阴茎勃起功能障碍的药物治疗进展

近20年来,随着勃起调节机制、勃起神经递质(NO等)和海绵体平滑肌功能等有关研究的巨大进展,出现了许多治疗阴茎勃起功能障碍(ED)的药物,如前列腺素E1、PDE5抑制剂(西地那非     

活性氧与勃起功能障碍

男性勃起功能障碍(ED)是男科常见疾病之一,当前全世界有15200万男性受到ED的困扰。近年来已经认识到活性氧(reactive oxygen species,ROS)在ED中起重要作用。本文总结近年来ROS在ED中作用的研究进展,并阐述ROS与ED中各种危险因子的关系以及抗氧化治疗进展,为开发治疗ED的药物提供新的方向。     

中药治疗勃起功能障碍的新进展

勃起功能障碍(ED)是最常见的男性性功能疾病之一,目前首选治疗药物为5型磷酸二酯酶抑制剂(PDE5Is),同时中药在ED的治疗中也起着重要的作用,随着中药在ED治疗上的研究,包括对其有效成分及作用机制的研究不断取得进展,日益受到广泛认可。     

脂肪来源干细胞在勃起功能障碍治疗中的研究进展

正阴茎不能获得和(或)维持充分的勃起以完成满意性交的病理状态称之为勃起功能障碍(erectile dysfunction,ED)。ED是一个广泛存在的健康问题,世界范围内的发病率约为10%~20%,其对病人及其伴侣的生活质量都带来了极大的困扰。1998年,磷酸二酯酶5抑制剂(phosphodiesterase type-5 inhibitors,PDE5-i)第一个代表药物西地那非的问世,使ED的治疗取得了突破性的进展。该类药     

勃起功能障碍全球视点:从科学进展到伴侣的解决方案——第一届亚太地区研讨会纪要

2006年2月24～26日,第一届“勃起功能障碍(ED)全球视点:从科学进展到伴侣的解决方案”亚太地区研讨会在中国上海举行。会议就男性的性健康问题、尤其是勃起功能障碍(ED)的最新科学数据及其对女性伴侣的影响进行了广泛的探讨。主要内容包括ED患者及其伴侣与医生这3者之间交流的重要性,女性伴侣在患者寻求和坚持药物治疗中的作用,慢性疾病对性健康的影响,睾酮在ED中的作用,特殊人群的性健康,如何进行个体化治疗以及如何获得成功的治疗反应,磷酸二酯酶5(PDE5)抑制剂(尤其是伐地那非)治疗ED的显著疗效和安全性,以及亚洲地区ED的治疗现状等。     

脂肪源性干细胞治疗勃起功能障碍的研究进展

勃起功能障碍(erectile dysfunction,ED)是男性常见疾病,直接影响患者的生活质量.近年来,人们对阴茎勃起机制和ED病理生理学的研究取得一定进展,有了许多治疗ED的方法,如:口服磷酸二酯酶5型(phosphodiesterase 5,PDE5)抑制剂、阴茎海绵体内注射血管活性药物及阴茎假体植入[1]等.     

治疗勃起功能障碍药物引起的皮肤反应

Beach等进行了一项研究报告了ED治疗药物引起的皮肤过敏反应，并对相关文献进行了回顾。在过去9年中，越来越多的男性使用药物治疗勃起功能障碍（ED）。这些药物，如磷酸二酯酶5（PDE5）抑制剂，帮助有勃起功能障碍的男性获得、维持勃起，可以同时改善性功能和性满意度。但是，这些药物也具有副作用。1例56岁男性在阴茎上出现环形红斑。这些皮损反复发生，皮损剥脱明显。     

原发性高血压与勃起功能障碍

勃起功能障碍（Erectile dysfunction，ED）是与男性年龄增长密切相关的严重影响生活质量的一类疾病。由于众所周知的高发病率和死亡率等原因，原发性高血压（Essensial hypertension，EH）也得到越来越多的重视。与此同时，有关抗高血压药物损害男性勃起功能的报道也相应增多，美国全国联合委员会第七次报告（JNC-7）也指出抗高血压药物治疗有可能在年龄的基础上进一步损害勃起功能。本文就ED与EH的关系及抗高血压药物治疗对ED的影响作一综述。     

