前列腺素E1乳膏治疗勃起功能障碍

目的：探讨前列腺素Ｅ１（ＰＧＥ１）乳膏尿道口给药治疗勃起功能障碍的疗效。方法：采用随机、双盲／开放、多中心的方法观察其安全性、有效性。在双盲组中６４例病人，每位随机给予ＰＧＥ１乳膏和安慰剂乳膏各１支，尿道口给 药。在开放试验组中，７９例病人各１支ＰＧＥ１乳膏尿道口给药。结果：双盲试验ＰＧＥ１乳膏组有效５６例（８７．５％），安慰剂乳膏组有效３例（４．７％），两者有显著性差异（Ｐ〈０．０１）；开放试验组有效５１例（６４．６％）。结论：ＰＧＥ１乳膏尿道口给药治疗勃起功能障碍是安全、有效的。     

勃起功能障碍患者可成功从海绵体内注射前列腺素E1改为口服枸橼酸西地那非治疗

海绵体内注射疗法是一种公认的治疗勃起功能障碍（ED）最有效的非手术疗法，但其具有侵入性且很可能发生阴茎异常勃起。为了寻求更安全的替代疗法，Giuliano等进行研究，评估了ED患者从海绵体内注射前列腺素E1转变为口服枸橼酸西地那非的成功率。     

小剂量前列腺素E1乳膏治疗勃起功能障碍的疗效观察

目的 :探讨小剂量前列腺素E1(PGE1)乳膏尿道口给药治疗勃起功能障碍 (ED)的疗效。　方法 :按入选标准及国际勃起功能问卷 (IIEF) 5评分录取 4 3例ED病人 ,经签知情同意书后 ,进入为期 4周的开放性临床研究。采用尿道口内挤入乳膏的方法 ,以手持阴茎保持向上位以手指关闭尿道口 30s ,每次尿道口给药量为 30 0mcgPGE1(75mg乳膏 ) ,每例最少用药 2次以上。　结果 :对主要疗效指标 (IIEFQ3+Q4 )的分析结果显示 ,受试者在使用本研究药物后进行性活动时 ,其阴茎勃起程度达到显效和有效者占 70 .73%。若按性交次数计算 ,性交成功率达 86 .4 1%。总体疗效评估的分析结果为 73.17%。同时 ,所有次要疗效评估 (IIEFQ1、Q2、Q5～Q15 )的分析结果 ,均一致支持主要疗效评估的分析结果。因各种原因中止试验的有 2例 ,发生尿道疼痛或阴茎红肿共 6例 ,占14 .6 3% ,多数为轻度、一过性的。　结论 :可将乳膏的PGE1给药剂量降至 30 0mcg时 ,采用尿道口挤入方法给药 ,仍可取得良好的疗效     

西地那非与前列腺素E1治疗勃起功能障碍的疗效比较

目的：比较口服西地那非与阴茎海绵体内注射前列腺素E1（PGE1）治疗勃起功能障碍（ED）的疗效。方法：54例ED患者随机分成两组，一组采用口服西地那非治疗（A组），另一组行海绵体内注射PGE1（B组）。治疗4－9个月，平均6个月。结果：A、B两组的有效率分别为80.0%和83.3%，二者之间差异无显著性意义（P＞0.05)。A组6例无效患者经海绵体内注射PGE1治疗，其中2例获得了勃起满意的疗效，而B组4例无效患者经口服西地那非治疗，无一例有效。结论：口服西地那非与海绵体内注射PGE1对各种病因所致的ED均有良好的治疗作用，对某些西地那非治疗无效者，可试用海绵体内注射PGE1，有时也能获得满意的效果。     

前列腺素E_1乳膏治疗勃起功能障碍

目的 :探讨前列腺素E1(PGE1)乳膏尿道口给药治疗勃起功能障碍的疗效。　方法 :采用随机、双盲 /开放、多中心的方法观察其安全性、有效性。在双盲组中 6 4例病人 ,每位随机给予PGE1乳膏和安慰剂乳膏各 1支 ,尿道口给药。在开放试验组中 ,79例病人各 1支PGE1乳膏尿道口给药。　结果 :双盲试验PGE1乳膏组有效 5 6例(87.5 % ) ,安慰剂乳膏组有效 3例 (4 .7% ) ,两者有显著性差异 (P <0 .0 1) ;开放试验组有效 5 1例 (6 4.6 % )。结论 :PGE1乳膏尿道口给药治疗勃起功能障碍是安全、有效的。     

