Skip to main content

Genitourinary Complications

  • Chapter
Diabetic Neuropathy

Part of the book series: Clinical Diabetes ((CLD))

Abstract

Urogenital complications are frequently found in patients with diabetes. In the overwhelming majority, neuropathy and/or angiopathy are the etiologies or most pronounced coetiologies of micturition or sexual dysfunctions. As the impairment of bladder storage and emptying as well as the erectile and ejaculatory dysfunction may have severe organic and psychosocial consequences, their existence (often inapparent to the patient) should be systematically screened for in the routine diabetes clinic. Given hints of existence, comprehensive evaluation of the impaired organ system is mandatory. For treatment, a wide spectrum of various approaches is available and can be individually offered following appropriate diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Stief CG, Ziegler D. Diabetic autonomic neuropathy. Urogenital system, In Textbook of diabetic neuropathy (Gries FA, Cameron NE, Low PA, Ziegler D, eds.), Thieme, Stuttgart, New York, 2003;262–274.

    Google Scholar 

  2. Paro M, Prashar A, Prosdocimi M, Cherian PV, Fiori MG, Sima, AAF. Urinary bladder dyfunction in the BB/W diabetic rat. J Urol 1994;151:781–786.

    PubMed  CAS  Google Scholar 

  3. Liu G, Daneshgari F. Alterations in neurogenically mediated contractile responses of urinary bladder in rats with diabetes. Am J Physiol Renal Physiol 2005;288:F1220–F1226.

    Article  PubMed  CAS  Google Scholar 

  4. Mannikarottu AS, Changolkar AK, Disanto ME, Wein AJ, Chacko S. Over expression of smooth muscle thin filament associated proteins in the bladder wall of diabetics. J Urol 2005; 174:360–364.

    Article  PubMed  CAS  Google Scholar 

  5. Ellenberg M. Development of urinary bladder dysfunction in diabetes mellitus. Ann Int Med 1980;92:321–323.

    PubMed  CAS  Google Scholar 

  6. Kaplan SA, Blavas TeAE, Urodynamic findings in patients with diabetic cystopathy. J Urol 1995; 153:342–344.

    Article  PubMed  CAS  Google Scholar 

  7. Starer P, Libow L. Cystometric evaluation of bladder dysfunction in elderly diabetic patients. Arch Intern Med 1990;150:810–816.

    Article  PubMed  CAS  Google Scholar 

  8. Brown JS, Wessells H, Chancellor MB, et al. Urologic complications of diabetes. Diabetes Care 2005;28:177–185.

    Article  PubMed  Google Scholar 

  9. Jackson RA, Vittinghoff E, Kanaya AM, et al. Aging and Body Composition (Health ABC) Research Group: Urinary incontinence in elderly women: finding from the Health, Aging, and Body Composition Study. Obstet Gynecol 2004; 104:301–307.

    PubMed  CAS  Google Scholar 

  10. Thon WF, und Stief CG. Blasenfunktionsstörungen als urologische Diabetes-Komplikation. Der Kassenarzt 1996;23:40–48.

    Google Scholar 

  11. Thon WF, und Grünewald V. Neurostimulation. Curr Opin Urol 1993;3:295–302.

    Article  Google Scholar 

  12. Grünewald V, Thon WF, Jonas U. Neuromodulation bei neurogener Blasenfunktionsstörung, In Neurogene Blasenfunktionsstörungen (herausgeg von Stöhrer M, Madersbacher H, und Palmtag H, eds.), Springer, Heidelberg 1996, pp. 163–175.

    Google Scholar 

  13. Thon WF. Elektrostimulation der sakralen Spinalnerven bei Blasenfunktionsstörungen. Med Welt 1994;45:195–203.

    Google Scholar 

  14. Eri LM, Tveter KJ. Alpha blockade in the treatment of symptomatic benign prostatic hyperplasia. J Urol 1995; 154:923–934.

    Article  PubMed  CAS  Google Scholar 

  15. Lue TF, Giuliano F, Montorsi F, et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med 2004; 1:6–23.

    Article  PubMed  Google Scholar 

  16. Wagner G, Saenz de, Tejada I. Update on male erectile dysfunction. Br Med J 1998;316: 678–682.

    CAS  Google Scholar 

  17. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts male ageing study. J Urol 1994;151:54–61.

    PubMed  CAS  Google Scholar 

  18. Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U. Epidemiology of erectile dysfunction: results of the “.Cologne Male Survey.” Int J Impot Res 2000;12:305–311.

