Оценка эффективности ингибитора фосфодиэстеразы 5-го типа в терапии нейрогенной эректильной дисфункции у пациентов с сахарным диабетом 1-го типа

Urogenital form of autonomous diabetic polyneuropathy is a specific lesion of the autonomic nervous system in patients with diabetes mellitus (DM) and is the main pathogenetic cause of sexual dysfunction in these patients. The most common form of the sexual dysfunction in patients with DM is an erectile dysfunction, the risk of which is at 3 times higher for patients with DM compared to the population without it. Considering that patients with DM are a special group because of the presence of specific complications, preferences in therapy is given to inhibitors of PDE-5 type inhibitors. Aim — optimization of diagnosis and treatment of neurogenic erectile dysfunction caused by urogenital autonomic diabetic neuropathy in patients with type 1 diabetes. Material and methods. The study included 40 patients with DM type 1 at the age of 25.7±6.1 years. The duration of the DM type 1 18±9.7 years. The average level of glycated hemoglobin at the time of inclusion of patients in the study 7.1±1.3%. All patients in addition to general clinical examination performed neuromyography of peroneal nerve and pudendal nerve (at baseline and after a course of therapy with sildenafil) and the analysis of endothelial function on the EndoPat ™ (baseline and after a course of therapy with sildenafil). Results. At baseline, all 40 men s complained on the quality of erection of varying severity. In 30 (75.0%) of men according to a survey on the unit EndoPat ™ determined endothelial dysfunction (RHI 1.45±0.16). In the range of the gray zone (RHI 1.79±0.13) IRG was detected in 7 (16.6%) men. RHI values, indicating normal functioning of the endothelium, were obtained in 3 (8.4%) cases. After 6 weeks, analisys of endothelial function after the course of treatment with sildenafil was repeated: endothelial dysfunction was found in 6 (16.6%) patients, in the range of the gray zone RHI was registered in 14 (33.4%). Evidence about normalized endothelial function were obtained from 20 (50.0%) patients. The results of neuromyomyographic test of n. peroneus and n. pudendus confirmed the presence of distal diabetic neuropathy and urogenital form of autonomic diabetic neuropathy baseline in all patients. Retest after treatment showed a significant positive trend in our patients. Conclusion. Our study showed the advisability of using inhibitiors PDE-5, in particular sildenafil, not only to improve erectile function in patients with DM type 1, but also to improve endothelial function and condition of the peripheral nerves. We are convinced that the examination of such patients should include both of these methods, because diabetic neuropathy in patients with DM directly linked with endothelial dysfunction.