前列腺素E1乳膏对勃起功能障碍患者阴茎血流的影响

我院于2001年11月至2005年1月采用前列腺素E1（PGE1）乳膏经尿道内给药，使用彩色多普勒超声波显像仪观察了109例勃起功能障碍（ED）患者用药前后阴茎背动脉，左、右海绵体动脉峰值血流速度（PSV）和海绵体周径变化，报告如下。     

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]).     

用可调节阴茎环和前列腺素E1增进勃起反应

近年来 ,经尿道给药及海绵体内注射前列腺素Ｅ1(ＰＧＥ1)已成为国内外治疗勃起功能障碍 (ＥＤ)的有效方法之一 ,但有部分病人局部药物治疗不能达到足够的静脉关闭而影响疗效。本文采用可调节外用阴茎环提高阴茎静脉回流阻力 ,增进勃起质量 ,以治疗过去经尿道及海绵体内注射ＰＧＥ1无反应者 ,疗效确实。1　资料与方法1.1　临床资料　本组 16例均是男性科门诊 1～ 5次经尿道应用ＰＧＥ130 0～ 10 0 0 μｇ或阴茎海绵体内注射ＰＧＥ115～ 4 0 μｇ无反应者 (6例曾试用了两种方法治疗 )。其中静脉性ＥＤ 11例 ,动脉性 2例 ,混合性 1例 ,心理性 2…     

自我注射前列腺素E1治疗勃起功能障碍

１９９４年１～１２月，采用自我注射前列腺素Ｅ１方法，治疗不同病因的勃起功能障碍患者６０例。阴茎海绵体注射前列腺素Ｅ１可使６１．７％的患者阴茎完全勃起；仅２６．７％的患者注射药物后，阴茎有轻微胀痛感；无阴茎血肿、异常勃起及海绵体纤维化等副作用。结果提示，前列腺素Ｅ１具有安全、有效和副作用小的特点，优于目前治疗勃起功能障碍的其它海绵体注射药物。     

前列腺素E1与西地那非治疗ED的比较

目的：比较口服西地那非与阴茎海绵体内注射前列腺素E1（PGE1）治疗勃起功能障碍（ED）的疗效。方法：54例ED病人随机分为两组，A组口服西地那非，B组行海绵体内注射PGE1，均治疗4－9个月，平均6个月，结果：A、B两组的有效率分别为80．0％和83．3％，两者差异无显著性（P＞0．05），A组6例无效病人经海绵体内注射PGE1治疗，2例获得满意勃起，而B组4例无效病人经口服西地那非治疗，无1例勃起，结论：口服西地那非与海绵体内注射PEG1对各种病因所致的ED均有良好的治疗作用。对西地那非治疗无效者，可试用海绵体内注射PEG1，有时也能获得满意的效果。     

Long-term efficacy and safety of self-intracavernous injection of prostaglandin E1 for treatment of erectile dysfunction in China

The study evaluated the long-term efficacy and safety profiles of self-intracavernous injection of prostaglandin E1 (PGE1) for erectile dysfunction (ED). Four hundred and sixteen ED patients were treated with self-intracavernous injection of PGE1 from January 1998 to December 2007 in our outpatient service. Follow-up was made to investigate the efficacy and side effects of this treatment. It was found that 261 patients (62.7%) felt satisfied and kept using this treatment due to its advantages of satisfactory efficacy and reasonable expense. Twenty-seven of them (6.5%) got rid of PGE1 treatment after five times injections and did not need any other drugs to maintain satisfactory sexual lives. Two hundred and fourteen (51.4%) patients kept using this treatment for over 1 year, 26 (6.2%) over 5 years, 12 (2.9%) over 8 years and 7 (1.7%) over 10 years. The major complications of self-intracavernous injection of PGE1 include fibrosis of corpus cavernosum (three cases), ecchymosis associated with vascular injury due to injection (23 cases) and pain associated with injection (295 cases). There were no patients displaying priapism. It is concluded that self-intracavernous injection of PGE1 is a safe and effective treatment for ED with various aetiologies and a broad range of severity, and no serious complications were observed after long-term application.     

