Treatment Options for Erectile Dysfunction in Diabetics

Abstract

Erectile dysfunction (ED) is defined as the persistent inability to achieve or maintain a penile erection suitable for sexual intercourse. This condition is common with diabetic males. This article comprehensively reviews various treatment options for Erectile Dysfunction (ED) in diabetic men, with a specific focus on the potential of Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT). Persistent hyperglycemia may decrease nitric oxide (NO) generation, the cycloguanosine monophosphate (cGMP) pathway, reactive free radical levels, the RhoA/Rho kinase pathway, and nerve function, all of which may be contributing factors to ED in diabetic patients. Elevated AGE expression in diabetes individuals' corpus cavernosum may result in structural alterations to the tissue, including thicker arterial walls, decreased flexibility, endothelial dysfunction, and atherosclerosis. Chronic hyperglycemia can produce nerve injury that affects both autonomic and other sensory patterns. The following are existing treatment options for ED; oral phosphodiesterase type 5 (PDE5) inhibitor, intracavernosal injection therapy, Intraurethral PGE1 suppository (IUS), Vacuum Erection Device (VED) and penile prosthesis or penile implant. Low-Intensity Extracorporeal Shockwave therapy (LI-ESWT), the treatment options for ED is a non-invasive procedure that focuses on address the root causes of ED. The mechanism underlying the efficacy of shock wave treatment is vasodilation and angiogenesis leading to improved blood flow to the penis by upregulating vascular endothelial growth factor (VEGF), nitric oxide synthase (NOS) and proliferating cell nuclear antigen. The review unveiled the success potential of (LI-ESWT) in treating diabetic impotence.