阴茎海绵体药物注射治疗勃起功能障碍19年1例报告

阴茎勃起功能障碍(ED)是指阴茎不能勃起和(或)不能维持勃起以达到满意的性生活,是男性最常见的性功能障碍之一.ED的治疗方法多种多样,有第一线的口服药物和负压式辅助装置等;第二线的阴茎海绵体内药物注射(ICI)以及经尿道内给药;第三线的假体植入手术治疗等([1]).     

枸橼酸西地那非治疗男性肾移植受者勃起功能障碍

目的 :评价枸橼酸西地那非治疗肾移植术后勃起功能障碍 (ED)的有效性和安全性。　方法 :随机选择 2 6～ 5 0岁、术后 6月以上及血肌酐 133μmol/L以下的已婚男性肾移植受者 170例 ,对他们肾移植术后的性功能状况行国际勃起功能指数 5 (IIEF 5 )评分 ,存在ED者首先进行心理治疗 3个月 ,无效者用枸橼酸西地那非治疗 6个月 ,对他们的性生活情况进行随访并作出评分。　结果 :170例肾移植受者中 ,5 3例存在经心理治疗无效的ED ,枸橼酸西地那非治疗半年后IIEF 5评分中的各项参数均明显改善 ,对血肌酐、环孢素A谷值浓度无影响 ,不良反应轻微且短暂。　结论 :枸橼酸西地那非治疗肾移植术后ED安全、有效。     

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.     

勃起功能障碍的手术治疗

近年来，对勃起器官组织生理及病理的认识、勃起组织超微结构和分子生物学机制的研究取得了有价值的成果，特别是治疗勃起功能障碍(ED)的口服药物西地那非(万艾可，英文名Viagra)应用于临床以来，使ED的药物治疗有效率达80％以上，长期应用临床资料表明安全有效，且能改善夜间勃起，并且能从根本上逆转部分病人的ED。但是对于一线、二线治疗方案无效的病人，以及某些阴茎发育或形态上的畸形影响性生活者，手术治疗是有效的方法。手术方法主要包括各种阴茎假体的植入、纠正血管畸形、阴茎畸形整复重建等方法，重塑阴茎的形态和功能，以满足外观和性活动的需要。     

西地那非对阴茎假体植入男性性满意度的作用

阴茎假体植入术目前仍为治疗勃起功能障碍（ED）的主要方法之一，而往往术后龟头充血不理想而影响患性生活的满意度。Mulhall JP等研究进行了一项研究，评价了西地那非对阴茎假体植入后阴茎龟头充血及男性性满意度的改善作用[BJU Int，2004，93（1）：97—99]。患在假体植入术后1个月，完成国际勃起功能指数（IIEF）评分表。随后，患服用西地那非治疗，并在治疗后再次完成IIEF评分。     

每日一次他达拉非对勃起功能及伴侣双方性生活质量的影响:一项双盲、随机化、安慰剂对照试验

有关勃起功能障碍（ED）的临床研究主要集中在男性患者以及各种治疗方法对患者勃起功能（EF）和性生活质量影响方面。但是,ED对男性患者及其女性伴侣的生活质量都产生了巨大影响。目前,研究男性ED治疗对女性伴侣影响的文献相当有限。确定他达拉非5mg每日一次在改善男性ED患者勃起功能和性生活质量方面的疗效,及这种治疗对其女性伴侣性生活质量的影响。     

评估勃起功能障碍男性患者的女性伴侣的性功能：对男性性功能障碍的治疗可以改善女性伴侣的性功能吗？

勃起功能障碍（ED）既影响患者也影响其女性伴侣对性生活的满意度，对ED的治疗，比如口服万艾可，能明显提高患者的满意度，而治疗是否也能提高女性伴侣对性生活的满意度呢？Cayan S等的研究对此作出了回答。研究者将87名妇女按她们的性伴侣是否有ED分为2组。男性ED患者中，30例分别行阴茎假体治疗（17例）或口服枸橼酸西地那非治疗（13例）。     