凯时阴茎海绵体注射及夫妻协同治疗心理性勃起功能障碍

目的探讨凯时(前列地尔，PGE1)阴茎海绵体注射(ICI)及夫妻协同治疗心理性勃起功能障碍(ED)的效果。方法对17例心理性ED患进行12周的治疗观察。ICI前对患的妻子／固定性伴侣进行性教育，具体解释心理性ED的诱发因素等。性需要前0．5h ICI凯时0．2～0．4mL(PGE12～4μg)，完全勃起后完成性生活。次日及时反馈性生活满意度．并给予鼓励性心理暗示。结果凯时ICI后平均6．9min即能完全勃起，12周后16例患不再依赖ICI治疗。17例患的妻子／性伴侣都能良好地协同治疗．双方的性满意度均为良好。结论凯时ICI及夫妻协同治疗心理性ED效果良好。患的妻子／性伴侣在协同治疗中起着医生不能替代的作用。     

静脉性勃起功能障碍硬度测试仪的表现特点（附247例临床分析）

作者回顾性分析了 2 47例经双核素阴茎海绵体血液动力学动态检查 (Penograme) ,确诊为静脉性勃起功能障碍患者 [阴茎动脉系统显像指数 (PIA) 15 8.8± 6 7.5 ,阴茎静脉系统显像指数 (PIV) - 6 3.7± 12 .4]的硬度测试仪 (Rigiscan)资料。 2 47例中 ,周径变化线或硬度指数高点间连线呈“锯齿波”样变化者 196例 ,其PIA 142 .1± 45 .9,PIV - 5 7.6± 5 .1;呈“斜向降低”者 40例。PIA 145 .9± 5 3.2 ,PIV - 6 4.2± 7.6 ;无变化者 (未勃起 )者 11例 ,PIA140 .4± 47.1,PIV - 6 0 .9± 9.8;三种变化之间 ,PIA、PIV无统计学差异 (P >0 .0 5 )。作者认为 ,“锯齿波”及“斜向降低”样变化是静脉性勃起功能障碍Rigiscan检查的主要表现 ,其机理是因为静脉回流过快导致阴茎海绵体内压力不稳定甚至渐降低所至     

Plasma levels of endothelin-1, angiotensin II, nitric oxide and prostaglandin E in the venous and cavernosal blood of patients with erectile dysfunction

OBJECTIVES: To determine the alterations in the plasma levels of endothelin-1, angiotensin II, nitric oxide (NO) and prostaglandin E(2) (PGE(2)) in the venous and cavernosal blood of patients with organic and psychogenic erectile dysfunction (ED). PATIENTS, SUBJECTS AND METHODS: The study included 32 patients complaining of ED; they were subdivided into two equal groups with either organic or psychogenic ED. Fifteen healthy potent age-matched male volunteers were enrolled as a control group. For each patient, venous and cavernosal blood samples were obtained, while venous blood was obtained from the controls. RESULTS: There were significantly greater mean plasma levels of endothelin-1 and angiotensin II, and significantly lower mean plasma levels of NO and PGE(2), in the venous blood of patients with ED than in the controls. Patients with organic ED had significantly higher levels of endothelin-1 and significantly lower levels of NO in both venous and cavernosal blood than had those with psychogenic ED. There were significant positive correlations in both venous and cavernosal blood between endothelin-1 and angiotensin II, and between NO and PGE(2) in all patients with ED and the two subgroups. There were significant negative correlations between venous and cavernosal endothelin-1 and NO, endothelin-1 and PGE(2), angiotensin II and NO, and between angiotensin II and PGE(2). CONCLUSION: The present results suggest that endothelin-1 could be a clinical marker of diffuse endothelial disease manifested by ED. As angiotensin-converting enzyme (ACE) activity controls angiotensin II there might be a rationale for the use of ACE inhibitors to prevent or treat ED. NO and PGE(2) may provide new strategies for the pharmacological treatment of ED.     

Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction

Aim： To assess the behavior of patients with diabetes mellitus （DM） and erectile dysfunction （ED） during 10 consecutive years of treatment with self-injection of vasoactive drugs. Methods： Thirty-eight diabetic men, including 12 with type Ⅰ and 26 with type Ⅱ diabetes, were followed up regularly for 10 years after they began self-injecting for severe ED. Real time rigidity assessment was used for the objective determination of the initial dosage and then doses were regulated in order to introduce an erection suitable for penetration and maintenance of erection for approximately 30 min. Patients were followed up every two months, and doses were increased only when the treatment response was not satisfactory. Results： The number of injections used per year by the patients was reduced each year （mean numbers： 50 in the first year and 22.5 in the 10th） and treatment shifted towards stronger therapeutic modalities （mixtures of vasoactive drugs instead of prostaglandin E1 alone）. Type Ⅰ diabetic men were standardized to a level of treatment as early as 5 years after the initiation of treatment. That level was finally reached by type Ⅱ patients after another 4-5 years. Conclusion： Treatment with self-injections of vasoactive drugs in diabetic men with severe El） is a safe and effective alternative in the long term. Diabetic men of both types show the same preferences in quality and quantity of treatment after 10 years. The key point for maintenance in treatment is the adjustment of the therapeutic method and dosage to optimal levels for satisfactory erections. （Asian J Androl 2006 Mar; 8： 219-224）     

Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year

Authors from Seoul describe their experience with patients already on triple therapy by intracavernosal injection who changed to oral sildenafil. Rather surprisingly, they found that patients had had a greater preference than expected for triple therapy, feeling that they had a better quality of erection on intracavernosal injection. The subject of the effect of renal transplantation on sperm quality and sex hormone levels is discussed by authors from Teheran. They found that sperm morphology and density remained unchanged, but there were significant improvements in sperm mobility. There was also an improvement in hormone levels and sexual function. OBJECTIVE: To investigate the efficacy and preference for oral sildenafil or intracavernosal injection (ICI) therapy in patients with erectile dysfunction (ED) already using ICI. PATIENTS AND METHODS: In all, 69 patients with ED (mean age 55.1 years, sd 12.3) on ICI therapy with triple solution (papaverine/phentolamine/prostaglandin-E1) for > 1 year were recruited for the study. Their erection quality, adverse reactions and selection rate of oral sildenafil or ICI as treatment, after using sildenafil for 3 months, and the reasons for their preferences, were compared between the regimens, RESULTS: Overall, 52 men (75%) responded to sildenafil; of these men, the erection quality with ICI was better than that with sildenafil in 46 (89%) and 16 (31%) preferred ICI as their treatment. Eighteen patients (35%) used each treatment alternately and 18 (35%) used sildenafil exclusively. The main reason given by patients for choosing ICI was a better quality of erection (74%). CONCLUSION: More patients with ED and using ICI preferred it as their main treatment than was expected, even though they had a good response to oral sildenafil. A better quality of erection with ICI was the reason why experienced patients chose this method, differing from the choice of patients starting treatment for ED.     

勃起功能障碍（ED）的联合疗法

二十世纪九十年代末二十一世纪初,口服PDE5抑制剂（PDE5Is）的引入在很大程度上革新了性医学领域。目前PDE5I已经成为勃起功能障碍（ED）的首选单一疗法。然而,对一些复杂型ED患者来说,PDE5I单一疗法的疗效还不尽人意。目前越来越多不易治疗的ED病例开始采用联合疗法治疗,但还缺少对当前使用的联合疗法的严格评估。基于此,本综述在Pubmed和Cochrane Library数据库中进行了全面的文献检索．主要检索对象是1990年1月到2010年12月间研究PDE5I单一治疗失败后接受联合疗法的所有相关综述、随机对照试验、队列研究和回顾性研究。同时还对检索所得文献的参考文献进行了人工筛选,获得了其它一些相关的文献资料。目前发表的联合疗法主要包括PDE5I加真空吸引器（VED）、尿道给药、阴茎注射（ICI）、雄激素补充疗法、α-阻断剂,还有其它一些联合疗法。本综述发现,有些联合疗法的初步试验结果是有效的。然而,进行治疗时还是要谨慎,因为近十年来发表的大部分联合疗法相关文章的研究方法有很多问题,比如研究偏见和样本量小等。尽管如此,目前的研究结果还是在为将来复杂型ED的治疗研究方面奠定了坚实的基础。