    Article  PubMed  CAS  Google Scholar 

  19. Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. J Urol 2000; 163:460–463.

    Article  PubMed  CAS  Google Scholar 

  20. Klein R, Klein BE, Lee KE, Moss SE, Cruickshanks KJ. Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 1996;19:135–141.

    Article  PubMed  CAS  Google Scholar 

  21. Fedele D, Coscelli C, Santeusanio F, et al. Erectile dysfunction in diabetic subjects in Italy. Diabetes Care 1998;21:1973–1977.

    Article  PubMed  CAS  Google Scholar 

  22. Parazzini F, Menchini FF, Bortolotti A, et al. Frequency and determinants of erectile dysfunction in Italy. Eur Urol 2000;37:43–49.

    Article  PubMed  CAS  Google Scholar 

  23. Lustman PJ, Clouse RE. Relationship of psychiatric illness to impotence in men with diabetes. Diabetes Care 1990;13:893–895.

    Article  PubMed  CAS  Google Scholar 

  24. Lue TF. Erectile dysfunction. N Engl J Med 2000;342:1802–1813.

    Article  PubMed  CAS  Google Scholar 

  25. Saenzde Tejada I, Goldstein I. Diabetic penile neuropathy. Urol Clin North Am 1988;15:17–22.

    Google Scholar 

  26. Seftel AD, Vaziri ND, Ni Z, et al. Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology 1997;50:1016–1026.

    Article  PubMed  CAS  Google Scholar 

  27. Hirata K, Kuroda R, Sakoda T, et al. Inhibition of endothelial nitric oxide synthase activity by protein kinase C. Hypertension 1995;25:180–185.

    PubMed  CAS  Google Scholar 

  28. Saenz de, Tejada I, Goldstein I, Azadzoi K, Krane RJ, Cohen RA. Impaired neurogenic and endothelium-mediated relaxation of penile smooth muscle from diabetic men with impotence. N Engl J Med 1989;320:1025–1030.

    Article  Google Scholar 

  29. Keegan A, Cotter MA, Cameron NE. Effects of diabetes and treatment with the antioxidant á-lipoic acid on endothelial and neurogenic responses of corpus cavernosum in rats. Diabetologia 1999;42:343–350.

    Article  PubMed  CAS  Google Scholar 

  30. Elabbady AA, Gagnon C, Hassouna MM, Begin LR, Elhilali MM. Diabets mellitus increases nitric oxide synthase in penises but not in major pelvic ganglia of rats. Br J Urol 1995;76:196–202.

    Article  PubMed  CAS  Google Scholar 

  31. Vernet D, Cai L, Garban H, et al. Reduction of penile nitric oxide synthase in diabetic BB/WORdp (type I) and BBZ/WORdp (type II) rats with erectile dysfunction. Endocrinology 1995;136:5709–5717.

    Article  PubMed  CAS  Google Scholar 

  32. Bivalacqua TJ, Champion HC, Usta MF, et al. RhoA/Rho-kinase suppresses endothelial nitric oxide synthase in the penis: a mechanism for diabetes-associated erectile dysfunction. Proc Natl Acad Sci USA 2004;101:9121–9126.

    Article  PubMed  CAS  Google Scholar 

  33. American Urological Association. Management of Erectile Dysfunction (’05/updated’06), http://www.auanet.org/guidelines/main_reports/edmgmt/chapter1.pdf.

    Google Scholar 

  34. Ralph D, McNicholas T. UK management guidelines for erectile dysfunction. BMJ 2000;321:499–503.

    Article  PubMed  CAS  Google Scholar 

  35. Azad N, Emanuele NV, Abraira C, et al. The effects of intensive glycemic control on neuropathy in the VA Cooperative Study on Type II diabetes mellitus. J Diabetes Complications 2000;13:307–313.

    Article  Google Scholar 

  36. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004;291:2978–2984.

    Article  PubMed  CAS  Google Scholar 

  37. Vogt HJ, Brandl P, Kockott G, et al. Double-blind, placebo-controlled safety and efficacy trial with yohimbine hydrochloride in the treatment of nonorganic erectile dysfunction. Int J Impot Res 1997;9(3): 155–161.

    Article  PubMed  CAS  Google Scholar 

  38. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and metaanalysis of randomized clinical trials. J Urol 1998;159:433–436.