应用新的治疗满意度量表来评估ED患者及其性伴侣对伐地那非治疗的满意度

治疗满意度量表(TSS)是为评估男性勃起功能障碍(ED)患者及其性伴侣对ED治疗的满意度而制订的一个新量表。该自我报告式的调查问卷由四大部分组成:未治疗期的患者,治疗期的患者,未治疗期患者的性伴侣,以及治疗期患者的性伴侣。对以下6个方面进行评估:自信心、勃起的容易度、对勃起功能的满意度、性快感、对性高潮的满意度以及治疗满意度。TSS量表已经过多国有效性检验和心理学测验,被证明能可靠评价患者及其伴侣对ED治疗的满意度。在最近完成的一项双盲、多中心、平行组、灵活剂量的临床试验中,应用这个新的TSS量表比较了ED患者及其伴侣对伐地那非和安慰剂治疗的满意度。结果发现,伐地那非能显着改善勃起功能以及ED患者和伴侣的自信心、感知到的勃起容易度、性快感、对勃起功能、高潮和药物治疗的满意度。     

勃起功能障碍的口服药物作用靶点磷酸二酯酶5型研究进展

近20年来，勃起器官组织超微结构和勃起生理以及勃起分子生物学机制的研究取得了变革性进展，特别是西地那非(万艾可)作为治疗勃起功能障碍(ED)口服药物自问世以来，已在大量临床使用中证明其对ED治疗的安全有效，对多种原因引起的ED临床有效率可达80％。因此，西地那非药理作用靶点磷酸二酯酶V型(PDE5)以及磷酸二酯酶家族(PDEs)的研究引起医学界的广泛关注。     

Surgery and hormonal treatment for prostate cancer and sexual function

Prostate cancer (PC) is one of the most common cancers effecting men today. With earlier detection and improvements in available treatment modalities, there still remains significant morbidity associated with the treatment of PC. Male sexual health and erectile function are greatly impacted by these therapies and remain a concern to PC survivors. This article reviews the current literature on male sexual health following radical prostatectomy (RP) or androgen ablation therapy for PC. Each treatment modality affects male sexual function to an appreciable level, although certain patients have better outcomes if they have preoperative potency, are younger, or have nerve-sparing surgery. There is a delayed recovery up to 2 years seen in erectile function following RP. With androgen deprivation therapy (ADT), attempts can be made at different administration strategies and exercise may possibly play a role in maintaining erectile function. Penile rehabilitation protocols attempt to protect erectile function immediately following therapy through different modalities, although no one approach has been agreed upon.     

Creative-dynamic image synthesis: a useful addition to the treatment options for impotence

In contrast to the impressive advances made in somatic research on erectile dysfunction, psychogenic erectile dysfunction is usually treated as a monolithic block. In this study, we evaluated the erectogenic power of creative-dynamic image synthesis in men with psychogenic erectile dysfunction. Sixty-nine men with a mean age of 46 y, suffering from erectile dysfunction of no known organic cause, were entered in a placebo-controlled study in which the erectogenic power of imagination, yohimbine and a placebo were compared. There was a significant difference between the subjective results of creative-dynamic image synthesis (75% increase of potency) and those achieved through treatment with the drug yohimbine (55% increase in potency) and with a placebo (30% increase in potency). Creative-dynamic image synthesis is a potent initiator of erections in men with psychogenic erectile dysfunction, has no known side effects and is very cost-effective.     

