As such, there are a few reports suggesting that bariatric surgery can improve diabetic complications including sexual Tubeimoside-I dysfunction in obese men. Microvascular injury and corpus cavernosal fibrosis are considered the main pathophysiological contributors to T2DMor obesity-related erectile dysfunction. Bariatric surgery may correct metabolic 
abnormalities such as glucose intolerance, and thereby reduce microvascular disease and improve erectile dysfunction. In spite of these advantages of bariatric surgery, little is known about the effects or mechanism of bariatric surgery on erectile dysfunction in patients with diabetes. Therefore, in this study, we investigated how bariatric surgery could lead to the improvement of diabetic and obesity-related erectile dysfunction by examining the structural and biochemical changes of the corpus cavernosum in the Otsuka Long-Evans Tokushima Fatty rat model. In the bariatric surgery group, duodenal-jejunal bypass surgery was performed according to the details published by F. Rubini et al. The entire duodenum with 10 cm of the proximal jejunum was divided and bypassed from the stomach. During the operation the stomach volume was maintained. Then, the gastrojejunal anastomosis was performed at 10 cm distal to the ligament of Treitz. The bibliopancreatic secretions were drained from the reconstructed biliary limb to the alimentary limb of the small bowel in Roux-en-Y fashion. Because the length of small bowel in rats has a length of approximately 100 cm, this procedure consists of a similar technique and functional outcomes as a stomach-sparing, proximal, Roux-en-Y bypass surgery in humans. The control group underwent a sham operation, in which the gastrointestinal tract was transected and reanastomosed to maintain the physiologic circuit of food through the bowel. Both forms of Diperodon diabetes mellitus involve an abnormal carbohydrate metabolism and hyperglycemia. However, the spectrum of diabetic conditions differs in characteristics of insulin production and obesity profile as well as cytokine and lipid levels. Of the two major types of diabetes, T2DM accounts for 90�C95% of adult cases of diabetes mellitus in the United States. The clinical manifestation of T2DM is insulin resistance and obesity. Because of these manifestations, T2DM is closely related with systemic diabetic complications such as hypertension, cardiovascular disease, and hyperlipidemia. These complications are sometimes hard to recover from without strict glucose control and proper medication, and may be fatal. Under sexual stimulation, corpus cavernosum smooth muscle relaxation is initiated and maintained by an increased nitric oxide production through the activation of neuronal nitric oxide synthase and endothelial nitric oxide synthase. The resulting increased arterial inflow and venous outflow occlusion causes dilation of the cavernosum. Subsequently, the maintenance of intracavernosal pressure creates penile erection. Besides these neuronal and vascular controls of penile erection, the RhoA/Rho kinase pathway also participates in penile smooth muscle tone contraction and relaxation through the intracellular calcium level. In many studies of diabetic rat models, and particularly in the T2DM model, vasodilatory signaling is impaired by a decrease in nNOS activity, non-adrenergic non-cholinergic dysfunction, impaired eNOS activation, oxidative stress, cavernosal hypercontractility, veno-occlusive dysfunction, and androgen deficiency.