Erectile dysfunction in patients with neurological disorders

Abstract

Introduction: Erectile dysfunction (ED) is a common symptom in many neurologic diseases. This fact has led to the increasing involvement of the neurologists in the evaluation of ED. Materials and Methods: 1.Bibliographic review on the topic: ED in patients with neurological disorders,- Ovid - 1995-2013, 40 selected sources, MedLine - 15 sources, HINARI - 20 sources; 2. Studying pathophysiological mechanisms of neurogenic ED; 3. Studying of medical cases of patients with neurological disorders and ED, in Neurology and Urology Clinics; 4.Evaluation of selected cases. Results: The clinical case reported below, is to reveal the importance of the collaboration between andrologist and neurologist in managing a patient with neurologic ED. G. is a 38-year-old man first time to andrologist. He reports significant ED, progressed over the past few months, no spontaneous erections. Other complaints-back pain radiating to left leg, bilateral paresthesia.Symptoms started about 4 years ago. He consulted several urologists, and was diagnosed with chronic prostatitis and followed several treatments with transient temporary relief. Medical history- diagnosed with a herniated lumbar disc 5-6 mm - 2009, conservative treatment. Sexual history- single, stable sexual partner, psychological climate appropriate torque. SHIM questionnaire = 11 points (moderate ED). Physical examination - normal genitalia and prostate.Laboratory results- no abnormalities.Treatment recommendations - inhibitor PDE 5, with positive effect. But due to complaints of back pain radiating to left leg and bilateral paresthesia was recommended lumbar MRI - found discal herniation 18-20 mm. The patient was referred to neurosurgery for surgical treatment. After 6 months, he presented to andrologist for evaluation. SHIM questionnaire = 20 points - satisfactory sexual function with no PDE5 medication. Conclusions: l. The evaluation of ED causes needs a multidisciplinary cooperation between several specialists in urology, endocrinology, neurology, psychiatry, and others. 2. The reported clinical case shows the importance of right neurologic evaluation. And the professional treatment has resolved not only the neurological problem but the andrological problem.