    Article  PubMed  CAS  Google Scholar 

  39. Rampin O, Bernabe J, Guilano F. Spinal control of penile erection. World J Urol 1997;15:2–13.

    Article  PubMed  CAS  Google Scholar 

  40. Padma-Nathan H, Auerbach S, Lewis R, Lewand M, et al. Efficacy and safety of Apomorphin vs placebo for male erectile dysfunction. J Urol 1999; 161:821.

    Google Scholar 

  41. Lewis R, Agre K, Rudd D. Efficacy of Apomorphin vs Placebo for erectile dysfunction in patients with hypertension. J Urol 1999;161:822.

    Article  Google Scholar 

  42. Reproductive Health Drugs Advisory Committee. Urology Subcommittee. www.fda.gov/ ohrms/dockets/ac/00/transcripts/36021.rtf.

    Google Scholar 

  43. Küthe A, Wiedentoth A, Stief C, Mägert H, Forssmann W, Jonas U. Identification of 13 PDE isoforms in human cavernous tissue. Eur Urol 1999;35:404.

    Google Scholar 

  44. Taher A, Stief CG, Raida M, Jonas U, Forssmann WG. Cyclic nucleotide phosphodiesterase activity in human cavernous smooth muscle and the effect of various selective inhibitors. Int J Impotence Res 1992;4(Suppl 2):P11.

    Google Scholar 

  45. Rendell MS, Rajfer J, Wicker PA, Smith MD. Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group. JAMA 1999;281:421–426.

    Article  PubMed  CAS  Google Scholar 

  46. Boulton AJM, Selam J-L, Sweeney M, Ziegler D. Sildenafil citrate for the treatment of erectile dysfunction in men with type II diabetes mellitus. Diabetologia 2001;44:1296–1301.

    Article  PubMed  CAS  Google Scholar 

  47. Sellam R, Ziegler D, Boulton AJM. Sildenafil citrate is effective and well tolerated for the treatment of erectile dysfunction in men with Type 1 or Type 2 diabetes mellitus. Diabetologia 2000;43(Suppl 1):A253.

    Google Scholar 

  48. Mitka M. Some men who take Viagra die—Why? JAMA 2000;283:590–593.

    Article  PubMed  CAS  Google Scholar 

  49. Shakir SAW, Wilton LV, Boshier A, Layton D, Heeley E. Cardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England. Br Med J 2001;322:651–652.

    Article  CAS  Google Scholar 

  50. Herrmann HC, Chang G, Klugherz BD, Mahoney PD. Hemodynamic effects of sildenafil in men with severe coronary artery disease. N Engl J Med 2000; 342:1622–1626.

    Article  PubMed  CAS  Google Scholar 

  51. De Angelis L, Marfella MA, Siniscalchi M, et al. Erectile and endothelial dysfunction in Type II diabetes: a possible link. Diabetologia 2001;44:1155–1160.

    Article  PubMed  Google Scholar 

  52. Desouza C, Parulkar A, Lumpkin D, Akers D, Fonseca VA. Acute and prolonged effects of sildenafil on brachial artery flow-mediated dilatation in type 2 diabetes. Diabetes Care 2002;25:1336–1339.

    Article  PubMed  CAS  Google Scholar 

  53. Katz SD, Balidemaj K, Homma S, Wu H, Wang J, Maybaum S. Acute type 5 phosphodiesterase inhibition with Sildenafil enhances Flow mediated vasodilation in patients with chronic heart failure. J Am Coll Cardiol 2000;36:845–851.

    Article  PubMed  CAS  Google Scholar 

  54. Cheitlin MD, Hutter AM, Brindis RG, et al. Use of sildenafil (Viagra) in patients with cardiovascular disease. Circulation 1999;99:168–177.

    PubMed  CAS  Google Scholar 

  55. Stolk EA, Busschbach JJ, Caffa M, Meuleman EJ, Rutten FF. Cost utility analysis of sildenafil compared with papaverine-phentolamine injections. BMJ 2000;320:1165–1168.

    Article  PubMed  CAS  Google Scholar 

  56. Smith KJ, Roberts MS. The cost-effectiveness of sildenafil. Ann Intern Med 2000; 132: 933–937.

    PubMed  CAS  Google Scholar 

  57. Wespes E, Rammal A, Garbar C. Sildenafil non-responders: haemodynamic and morphometric studies. Eur Urol 2005;48:136–139.

    Article  PubMed  CAS  Google Scholar 

  58. Saenz de, Tejada I, Anglin G, Knight JR, Emmick JT. Effects of tadalafil on erectile dysfunction in men with diabetes. Diabetes Care 2002;25:2159–2164.

