int J Impot Res 17, 431–436 (2005). https://doi.org/10.1038/sj.ijir.3901337
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ijir.3901337
Keywords
This article is cited by
-
Erectile dysfunction and its management in patients with diabetes mellitus
Reviews in Endocrine and Metabolic Disorders (2015)
-
Losartan improves erectile dysfunction in diabetic patients: a clinical trial
International Journal of Impotence Research (2012)
-
Vacuum erection devices to treat erectile dysfunction and early penile rehabilitation following radical prostatectomy
Current Urology Reports (2008)