JOURNAL

READING
Peripheral neuropathy : an

underdiagnosed cause of erectile

dysfunction
Pediatrics
2008
CREATED BY :
Arum Diannitasari
Presented(012106093)
by :
Arum Diannitasari
012106093
Adviser : dr. Susatyo PH, Sp.S

ABSTR
ACT

INTRODUCTI
ON
PATIENTS
AND
METHODS

RESULTS
DISCUSS
ION

CONCLUSIO
NS

ABSTRACT

INTRODUCTION

Erectile
Dysfunction
(ED)

Inability to achieve or
maintain a sufficient
erection for
satisfactory sexual
intercourse

Traditionally little attention has

been paid to determining the importance
of
neurogenic risk factors in ED patients

Aims of The Study

Assess the
clinical shape and
prevalence of
peripheral
neuropathy in
patients suffering
from ED
To evaluate the reliability of
clinical tests (IIEF-5 and NSS)

PATIENTS AND
METHODS

Anamnesis
Risk Factor
90 Patients
department of
urology of the central
hospital of austrias

Clinical Test
Neurophysiologic
al Tests

Cardiovascular, Neurogenic,
Psychological, Diabetes
IIEF-5
NSS
Large Fiber
Neuropathy
Small Fiber
Neuropathy

EMG, NCSs,
PTSSEPs,
PDEPs, BCR
SSR
QSTs

CDT
HPT0.5
dan
HPT5

Clinical
Test

International Index
of Erectile Fuction
(IIEF-5)

Neuropathy
Symptom Score
(NSS)

Pelvic floor
electromy
ography
(EMG)

Left and right

bulbocavernosus muscles
and if indicated in
additional:lumbosacral
Abnormal
sign of
miothomesor a
acute denervation
phathological degree
of chronic axonotmesis

Nerve
Conduction
Studies
(NCSs)

Conduction velocity
and amplitude
results
Pathological : Z
score and Z
values > 2

Posterior Tibial
Somatosensory nerve Evoked
Potentials (PTSSEPs) and
Pudendal Nerve Evoked
Potentials (PDEPs)
Neurophysiological
Test
(Large Fibre
Neuropathy)
Bulbocavernosus Reflex
(BCR) test

Latency times of cortical P40>45 ms or

left-right difference > 2,5 ms after
posterior tibial nerve stimulation
P40 latency > 44,1 ms after
pudendal nerve stimulation
Using electrical pulses on the penis and
responses were recorded from both
bulbocavernosus muscles with
concentric needle electrodes
Abnormal : Absent responses, latency
times > 37 ms and interside differences
> 1,5 ms

Small Fibre Neuropathy

assess C-fibre efferent
on the dorsum skin of the foot and penis
function.
cold perception threshold (CDT) test : A- electrical stimuli were
fibre function
applied over a median
heat pain detection threshold (HPT0.5)
nerve, and responses were
and heat pain tolerance threshold (HPT5) :
recorded on the skin of the
afferent C-fibre function
contralateral palm and
HPT0.5 :
.
sole, as well as in the
Hypersensitive : percentile 10
dorsum of the penis.
Normal : percentile 1090
Pathological : percentile 90.
Normal : latency
HPT5 :
thresholds of 1.5 ms for
Normal
the hand and penis, and 2
Hypotolerant :percentile 010
ms for the foot.
Normotolerant : percentile 10
Pathological : Longer
90
latencies and response
Pathological

Statistical
Analysis
1. SPSS-11 program. P value < 0.05
(significance)
2. Quantitative variables (median (SD) values) and
qualitative variables (frequencies and percentages)
3. KolmogorovSmirnov test : normal distributions
4. T-test : comparing two median values
5. MannWhitney U test : ordered categories
6. Spearmans and Pearsons : correlation coefficients
7. chi-squared test and contingence tables : possible
associations between variables

RESULTS

 Pathological 30.5% in the foot and 7.3% and in the

penis
Lower age in pathological CDT on the foot (P=0.005)
and the penis (P=0.007).
Diabetes
and
severe
hadand
more
frequently
abnormal
in more
14.6%
on theED
foot
7.3%
penis
CDT
(P=0.023
andfrequently
P=0.024).found in patients with
Abnormal
more
diabetes (76.93% in the foot and 78.6% in the
penis)
statistical association between HPT0.5 and HPT5
both in the penis (P=0.005) and the foot (P=0.001)
Penile HPT0.5 significantly correlated with CDT and
pathological bulbocavernosus EMG correlated
Abnormal
the foot
and 21.5% in the penis
(P=0.033)16%
withinaltered
CDT
diabetes had higher HPT5s in the foot (P=0.004)
Abnormal CDT and HPT5 results for the foot were
found to be correlated significantly (P=0.008)
Somatic NSS tended to be higher in patients with

DISCUSSION

DISCUSSION

Age is an established risk factor for prevalence and

severity of ED. Only
2.2% of the patients in the present study were > 70 years.
Reasons for this, patients and/or their partners poor
expectations about sexual functioning in advanced age
and/or primary care physicians
protocols when dealing with this pathology
Younger patients had lower IIEF-5 scores, which could
be attributable to their higher expectations or to a
higher number of organic risk factors.
ED has been a sentinel symptom of diabetes in some
of our patients. Patients with neurogenic risk factors
had more severe ED

DISCUSSION

The highest incidence of

abnormal results were found in
lower limb NCV followed by pelvic
floor EMG and upper limb NCS.
So we propose that an NCS
screening protocol for
polyneuropathy should be
part of the neurophysiological
examination in ED.

DISCUSSION
NSS identify patients with more peripheral neuropathy
symptoms and NSSt scores were a prognostic factor.
so that patients with higher scores showed more severe
ED and required more aggressive therapies
The combined techniques allowed us to find neurogenic
alterations in a high number of patients (68.9%), with
some type of peripheral neuropathy found in 61% of
them

CONCLUSSION
Up to now,
the impact of peripheral
neuropathy on the pathogenesis of ED has
been underestimated.
The combination of anamnesis and an ad
hocdesigned neurophysiological protocol
allowed us to show its high prevalence and so
provide a more accurate prognosis.
Day-to-day clinical practice should, in future,
optimize the assessment of pelvic small
fibre function

JOURNAL TITLE
Peripheral neuropathy : an underdiagnosed
cause of erectile dysfunction
Title :
Interesting
Do not use abbreviations
Informative comprise <12 words
Is in conformity with the contents of the study

ABSTRAK

CONSISTS OF :
Objectives, Methods, Results, Conclusions, Keywords

AUTHOR

Author has accordance with his

expertise

Question
Is the allocation of patients in this study
randomized?

YES

Is observations of patients done quite long

and complete?

YES

Are all patients in the group randomized,

analyzed?

YES

Are patients and physicians remain blind in NO

therapy, apart from the therapy being
tested?

Applicable
Is there a difference in our patients No difference
when compared with that found in
previous studies that these results can
not be applied to our patients?

Is the therapy might be applicable to Yes

our patients?
Does the patient have the potential Yes
mutually beneficial or detrimental if
the therapy is applied?