A. Veves et al., ETIOPATHOGENESIS AND MANAGEMENT OF IMPOTENCE IN DIABETIC MALES - 4 YEARS EXPERIENCE FROM A COMBINED CLINIC, Diabetic medicine, 12(1), 1995, pp. 77-82
Citations number
NO
Categorie Soggetti
Endocrynology & Metabolism","Medicine, General & Internal
The contribution of organic and psychogenic factors in the aetiopathog
enesis of impotence was studied in a large number of diabetic males, t
o develop an algorithm for its management. We examined 110 consecutive
patients who were refereed to the Impotence Clinic of the Diabetes Ce
ntre. All patients were initially evaluated by a diabetologist and the
n underwent psychosexual assessment by a specialized psychiatrist. Pat
ients with primarily organic disease were referred to a urologist for
further management while those with psychogenic impotence received psy
chosexual counselling. Peripheral neuropathy was present in 71 (65 %)
and two or more autonomic tests were abnormal in 22 (20 %) patients. N
europathy was the only cause detected in 29 (27 %) patients, the main
cause in 22 (20 %), and contributing, but not the main factor, in 20 (
18 %). Psychogenic factors were the only cause detected in 12 (11 %) p
atients, the main cause in 26 (24 %) and contributed in 19 (17 %). Mar
ital disharmony, medical treatment, and peripheral vascular disease we
re the main aetiopathogenic factors in the remaining cases. Psychosexu
al counselling resulted in successful intercourse in 17 (60 %) out of
the 24 treated patients and papaverine injections in 31 (61 %) out of
56 treated patients. It is concluded that although organic factors are
mainly responsible for the development of impotence in diabetic males
, psychological factors contribute significantly and psychosexual asse
ssment and counselling are essential adjuncts to its management. Treat
ment with papaverine injections is generally inexpensive and effective
to overcome the multifactorial causes of erectile dysfunction in this
population. An algorithm which may facilitate the investigation and t
reatment of impotent diabetic males is proposed.