الفهرس 
Introduction and RationaleOnly 14 pages are availabe for public view
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Abstract
Pathophysiology of ED with DM is a multifactorial neural and endothelial mechanism that affects normal corporeal SM relaxation. ED associated with DM is strongly associated with decreased NO activity and upregulation of TGF-β action. Early administration of PDE5Is are thought to be an effective method to ameliorate the deleterious effect of DM.
In the current study, 60 adult male Albino Wistar rats were equally divided into six groups; Sham, DM with no treatment and four treatment groups which received vardenafil treatment starting at day 0, 4th, 8th and 12th week after the induction. Rats were subjected to cavernous nerve stimulation and ICP measurement. Different penile segments were subjected to histopathologic, ultrastructural examination and assessment of NOS isoforms (iNOS, nNOS and eNOS) and TGF-β1 genes expression.
We found that ICP was significantly higher in sham and early treatment groups compared to DM with no treatment and late treatment groups. Histopathologically, Sham and early treatment groups showed normal cavernous tissue architecture with absent fibrosis. Conversely, DM with no treatment and late treatment groups showed distorted cavernous architecture and extensive fibrosis. SM to collagen ratios were significantly increased in sham and early treatment groups compared to DM with no treatment and late treatment groups. In DM with no treatment and late treatment groups, all NOS isoforms (iNOS, nNOS and eNOS) genes were downregulated, while TGF-β1 gene was upregulated. Contrarily; in sham and early treatment groups, all NOS isoforms were upregulated, while TGF-β1 gene was downregulated.
According to the structural, ultrastructural and molecular biology findings of our study; we can address that early administration of PDE5Is could prevent the upcoming deleterious effects of DM on erection in DM patients. We recommend that early diagnosed DM men should receive chronic low-dose PDE5I as they are liable to develop ED sometime throughout their disease period. Nevertheless, there is still a long way to go in that multifactorial perspective and further research should be conducted on a large scale multicenter and long-term studies.