La Vignera S, Calogero A E, Condorelli R, Lanzafame F, Giammusso B, Vicari E
Endocrinology Section, Andrology and Internal Medicine, Biomedical Science Department, Garibaldi Hospital (Centre), University of Catania, Catania, Italy.
Minerva Endocrinol. 2009 Mar;34(1):1-9.
In the management of the chronic complications caused by diabetes mellitus, an important role is played to andrological problematics, which require a specialistic evaluation combined in order to concretely contribute to the improvement of quality of life of such patients. The erectile disfunction in the diabetic patient notoriously correlates with the main cardiometabolics risk factors, and recently it has been pointed out how after chronic use of inhibitors of the phospodiesterase-enzyme-5 (PDE5-I) it is possible to improve the vascular response profile, evaluated through ecolor doppler (ECD) penile dynamic. The incidence of the vascular extra-genital pathology in the patients with ED of organic arterial type has also been observed, underlining in particular the correlation with a low value of the systolic peak at penile level. Little attention has been paid to other andrologic pathologies that preliminary clinic evidences or less followed research points have individuated as real emerging problems; among them there are: 1) the hypogonadism in adult age (late onset hypogonadism); 2) the lower urinary tract symptoms (LUTS) correlated to the condition of prostatic hypertrophy; 3) the infections of the male genito-urinary tract with different characterization for imaging respect to the not diabetic population; 4) different sexual disorders; 5) implications over the male reproductive sphere.
Retrospective analysis of the clinic, laboratory (spermatic, microbiologic and hormonal), ultrasonography integrated data, led on a diabetic population examined during the last 3 years; finalized at the estimation of the distribution of the andrological pathology characterizing such population, with the comparison of the data on the basis of years of duration disease, grade of glicometabolic compensation and levels of total testosterone.
ED was present in 16.36% of the examined population; 50% showed vascular arterial form; hypogonadism was present in 10% of the population. A very high prevalence of subfertility was observed 51.82%. The ultrasonographic characterization of the didimo-epididimary and prostatic-vesicular regions showed reduced testicular volume the 16.36% of cases, increase of the prostatic glandular volume in 45.45% of cases, altered thickness of the seminal vesicles in the 24.45% of cases. The microbiologic characterization evidences the contemporary positivity of the 3 prechosen indicators (spermiocolture, urinocolture, leukocytospermia) in 34.55% of patients.
The study has contributed to enrich the data relative to the heterogeneity of the clinic-andrological presentation of the diabetic patient.
在糖尿病所致慢性并发症的管理中，男性学问题起着重要作用，这需要进行专业评估，以便切实有助于改善此类患者的生活质量。糖尿病患者的勃起功能障碍与主要的心血管代谢危险因素显著相关，最近有研究指出，长期使用磷酸二酯酶-5抑制剂（PDE5-I）后，通过阴茎彩色多普勒（ECD）动态评估，可以改善血管反应情况。在患有器质性动脉型勃起功能障碍的患者中，也观察到了血管外生殖器病变的发生率，尤其强调了与阴茎水平收缩期峰值低值的相关性。对于其他男性学病理情况，关注较少，初步临床证据或较少受到关注的研究指出这些是真正新出现的问题；其中包括：1）成年期性腺功能减退（迟发性性腺功能减退）；2）与前列腺肥大相关的下尿路症状（LUTS）；3）男性生殖泌尿系统感染，其影像学特征与非糖尿病人群不同；4）不同的性功能障碍；5）对男性生殖领域的影响。
对过去3年检查的糖尿病患者人群进行临床、实验室（精液、微生物和激素）、超声综合数据的回顾性分析；旨在评估该人群男性学病理特征的分布情况，并根据病程、糖代谢补偿程度和总睾酮水平对数据进行比较。
在检查人群中，16.36%存在勃起功能障碍；50%表现为血管动脉型；10%的人群存在性腺功能减退。观察到不育症的患病率非常高，为51.82%。睾丸-附睾和前列腺-精囊区域的超声特征显示，16.36%的病例睾丸体积减小，45.45%的病例前列腺腺体积增加，24.45%的病例精囊厚度改变。微生物学特征表明，34.55%的患者3个预选指标（精液培养、尿液培养、白细胞精子症）同时呈阳性。
该研究有助于丰富有关糖尿病患者临床-男性学表现异质性的数据。
