Department of Andrology, Imperial Healthcare NHS Trust, London, UK.
Department of Reproductive Endocrinology, Imperial Healthcare NHS Trust, London, UK.
Andrology. 2023 Feb;11(2):379-398. doi: 10.1111/andr.13262. Epub 2022 Aug 26.
Diabetes mellitus is a rapidly rising metabolic disorder with important systemic complications. Global figures have demonstrated the prevalence of diabetes mellitus has almost quadrupled from 108 million in 1980 to 422 million in 2014, with a current prevalence of over 525 million. Of the male sexual dysfunction resulting from diabetes mellitus, significant focus is afforded to erectile dysfunction. Nevertheless, ejaculatory dysfunction constitutes important sexual sequelae in diabetic men, with up to 35%-50% of men with diabetes mellitus suffering from ejaculatory dysfunction. Despite this, aspects of its pathophysiology and treatment are less well understood than erectile dysfunction. The main disorders of ejaculation include premature ejaculation, delayed ejaculation, anejaculation and retrograde ejaculation. Although ejaculatory dysfunction in diabetes mellitus can have complex multifactorial aetiology, understanding its pathophysiological mechanisms has facilitated the development of therapies in the management of ejaculatory dysfunction. Most of our understanding of its pathophysiology is derived from diabetic animal models; however, observational studies in humans have also provided useful information in elucidating important associative factors potentially contributing to ejaculatory dysfunction in diabetic men. These have provided the potential for more tailored treatment regimens in patients depending on the ejaculatory disorder, other co-existing sequelae of diabetes mellitus, specific metabolic factors as well as the need for fertility treatment. However, evidence for treatment of ejaculatory dysfunction, especially delayed ejaculation and retrograde ejaculation, is based on low-level evidence comprising small sample-size series and retrospective or cross-sectional studies. Whilst promising findings from large randomised controlled trials have provided strong evidence for the licensed treatment of premature ejaculation, similar robust studies are needed to accurately elucidate factors predicting ejaculatory dysfunction in diabetes mellitus, as well as for the development of pharmacotherapies for delayed ejaculation and retrograde ejaculation. Similarly, more contemporary robust data are required for fertility outcomes in these patients, including methods of sperm retrieval and assisted reproductive techniques in retrograde ejaculation.
糖尿病是一种迅速上升的代谢紊乱，伴有重要的全身并发症。全球数据表明，糖尿病的患病率从 1980 年的 1.08 亿增加到 2014 年的 4.22 亿，目前患病率超过 5.25 亿。在糖尿病引起的男性性功能障碍中，勃起功能障碍受到了极大的关注。然而，射精功能障碍是糖尿病男性重要的性后遗症，高达 35%-50%的糖尿病男性患有射精功能障碍。尽管如此，其病理生理学和治疗方面的理解还不如勃起功能障碍。射精的主要障碍包括早泄、延迟射精、不射精和逆行射精。尽管糖尿病患者的射精功能障碍可能具有复杂的多因素病因，但了解其病理生理学机制有助于开发治疗射精功能障碍的疗法。我们对其病理生理学的大部分理解来自于糖尿病动物模型；然而，对人类的观察性研究也提供了有用的信息，阐明了可能导致糖尿病男性射精功能障碍的重要关联因素。这为根据射精障碍、糖尿病的其他共存后遗症、特定代谢因素以及生育治疗的需要，为患者制定更有针对性的治疗方案提供了可能性。然而，射精功能障碍的治疗证据，特别是延迟射精和逆行射精的治疗证据，仅基于低水平证据，包括小样本量的系列研究和回顾性或横断面研究。虽然来自大型随机对照试验的有希望的结果为获得许可的早泄治疗提供了强有力的证据，但仍需要类似的强有力研究来准确阐明预测糖尿病患者射精功能障碍的因素，以及开发治疗延迟射精和逆行射精的药物疗法。同样，这些患者的生育结局也需要更现代的、强有力的数据，包括逆行射精患者的精子获取方法和辅助生殖技术。
