الفهرس 
Materials and methodsOnly 14 pages are availabe for public view
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Abstract
This work aimed at determination of the underlying causes of impotence among diabetic patients and detection of the appropriate modality of treatment of each cause.
Sixty five men with diabetes mellitus complaining of impotence were included in this study. The patients had been selected from the out-patient clinic of Urology Department, Benha Faculty of Medicine.
A detailed history was taken from the patients.Every diabetic patient was subjected to general, genital and neurological examination.
In addition to routine detection of the blood sugar level in each patient, hormonal assay was requested when indicated. Vascular testing techniques including papaverine test, Doppler detection of penile brachial index (PI31), colour duplex Doppler sonography and phannacocavemoso-metry and cavernosography were performed to assess the veno-occlusive mechanism in diabetic patients. Lastly, penile electromyography using SPACE device was performed to evaluate the cavernous autonomic
supply.
The results showed that the vascular disorders, arterial and venous, either alone (33.8% and 29.2% respectively) or combined (9.2%), are the most common cause of impotence in diabetic men where autonomic neuropathy represent the next common etiology (26%) followed by psychogenic disorders (16.9%) where endocrinal disturbance was the least
Summary
168
factor encountered in the pathogenesis of impotence among diabetic men (7.6%).
The duration and type of diabetes mellitus, duration of impotence and age of the patients does not influence the development of a specific type of impotence in diabetic patients.
Results obtained by Doppler stethoscope (P131) was highly correlated with that obtained by colour duplex scanning of the penis in
regard to diagnosis of arterial insufficiency in diabetic patients.
Peak systolic velocity (PSV) was the only significant parameter of colour duplex ultrasonography in diagnosis of arteriogenic impotence where post-infusion DROP of intracavernosal pressure was the only significant parameter of pharmacocavernosometry in diagnosis of venous leakage in diabetic patients.
Registration of cavernous electrical activity using SPACE device can differentiate between the normal autonomic supply to cavernous tissue and autonomic neuropathy, as a possible cause of impotence among diabetic patients, through the shape, amplitude and degree of synchronization of the registered potentials.
There was a significant correlation between neurogenic bladder symptoms, especially decrease the urinary flow rate due to non-obstructive causes, and autonomic neuropathy diagnosed by penile electromyography using SPACE device.
Summary
169
Management of impotence was based on the etiology of impotence in each diabetic man. Prosthesis implantation, venoligation, suction device, pharmacologic injection program, medical and hormonal treatment were
the modalities of treatment encountered in this study. 15 patients (23%) required another modality of treatment after failure of their initial therapy.
The response to each modality of treatment was followed up to one year.
Patients treated by prosthesis implantation (11 patients) showed good response, in regard to sexual satisfaction, in 71.4% 6 to 12 months after surgery with low complication rate in the form of periprosthetic infection (9%) and under-sizing of the prosthesis (18%).
Venoligation surgery was the modality of treatment in 12 patients with proved venous leakage. Follow up of these patients revealed long-term deterioration where non of these patients reported satisfactory results one year after surgery.
The majority of patients treated by intracavernosal injection of vaso-active agents and vacuum constriction device showed satisfactory results.
The response obtained by diabetic patients treated medically was gradually improved, especially those patients with psychogenic impotence, where 40% of those patients showed good response 6 to 12 months after treatment.