Radiogenic erectile dysfunction

Frequency data vary between 22-84% [20]. For interstitial radiation, the incidence of postoperative sexual dysfunction is said to be more favorable [5]. According to Goldstein [6], radiotherapy is said to accelerate arteriosclerotic changes in the iliac arteries. Accordingly, the erectile dysfunctions induced by it were mainly of arterial origin. However, the sometimes abrupt onset of symptoms with the start of therapy in some patients also casts doubt on this hypothesis. In radical prostatectomy of previously radiotherapied patients, the vascular-nerve bundle is found in a thick scar plate, so that compression occlusion of the arteries in this area also seems possible.

4.6 Diabetes mellitus

About 50% of patients with diabetes mellitus are expected to develop erectile dysfunction in the course of their disease [18]. Erectile dysfunction may also be the first clinical manifestation of as yet unknown diabetes mellitus. Aetiologically, micro- and macroangiopathy of the penile vessels, neuropathy, but also damage in the cavernous tissue [13] must be included in the differential diagnostic considerations. In vitro studies of isolated corpus cavernosum strips from impotent diabetic patients also demonstrated that endothelium-dependent relaxation of the tissue was attenuated [24]. During the diagnostic workup, SKAT responders and SKAT non-responders are found. The workup should definitely include a bladder function examination, since bladder voiding dysfunction may be the first sign of autonomic neuropathy. Therapeutically, SKAT was preferred for SKAT responders and a vacuum suction pump (EHS) was used as a therapeutic option for non-responders. Other research groups even generally prefer the use of the vacuum pump [18]. Hauri [9] reported good success of arterial revascularization of penile gradients. However, because of the insufficient detection of vegetative neuropathies and the damage in the cavernous tissue demonstrated by light microscopy in patients with diabetes mellitus, other authors urge surgical restraint in this disease.

A compilation by Price et al. [18] criticized the current lack of information on erectile dysfunction treatment among both patients and physicians. Although most patients with erectile dysfunction wanted treatment, they rarely approached their GP about the problem or received merely useless advice from their doctor [12].

4.7 Scleroderma (progressive systemic sclerosis)

The occurrence of erectile dysfunction has also been reported in scleroderma, which belongs to the group of collagenoses [17]. Contrast cavities in the cavernosogram [18] and local accumulations of collagenous connective tissue [23] in the corpus cavernosum detectable by light microscopy suggest an organic cause in the sense of cavernous fibrosis. Because of the frequent occurrence of Raynaud's phenomenon in the hands of these patients, a secondary arteriopathy seems to be a relevant etiopathogenetic factor. Therapeutically, D-penicillamine and corticosteroids are used in the usually unfavorable course of the underlying disease, but little information is available on the value of this therapy in influencing erectile dysfunction. Isolated reports have been made of penile prosthesis implantation, which is difficult because of extensive cavernous fibrosis, and also of prosthesis removal because of postoperative glans necrosis [1]. In any case, interdisciplinary therapy planning with consideration of the overall prognosis seems reasonable.

Summary

Injuries to the penis or adjacent structures and diseases of the corpus cavernosum may be associated with erectile dysfunction. This must be considered during the history and clinical examination. Erectile dysfunction can also be a consequence of therapeutic interventions, and the patient must be informed of this preoperatively. In diabetes mellitus, erectile dysfunction must be expected to occur in every second patient in the course of the disease.

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