Peripheral neuropathy: an underdiagnosed cause of erectile dysfunction

BJU International - Tập 108 Số 11 - Trang 1855-1859 - 2011
C. Valles-Antuña1, J.M. Fernández Gómez2, Fernando Fernández-González1
1Departments of Neurophysiology and
2Urology, Hospital Universitario Central de Asturias, Oviedo, Spain

Tóm tắt

OBJECTIVES• To assess the prevalence of peripheral neuropathy in patients with erectile dysfunction (ED).• To evaluate the reliability of clinical tests such as the five‐item version of the International Index of Erectile Function (IIEF‐5) and the Neuropathy Symptom Score (NSS) classification system in predicting the concurrence of peripheral neuropathy.PATIENTS AND METHODS• We studied 90 patients who were consecutively recruited from the Department of Andrology of the Central Hospital of Asturias.• Anamnesis included questions about risk factors related to ED.• The severity of ED was classified according to IIEF‐5 scores and symptoms of peripheral neuropathy were assessed using the NSS.• Neurophysiological tests included electromyography, nerve conduction studies, evoked potentials from pudendal and tibial nerves as well as bulbocavernosus reflex.• Small fibre function was assessed using quantitative sensory tests and sympathetic skin response. Statistical analysis was performed using the SPSS‐11 program.RESULTS• Patients with more severe symptoms of peripheral neuropathy showed lower (worse) IIEF‐5 scores (P= 0.015) and required more aggressive therapies (P < 0.001).• Neurophysiological exploration confirmed neurological pathology in 68.9% of patients, of whom 7.8% had myelopathy and 61.1% peripheral neuropathy.• Polyneuropathy was found in 37.8% of the patients, of whom 8.9% had pure small fibre polyneuropathy, and pudendal neuropathy was diagnosed in 14.4%.• No association between neurophysiological diagnosis and IIEF‐5 score was detected, but a statistical association was found between neuropathy and NSS scores.CONCLUSIONS• Up to now, the impact of peripheral neuropathy in the pathogenesis of ED has been underestimated. The combination of anamnesis and an ad hoc neurophysiological protocol showed its high prevalence and provided a more accurate prognosis.• In future, clinical practice should optimize the assessment of pelvic small fibre function.

Từ khóa


Tài liệu tham khảo

NIH Consensus Conference. Impotence, 1993, NIH Consensus Development Panel on Impotence, JAMA, 270, 83, 10.1001/jama.1993.03510010089036

10.4321/S0004-06142008000300007

10.1038/sj.ijir.3901215

10.1016/j.eururo.2008.10.028

10.1038/sj.ijir.3900472

10.1002/ana.410080608

Buchthal F, 1950, Electromyography in diagnosis of central and peripheral lesions of the nervous system, Neurol Psychiatr Ceskolov, 13, 117

Falck B, 1994, Sensory nerve conduction studies with surface electrodes. Methods in Clinical Neurophysiology, Dantec, 5, 1

Trojaborg W, 1992, Sensory nerve conduction: near nerve recording methods in clinical neurophysiology, Dantec, 3, 41

10.1016/0013-4694(94)90012-4

10.1016/0022-510X(76)90044-7

Claus D, 1999, Recommendations for the Practice of Clinical Neurophysiology (EEG), 277

10.1016/0022-510X(95)00277-9

10.1212/WNL.43.8.1508

10.1097/01.ju.0000165389.73148.d1

10.1097/01.ju.0000162049.95483.51

10.1016/S0022-5347(17)34871-1

10.1016/S0022-5347(05)65986-1

10.1016/S0014-2565(02)71101-6

10.1016/S0022-5347(01)65857-9

10.1016/S0090-4295(00)00906-7

10.1097/01.ju.0000065824.35996.c8

10.1111/j.1600-0404.1987.tb03540.x

10.1016/0013-4694(95)00168-9

Dettmers C, 1994, Evaluation of erectile dysfunction with the sympathetic skin response in comparison to bulbocavernosus reflex and somatosensory evoked potentials of the pudendal nerve, Electromyogr Clin Neurophysiol, 34, 437

10.1111/j.1464-410X.2009.08796.x

Vardi Y, 1996, Polyneuropathy in impotence, Int J Impot Res, 8, 65

Garcia de Gurtubay Galligo I, 1999, Neurophysiologic techniques in the diagnosis of erectile dysfunction: study of 105 cases, Arch Esp Urol, 52, 262

10.1179/016164101101198965

Thông tin
Thông tin xuất bản

BJU International

Tập 108 Số 11

1855-1859

Thông tin tác giả