Abstract

Erectile dysfunction (ED) is one of the most common complications of diabetes, being oxidative stress an important feature of diabetic ED. Deleterious events induced by oxidative stress lead to crucial cellular and tissue alterations targeted by oxidative lesions. However, the noxious effects of oxidative stress mechanisms in penile tissue with the progression of diabetes, remains unclear. We intended to evaluate systemic and penile oxidative stress in an early and late stage of diabetes. Male Wistar rats were divided in groups: 2 and 8‐weeks of streptozotocin‐induced type 1 diabetes, and age‐matched controls. Systemic oxidative stress was evaluated in urine by hydrogen peroxide (H2 O2 ) quantification and in plasma by reduced/oxidized glutathione (GSH/GSSG) ratio. Penile oxidative status was assessed by H2 O2 production and by the evaluation of protein nitration through the detection of 3‐nitrotyrosine (3‐NT). 3‐NT was quantified by Western blotting analysis and immunohistochemistry allowed to identify its cavernosal cellular location. Systemic evaluation revealed a significant increase in urinary H2 O2 levels in both diabetic groups. A significant decrease of circulating GSH/GSSG ratio was observed in animals with late stage diabetes. In cavernosal tissue, H2 O2 production was significantly increased at 8‐weeks diabetes. Regarding 3‐NT cavernosal formation, data revealed a significant increment in advanced diabetes and a predominant location in cavernosal smooth muscle cells. We observed that systemic and cavernosal noxious effects induced by oxidative stress are predominant in advanced diabetes. Increased penile protein oxidative modifications in late‐staged diabetes may be responsible for structural/functional deregulations in cellular/molecular systems, contributing to the development of diabeticassociated ED.

Abstract

Penile prosthesis implantation is a common, well‐established treatment for correcting medical refractory erectile dysfunction. Although more invasive than some of the other currently available therapies, PP surgery has the advantages of high patient satisfaction rates. The aim of this study was to evaluate the surgical results and patient satisfaction after implantation of PP in 25 patients treated at the University Hospital of Coimbra (CHUC). We evaluated 25 patients with erectile dysfunction who underwent implantation of PP, inflatable and semi‐rigid, between November 2000 and November 2013. The information was obtained from medical records and telephone interviews and encompassed clinical severity, comorbidity, etiology, PP type, surgical complications, need for reintervention and degree of patient satisfaction. 88% of patients had severe ED. The main etiologies reported were: multifactorial (46.4%), atherogenic (24%) and neurologic (16%). Most devices implanted were inflatable prostheses (84%). In 80% of the cases there were no complications reported, the rate of re‐intervention was 20%. There were a high percentage of satisfied / very satisfied patients (65%). PP surgery remains an excellent alternative in restoring erectile function in patients whose medical therapies have failed. Despite its invasive nature, the implementation of PP has proven to be associated with a low rate of complications and a high degree of patient satisfaction.