Erectile dysfunction in the elderly: epidemiology,etiology and approaches to treatment

PURPOSE: Erectile dysfunction is experienced at least some of the time by most men who have reached 45 years of age, and it is projected to affect 322 million men worldwide by 2025. The prevalence of erectile dysfunction is high in men of all ages and increases greatly in the elderly. MATERIALS AND METHODS: This paper reviews the epidemiology of erectile dysfunction with an emphasis on the experience of older men, normal age related changes in the structure and function of the penis that may contribute to increased risk with age, how the accumulation of risk factors with age may contribute to the high prevalence of the disease in older men, and established and emerging therapies. The normal aging process and age related risk factor accumulation contribute to the increased prevalence of erectile dysfunction in the elderly. RESULTS: Remarkable progress has been made in the treatment of erectile dysfunction. At present inhibition of phosphodiesterase 5 with oral agents such as sildenafil would appear to be the initial treatment of choice. These drugs have been shown to be safe and effective, and sildenafil has demonstrated efficacy in patients with many of the comorbidities observed in older men with erectile dysfunction. New treatments, in particular transfection with genes for key mediators of erectile function that are known to be down-regulated in elderly men, also hold promise. CONCLUSIONS: Further research into the neural, vascular and molecular mechanisms involved in penile erection will lead to the development of even safer, more effective and more convenient therapies for men with erectile dysfunction.     

Venous insufficiency of the corpora cavernosa as (additional) cause of erectile dysfunction

In 25-30% of the patients with erectile dysfunction, venous insufficiency is the (additional) reason for the erectile failure. Surgical procedures and prognosis depend largely on the precise localisation of the pathological drainage. The venous leakage is proven and exactly localized by a multiprojectional cavernosography, measurement of the maintainance flow and intracavernous pressure monitoring. The most reliable screening test for venous erectile dysfunction is the intracavernous application of a standardised vasoactive drug combination.     

Current use of penile implants in erectile dysfunction

Penile implants became popular with the introduction of effective models more than 30 years ago. Today they play a secondary but definitive role in the treatment of erectile dysfunction at times when more conservative therapies have failed. Improvements in reducing the incidence of infection, treating infection with antiseptic washes, enhancing device longevity, and instituting new techniques to manage complicated implantation procedures have made them more acceptable to patients. Although penile implants are the least often chosen and most invasive treatment for erectile dysfunction, they have the highest satisfaction rate—in the range of 80% to 90%—among both patients and partners.     

Erectile dysfunction and the effects of sildenafil treatment in patients on haemodialysis and continuous ambulatory peritoneal dialysis.

BACKGROUND: Sexual dysfunction, including erectile dysfunction, is common in patients with uraemia. Despite successful treatment of male sexual dysfunction with sildenafil in non-uraemic population, its efficacy in dialysis patients is unknown. PATIENTS AND METHODS: In this study, 35 male HD patients (mean age 48+/-12 years) and 15 male CAPD patients (mean age 44+/-12 years) were included. In the baseline period, haemoglobin, serum urea, and albumin, Kt/V, several hormonal parameters, Beck depression scale, and penile Doppler blood flow, (peak systolic velocity after intracavernous papaverine administration) were measured. The international index of erectile function (IIEF) form was used to evaluate erectile dysfunction. Sildenafil was given to patients with erectile dysfunction at a dose of 50-100 mg/day twice a week. RESULTS: The percentage of erectile dysfunction was similar between patients on HD (71%) and those on CAPD (80%). Patients with erectile dysfunction were significantly older and had lower free-testosterone serum levels and penile blood flow than those without. In linear regression analysis for baseline IIEF score, penile blood flow was the only independent variable associated with erectile dysfunction. IIEF score increased to a similar extent after sildenafil treatment in both HD patients (from 8.10+/-5.54 to 21.70+/-9.61, P<0.001) and CAPD patients (from 9.90+/-3.87 to 21.60+/-10.18, P=0.011). Changes in IIEF scores after sildenafil treatment were associated with baseline penile blood flow as an independent variable by linear regression analysis. Adverse events observed during sildenafil treatment were dyspepsia in two patients and headache in one patient. CONCLUSION: The rate of erectile dysfunction is high in dialysis patients. Penile blood flow is the most important factor for predicting both the development of erectile dysfunction and the response to sildenafil therapy in such patients. Oral sildenafil is an effective, reliable, well-tolerated treatment for uraemic patients with erectile dysfunction.     