西地那非显著增强阴茎假体植入患者的性满意度

阴茎假体植入是治疗勃起功能障碍（ED）的有效手段之一，但由于各种原因，患者术后往往对性生活的满意度欠佳，而治疗ED的一线口服药西地那非能否给此类患者带来额外的性满意度呢？Mireku—Boateng等人进行的相关研究给我们带来了一些经验。他们对12例可膨胀阴茎假体植入患者，给予口服西地那非治疗。在服药前、后使用国际勃起功能指数问卷中的第7，8，13和14这4个满意度方面的问题进行评价。     

西地那非在阴茎假体移植病人中的应用

阴茎假体移植手术不是治疗勃起功能障碍（ED）的一线治疗方染，常被应用于一些口服药无效的难治性ED患者。那么在移植术后再使用西地那非是否有效并进一步提高患者性生活满意度呢？Mireku Boateng AO等人进行的一项题为“西地那非在阴茎假体移植病人中的应用”的研究，给我们带来了相关的经验。他们对12位接受可膨胀性阴茎假体植入术的患者在术后口服西地那非治疗进行了研究。     

慢性前列腺炎致勃起功能障碍的机制研究进展

勃起功能障碍(ereetile dysfunction,ED)是指阴茎不能达到或维持实现性交的勃起.ED对男性正常性生活具有巨大负面影响.一项调查研究显示很多人非常重视性生活[1]:42%的男性认为性生活非常重要,另外41%认为至少偶尔需要满意的性生活,仅17%的男性认为性生活是可有可无的.     

男性患者肾移植前后的阴茎勃起功能研究

目的　探讨男性肾功能衰竭患者肾移植前后的阴茎勃起功能,以提高肾移植患者的生存质量。方法　50例男性肾功能衰竭患者在肾移植前后填写国际勃起功能指数(IIEF)调查表,并同时测定性激素水平。结果　肾移植前阴茎勃起功能障碍(ED)发病率为84 %,肾移植后肾功能正常时降至54 %(P<0.05);术前血液透析时间在6个月以内者IIEF评分高于透析时间在6~24个月和超过24个月者;不论患者的年龄大小,肾移植术后IIEF评分均有不同程度的提高(P<0.05);肾移植后血清睾酮水平上升(P<0.05),雌二醇和催乳激素明显下降(P<0.05, P<0.01)。结论　肾移植能有效改善肾功能衰竭患者的阴茎勃起状况,受者术后的心理疏导有助于降低ED发病率。     

Sexual and reproductive function in end-stage renal disease and effect of kidney transplantation

Advanced chronic kidney disease is associated with impaired spermatogenesis and testicular damage. Semen analysis typically shows a decreased volume of ejaculate, oligo-or complete azoospermia, and a low percentage of motile sperm. Erectile dysfunction （ED） is also common in patients with chronic renal failure （CRF） and is observed in excess of 50% of these patients. There have been ongoing improvements in survival and quality of life after renal transplantation. One of the most impressive aspects of successful renal transplantation in the young people is the ability of the male patient to father a child. In this article we first review pathophysiology of reproductive failure in end-stage renal disease （ESRD）, then ED in ESRD and its management are discussed, finally sexual function in renal transplant patients and management of ED in these patients are reviewed.     

Couples After Renal Transplantation: Impact of Sex and Relationship Quality on Adherence in a Prospective Study

BackgroundIn patients after kidney transplantation, nonadherence to immunosuppressant medication is a common problem. Identifying factors that influence adherence could optimize medical care and prevent nonadherence. Kidney transplantation is a stressful situation for the patient and also for the relatives. The recipients of renal transplants as well as the family system have to be taken into account as potential impact factors.MethodsFifty-six couples with a renal transplant recipient were investigated regarding adherence, relationship satisfaction, social support, and quality of life. Moreover, sex and role differences (patient vs partner) as well as differences within the couple were analyzed. Impact factors on adherence were identified.ResultsFemale recipients of renal transplant reported higher relationship satisfaction than male recipients, female spouses, and male spouses. Physical quality of life was lower in renal transplant recipients compared with caregivers. For male renal transplant recipients, significant predictors of adherence, such as social support, relationship quality, and quality of life emerged, whereas for female renal transplant recipients mental quality of life and education level were found to influence adherence.ConclusionsThe study reveals the importance of relationship functioning of couples after kidney transplantation, as well as considering sex and role differences. There is a need to examine the posttransplantation nonadherence risk profile of women and men separately.     

