Erectile Dysfunction in Diabetic Patients: Surgical Options Explored

Sexual dysfunction in patients with diabetes?

I am a diabetic patient and have been diagnosed with diabetes for about 10 years.
My blood sugar control is approximately an HbA1c of 7.
In my younger years (around 20 to 30 years old), I experienced difficulty with ejaculation, but when I engage in self-stimulation, I can ejaculate normally.
However, during actual intercourse, I often find myself exhausted and still unable to ejaculate.
I have been experiencing erectile dysfunction for about 6 to 7 years, which I believe is severe.
I do not have morning erections, and I cannot achieve an erection even during self-stimulation.
At most, there is a slight increase in size, but there is no rigidity at all.
I consulted a urologist, who prescribed Cialis, but the medication does not always work.
Even when I take the medication, the rigidity is not sufficient, and it softens after just a few minutes.
Recently, I have been unable to achieve an erection even with medication, and the side effects of taking Cialis or Viagra make me very uncomfortable, causing eye strain and headaches.

I recently came across the surgical procedure proposed by Dr.
Hsu Geng-Rong, which piqued my interest.
However, I found some online reports suggesting that some patients experienced a return of erectile dysfunction shortly after surgery due to the proliferation of other uncut microvessels.
Yet, Dr.
Hsu's research claims that the new surgical method he has discovered does not have this issue.
I would like to ask for your opinion on this new penile venous ligation surgery.
Is it true that erectile function may diminish again shortly after the procedure? Given the severity of my symptoms, would you recommend that I undergo this surgery? Thank you.

Xiao Shen, 40~49 year old female. Ask Date: 2011/08/02

Dr. Xu Weikai reply Urology

Hello, regarding erectile dysfunction, it is advisable to consider further examinations to determine the underlying cause, whether it is neurological or vascular.
This is essential for proceeding with appropriate surgical treatments.
Common reasons for treatment failure often stem from inaccurate diagnoses, such as addressing a neurological issue with a vascular surgical approach, which is not ideal.
If you have any further questions or need clarification, feel free to ask, and we can discuss and research together.
This message is from Dr.
Hsu Wei-Kai, Director of the Urology Department, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2011/08/02

More Info

Erectile dysfunction (ED) is a common issue among diabetic patients, often resulting from a combination of vascular, neurological, and psychological factors. Given your history of diabetes for about ten years and your struggles with severe ED, it’s understandable that you are exploring surgical options, particularly the penile venous stripping procedure proposed by Dr. Hsu.

Firstly, it’s essential to recognize that diabetes can lead to vascular damage, which affects blood flow to the penis, resulting in difficulties achieving and maintaining an erection. The fact that you have experienced ED for several years, along with other symptoms like difficulty with ejaculation and lack of morning erections, indicates that the condition may be multifactorial and possibly severe.

The penile venous stripping procedure aims to address the issue of venous leakage, where blood flows into the penis but cannot be retained due to improper closure of the veins. This surgery is designed to enhance the rigidity of erections by preventing blood from flowing back out of the penis too quickly. However, as with any surgical intervention, there are risks and potential complications.

One concern you mentioned is the possibility of the procedure losing effectiveness over time. Indeed, some studies suggest that while many patients experience improvement post-surgery, a subset may find that their symptoms return after a period. This can occur due to the development of new pathways for blood flow or the progression of underlying vascular disease that was not addressed by the surgery. However, advancements in surgical techniques, such as those mentioned by Dr. Hsu, may mitigate these risks, but it’s crucial to have a thorough discussion with your urologist about the specific techniques and their expected outcomes.

Before considering surgery, it is advisable to explore all non-surgical options thoroughly. Since you have already tried medications like sildenafil (Viagra) and tadalafil (Cialis) with limited success and side effects, you might want to discuss other alternatives with your healthcare provider. Options such as vacuum erection devices, penile injections, or even penile implants could be considered, depending on your overall health and preferences.

Moreover, it’s important to ensure that your diabetes is well-managed, as optimal blood sugar control can significantly improve erectile function. Aiming for a lower HbA1c level may help in reducing the severity of ED and improving your overall health.

In conclusion, while penile venous stripping may offer a solution for some men with ED, it is not without risks and potential for recurrence of symptoms. Given your severe symptoms, it is crucial to have a comprehensive evaluation by a urologist who specializes in erectile dysfunction. They can help determine if you are a suitable candidate for this surgery or if other treatment modalities may be more appropriate for your situation. Always weigh the benefits against the risks and ensure that you have a clear understanding of what to expect post-surgery.

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