    Article  Google Scholar 

  59. Fonseca V, Seftel A, Denne J, Fredlund P. Impact of diabetes mellitus on the severity of erectile dysfunction and response to treatment: analysis of data from tadalafil clinical trials. Diabetologia 2004;47:1914–1923.

    Article  PubMed  CAS  Google Scholar 

  60. Goldstein I, Young JM, Fischer J, et al. Vardenafil, a new phosphodiesterase type 5 inhibitor, in the treatment of erectile dysfunction in men with diabetes: a multicenter double-blind placebo-controlled fixed-dose study. Diabetes Care 2003;26:777–783.

    Article  PubMed  CAS  Google Scholar 

  61. Ziegler D, Merfort F, van Ahlen H, Yassin A, Reblin T, Neureither M. Efficacy and safety of flexible-dose vardenafil in men with type 1 diabetes and erectile dysfunction. J Sex Med 2006;3:883–891.

    Article  PubMed  CAS  Google Scholar 

  62. Becker AJ, Stief CG, Machtens S, Schultheiss D, Truss MC, Jonas U. Oral phentolamine as treatment for erectile dysfunction. J Urol 1998; 159:1214–1216.

    Article  PubMed  CAS  Google Scholar 

  63. Dutta TC, Eid JF. Vacuum constriction devices for erectile dysfunction: a long-term, prospective study of patients with mild, moderate, and severe dysfunction. Urology 1999; 54:891–893.

    Article  PubMed  CAS  Google Scholar 

  64. Padma-Nathan H, Hellstrom WJ, Kaiser FE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med 1997;336:1–7.

    Article  PubMed  CAS  Google Scholar 

  65. Porst H. Transurethrale Alprostadilapplikation mit MUSE™ (medicated urethral system for erection). Urologe [A] 1998;37:410–416.

    Article  CAS  Google Scholar 

  66. Spivack AP, Peterson CA, Cowley C, et al. Long-term safety profile of transurethral alprostadil for the treatment of erectile dysfunction. J Urol 1997;157(Supp l):203.

    Google Scholar 

  67. Fulgham PF, Cochran JS, Denman JL, et al. Disappointing initial results with transurethral alprostadil for erectile dysfunction in a urology practice setting. J Urol 1998;160:2041–2046.

    Article  PubMed  CAS  Google Scholar 

  68. Linet OI, Ogrinc FG. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group. N Engl J Med 1996;334:873–877.

    Article  PubMed  CAS  Google Scholar 

  69. Shabsigh R, Padma-Nathan H, Gittleman M, McMurray J, Kaufman J, Goldstein I. Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over intraurethral alprostadil plus optional actis: a comparative, randomized, crossover, multicenter study. Urology 2000;55:109–113.

    Article  PubMed  CAS  Google Scholar 

  70. Porst H, Buvat J, Meuleman EJH, Michal V, Wagner G. Final results of a prospective multicenter study with self-injection therapy with PGE1 after 4 years of follow-up. Int J Impot Res1996;6:151:D118.

    Google Scholar 

  71. Ewing DJ, Clarke BF. Diabetic autonomic neuropathy: present insights and future prospects. Diabetes Care 1986;9:648–665.

    PubMed  CAS  Google Scholar 

  72. Enzlin P, Mathieu C, Van Den Bruel A, Vanderschueren D, Demyttenaere K. Prevalence and predictors of sexual dysfunction in patients with type 1 diabetes. Diabetes Care 2003;26:409–414.

    Article  PubMed  Google Scholar 

  73. Esposito K, Ciotola M, Marfella R, Di Tommaso D, Cobellis L, Giugliano D. The metabolic syndrome: a cause of sexual dysfunction in women. Int J Impot Res 2005; 17:224–226.

    Article  PubMed  CAS  Google Scholar 

  74. Enzlin P, Mathieu C, Vanderschueren D, Demyttenaere K. Diabetes mellitus and female sexuality: a review of 25 years’ research. Diabetes Med 1998;15:809–815.

    Article  CAS  Google Scholar 

  75. Jovanovic L. Sex and the woman with diabetes: desire versus dysfunction. IDF Bull 1998;43:23–28.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Ziegler, D., Stief, C. (2007). Genitourinary Complications. In: Veves, A., Malik, R.A. (eds) Diabetic Neuropathy. Clinical Diabetes. Humana Press. https://doi.org/10.1007/978-1-59745-311-0_27

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-311-0_27

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-626-9

  • Online ISBN: 978-1-59745-311-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics