The present study deals with the diabetic neuropathies prevailing in the male population. In this investigation 100 insulin dependent diabetes mellitus (IDDM) and 314 non insulin dependent diabetes mellitus (IDDM) patients with and without an objective evidence of neuropathy, having the age span in between 15 to 80 years and the duration of diabetes distributed over 1-33 years were included along with their age matched non diabetic controls. The diabetic subjects were evaluated for the incidence of erectile impotence, induction of erectile responses, semen composition serum and urinary levels of pituitary-gonadal hormones, residual urine retention, gastric emptying time, penile nerve conduction velocities and penile brachial index. The largest correlation of the incidence of erectile impotence (about 80%) was found in both IDDM and NIDDM patients having symptomatic autonomic neuropathy. Similarly investigation of induction of erectile responses to erotic stimulation by film and fantasy revealed stricking results in diabetic patients having established neuropathy. Both IDDM and NIDDM patients with neuropathy exhibited a highly significant decrease (p<0.0005) in penile diameter and length, penile arterial pulse amplitude, both systolic and diastolic blood pressures and heart rate from the controls of the same age group. However both IDDM and NIDDM patients with out neuropathy showed a non significant difference in the above mentioned parameters than their respective control subjects. A non significant association of induction of erectile responses to erotic stimulations among IDDM and NIDDM patients with and without neuropathy was also observed, thus suggesting that impotence and altered erectile responses are likely to be associated with an increased frequency to autonomic neuropathy in these patients irrespective of their type of diabetes.
Results of semen analysis showed a highly significant increase (P<0.0005) in total sperm out put and sperm concentration in both IDDM and NIDDM neuropathic diabetic men. On the other hand sperm motility, and semen volume were found to be about 30% and 60% less respectively in IDDM and NIDDM patients, where as sperm morphology and quality of sperm motility remained unaffected. A comparison between IDDM and non neuropathic and non neuropathic diabetic groups further indicated a non significant difference in the parameters of semen analysis thus suggesting an endocrine basis for che sexual disturbances of diabetic neuropathy and that the testicular hypofunction in these patients can not be regarded as an indefinable complication to the vascular disease. A significant rise in total sperm out put in both IDDM and NIDDM neuropathic diabetic patients and a significant decrease in semen volume in both types of diabetic neuropathic patients thus suggests some kind of leydig cell hyperplasia which in turn may stimulate spermatogenesis and atonia of the bladder and urethera resulting retrograde ejaculation.
Results of pituitary-gonadal hormonal studies have shown strikingly low levels of serum and urinary testosterone (P<0.0005), and significantly high levels of serum and urinary FSH & LH and serum prolactin (P<0.0005) in both IDDM and NIDDM neuropathic diabetic patients. These results suggest some kind of gonadal disorder (Hypogonadotropic hypogonadism ?) in these patients probably due to neuropathy.
Ultrasonographic studies of the measurement of residual urine (R.U) showed a significant residual volume in both IDDM and NIDDM patients and a generalized massive hypotonia of bladder was found to be established. These results revealed that the occurrence of neurogenic b1adder was found to be in a significant association (P<0.00l) with periphera neuropathy. Amongst the manifestations of autonomic neuropathy, only impotence (P<0.0l), and decreased pupil motility (P<0.05) were observed in both IDDM and NIDDM patients having neurogenic bladder while orthostatic hypotepension was found only in NIDDM patients with neurogenic bladder.
For the study of gastric emptying in diabetics, 12 patients were selected. Amongst those 3 were excluded due to diabetics (Both neuropathic and non neuropathic) showed a loss of differentiation in between the movement of liquid and solid markers. In addition, gastric emptying time was very significantly increased (P<0.00l) in the diabetic patients as compared to normal during 120 minutes of scanning period after the meals thus suggesting an abnormality of antral peristalsis in the diabetic patients without stasis, not attributable to vagal denervation. Both intravenous and oral metoclopramide produced symptomatic improvement in two patients with gastric stasis and restored solid and liquid emptying in the diabetics. These results suggest that metochlopromide may be helpful in the clinical management of gastric stasis in the diabetics.
Neuro physiological studies in diabetic neuropathic patients exhibited a significant slowness (P<0.0005) of nerve conduction velocity of dorsal nerve of penis. The penile brachial index indicated an impaired electrical activity in diabetics owing perhaps to multiple etiologies with a penile/pudendal neuropathic condition as one of the several causes.