肾移植对男性勃起功能及性激素水平的影响

目的：探讨肾移植对男性勃起功能及性激素水平的影响。方法：对24例接受肾移植的已婚男性患者进行勃起功能国际问卷调查（IIEF）和手术前后性激素水平检测,调查肾移植前后不同阶段ED患病率;观察不同年龄、尿毒症病史和透析时间的患者在移植前后IIEF评分的变化;比较肾移植前后的性激素变化。结果：尿毒症期ED患病率高达87．5％,其中重度ED患病率达37．5％。肾移植术后ED患病率降低到45．9％,尤以病史短于3年、透析时间小于3个月和年龄大于46岁者勃起功能改善明显（P〈0．05）;肾移植后能明显降低男性患者泌乳素和雌二醇,升高睾酮。结论：肾移植能改善勃起功能,尤以病史和透析时间短的患者为明显;性激素水平的变化可能在其中发挥一定作用。     

Critical evaluation of the factors influencing erectile function after renal transplantation

A total of 400 male renal transplant recipients (RTR) were investigated. Data on medical, sexual history, clinical examination and laboratory variables were collected. The severity of erectile dysfunction (ED) was assessed using the International Index of Erectile Function questionnaire. Univariate and multivariate logistic regression analyses were used to determine prognostic variables, which have independent impact on erectile function. ED was detected in 35.8% of the whole group. Current erectile function as compared to pretransplant status was improved, deteriorated or remained static in 44, 12.5 and 43.5% of the evaluated transplant recipients, respectively. After logistic regression analysis, age, hemoglobin level and presence of DM and/or peripheral neuropathy had significant and independent negative impact on erectile function. We concluded that renal transplantation has varying effects on erectile function. ED is highly prevalent among RTR and its pathogenesis is multifactorial.     

男性患者肾移植前后性相关激素、微量元素及勃起功能情况调查

目的　探讨男性尿毒症患者在血液透析期、肾移植术后的性相关激素、微量元素和勃起功能情况及其相互间的关系。方法　回顾性分析 1 999年 3月～ 2 0 0 2年 1 2月期间 6 80例肾移植中的1 36例男性患者 (实验组 )肾移植前后的随访资料 ;对照组为 30例肾功能正常的男性。结果　实验组尿毒症患者在血液透析期间的性相关激素、微量元素和勃起功能情况与对照组比较 ,差异有显著性(P <0 .0 0 1 ) ;肾移植术后 ,其性相关激素、微量元素和勃起功能情况和血液透析期间比较 ,差异有显著性 (P <0 .0 1 )。结论　血液透析不能改善尿毒症患者在性相关激素、微量元素和勃起功能方面的异常 ;而肾移植术多能改善这些异常 ,尤其是勃起功能的改善 ,提高了尿毒症患者的生活质量。     

男性肝移植受者性生活状态的调查

目的探讨肝移植手术对男性受者性生活状态的影响。方法研究对象为2007年7月至2012年12月在中山大学附属第三医院肝移植中心行肝移植且术后存活半年以上的男性肝移植受者,共69例。采用自制问卷调查与直接询问相结合的方法了解受者发病前、发病后及手术后的性生活状态。调查内容包括性欲状况、阴茎勃起情况(夜间及清晨)、勃起强度、性生活频度、性高潮情况、性生活满意度以及性生活认知情况(性生活对肝功能是否有影响)。结果受者发病后的性欲状况、阴茎勃起强度异常的发生率高于发病前和手术后,两者比较差异均有统计学意义(均为P<0.01)。与发病前比较,受者发病后和手术后性生活频度、性高潮情况、性生活满意度异常的发生率均较高,两者比较差异均有统计学意义(P<0.01或P<0.05);与发病后比较,受者手术后性生活频度、性高潮情况、性生活满意度异常的发生率较低,两者比较差异有统计学意义(均为P<0.01)。夜间及清晨阴茎勃起异常的发生率和性生活认知(认为性生活对肝功能有影响)的几率,发病前、发病后、手术后,两两比较差异均无统计学意义(均为P>0.05)。结论肝移植可改善终末期肝病男性患者的性生活状态。     