Relationship between perineal muscle contractions, penile tumescence, and penile rigidity during nocturnal erections

The mechanism of penile erection and erectile dysfunction is still unclear and widely debated. The role of the perineal muscles in the erectile process, especially in changes in intracavernous pressure, is increasingly being studied on the hypothesis that perineal muscular contractions are essential to full penile rigidity. In a previous investigation we studied the correlation between voluntary perineal muscle contractions and intracavernous pressure during artificially induced erections. The purpose of the current study was to examine whether under normal conditions of nocturnal erection a similar relationship exists between the electromyographic activities of perineal muscles and changes in penile rigidity. Nocturnal penile recordings were made of seven volunteers with psychogenic erectile dysfunctions. During nocturnal erections simultaneous computerized recordings were made of penile tumescence, penile rigidity, and electromyographic activities of perineal muscles. The peaks for the three variables were reached simultaneously. The results of this study suggest the existence of two different physiologic phases: a vascular phase and a muscular phase. Furthermore, in cases of dysfunctions, specific diagnostic assessment and therapeutic management will be required for both penile tumescence and penile rigidity.     

Impotence literature: Scientometric analysis of erectile dysfunction articles between 1975 and 2018

Erectile dysfunction (ED) is portrayed as lasting deficiency to achieve or sustain penile erection in successful vaginal penetration and is a major problem affecting the quality of life in men. The number of ED sufferers worldwide is anticipated to reach 322 million, by 2025. In recent years, many publications and studies have been made in the field of ED. Our aim was to perform a detailed bibliometric analysis of erectile dysfunction literature. In this study, we downloaded the data of the publications from the Web of Science Core Collection. All items indexed in these databases between 1975 and 2018 were included. Documents produced in 2019 were excluded. We searched in WoS databases for the keywords of ‘erectile dysfunction’ and ‘impotence’. Our basic search into WoS databases retrieved a total of 28,266 documents indexed between 1975 and 2018. English dominated impotence literature (92.541%) followed by German, French and Korean (2.136%, 1.920% and 1.180% respectively). The United States has made tremendous improvement in ED studies and is still the effective country. The most prolific author was Montorsi F with 330 articles from Italy, and three-fifth of the authors were from the USA.     

Erectile dysfunction in the 21st century: whom we can treat, whom we cannot treat and patient education

Erectile dysfunction affects 31-52% of American men. Although considerable advances have been made in the diagnosis and treatment of erectile dysfunction in the past decade, more than 80% of men with erectile dysfunction are not treated because they do not seek medical attention or their physicians do not initiate a dialogue about sexual problems during their visits. This despite patients' desires to confront sexual problems and receive treatment. Most subgroups of men can now be effectively treated for sexual dysfunction. Although men with severe cardiac disease may require stabilization of their cardiac condition before treatment, most can successfully return to an active sex life. Some men, however, do not respond to the use of oral agents. These men can be treated with second- and third-line treatment modalities or with the newer concept of combined-modality treatment. Despite excellent treatment alternatives, many men have low libido or hypoactive sexual desire disorder. In the ultimate resolution of a patient's sexual dysfunction, physicians must open a free and sympathetic dialogue and offer a full spectrum of treatment modalities tailored to the individual patient and partner. If initial treatment modalities fail, more invasive alternatives or combination therapy should be offered to cure the patient's erectile dysfunction.     

Penile revascularization

Penile revascularization surgery has dramatically improved the lives of many young patients who otherwise had to consider prosthetic options for treatment of their erectile dysfunction. Nonetheless, it appears that only few patients with erectile impotence are truly excellent candidates. Dynamic infusion cavernosometry and cavernosography studies reveal that corporal leakage syndrome exists in more than 80 per cent with organic erectile dysfunction. As the pathophysiology of corporal leakage syndrome is better appreciated, the role for penile reconstructive surgery will become more obvious. It may be realized that most patients with corporal leakage syndrome will be treated medically with intracavernosal pharmacotherapy. In these cases, reconstructive surgery may be utilized primarily to augment the pharmacologic erectile response.