再次肾移植对尿毒症患者性功能的影响

目的:探讨再次肾移植对尿毒症患者性功能的影响。方法:对接受2次肾移植和同期双肾移植的30例患者术后的性功能状态进行问卷调查及阴茎血流多普勒超声检查。2次移植选用髂外动脉与供肾动脉吻合者9例(A组);一侧选用髂内动脉另一侧选用髂外动脉吻合者11例(B组);均选用髂内动脉与供肾动脉吻合者10例(C组),其中包括同期行双肾移植的1例患者。结果:术后半年恢复正常性生活者,A组8例;B组7例;C组5例。C组患者的阴茎海绵体动脉收缩期最大血流速度明显低于A及B组。结论:2次肾移植均选用髂内动脉与供肾动脉吻合,对患者的性生活有影响;但通过侧支循环代偿一段时间后,一部分患者仍可有满意的性生活。     

Sexual health after orthotopic liver transplantation.

Many studies have reported improved health-related quality of life outcomes after orthotopic liver transplantation; however, specific research regarding sexual health in liver transplant recipients is limited. We surveyed liver transplant recipients to determine the prevalence of sexual dysfunction. Of the 320 adult liver transplant recipients surveyed by mailed questionnaire, 150 responded (42%). The median age was 54 years. A total of 62% of respondents were male, and 93% were at least 1 year after transplantation. Thirty-six respondents (24%) reported sexual dysfunction before transplantation; this persisted in 22 patients (15%) after transplantation. A total of 48 respondents (32%) reported de novo sexual dysfunction after transplantation. After transplantation, 23% of male and 26% of female respondents reported decreased libido, and 33% of men and 26% of women reported having difficulty reaching orgasm with intercourse. A total of 42% of respondents felt that immunosuppressive medication was the main contributing factor to their sexual problems: 33% and 35% of respondents receiving tacrolimus or cyclosporine monotherapy, respectively, experienced some degree of sexual problems after transplantation. Despite the reported sexual problems, 59% of respondents were "moderately" to "very satisfied" with their sexual relationships after transplantation. Nineteen percent of the respondents used sildenafil to improve their sexual function, and 65% of these reported benefit. In conclusion, sexual problem after orthotopic liver transplantation is a common but poorly studied problem. Although this single-center study has shed some light on the relationship between liver transplantation and sexual health, further prospective studies, involving larger study population and validated instruments, will be needed to better evaluate the influence of liver transplantation on recipients' sexual health.     

Analysis of sexual functions in male nondiabetic hemodialysis patients and renal transplant recipients

Disturbance of sexual functions among hemodialysis patients and renal transplant recipients (RTRs) is controversial. Diabetes mellitus (DM) is known to have a significant negative impact on sexual functions. Most previous studies concerning the issue of disturbance of sexual functions among hemodialysis patients and renal transplant recipients have included diabetic patients also, which might have influenced their results. The aim of this study was to evaluate sexual functions of nondiabetic male (NDM) dialysis patients and RTRs, and to compare our findings with those of the others. Twenty‐five nondiabetic male RTRs, 25 age‐matched NDM hemodialysis patients, and 25 age‐matched NDM controls were the subjects of this study. Sexual functions of all subjects were assessed using the International Index of Erectile Function (IIEF) questionnaire. Statistical analysis was performed using appropriate statistical tests with the level of significance set at P < 0.05. Data were described using mean, standard deviation (SD), median and interquartile range (IQR). Renal transplant recipients (RTRs) and hemodialysis patients had depressed erectile function (EF) and Intercourse satisfaction (IS) function, but normal orgasmic (OF) function. Sexual desire (SxD) function of RTRs group, although subnormal, was better than that of hemodialysis patients. Overall satisfaction (OS) of RTRs, unlike that of hemodialysis patients, was normal. Sexual dysfunction is prevalent even in NDM hemodialysis patients and RTRs. Although ED is equally prevalent among these two groups, it is more profound among the former one. OF is spared in these patients. Renal transplantation seems to normalize OS and improve SxD function of nondiabetic male renal transplant recipients (NDM RTRs).