肾移植患者阴茎勃起功能影响因素分析

目的:研究肾移植对勃起功能的影响,并对相关影响因素进行分析,以期提高移植术后患者的生活质量。方法:对250例肾移植术后移植肾功能良好的已婚男性受者进行勃起功能国际问卷调查,并收集一般临床资料、病史、性生活史和实验室检查资料。应用单因素分析和多因素Logistic回归分析确定对勃起功能有独立的和显著影响的相关因素。结果:212例完成整个调查,114例移植术前为ED(53.8%),移植术后94例被确定为ED(44.3%),两者差异无显著性(P>0.05)。根据ED分度移植前后的变化,91例(42.9%)勃起功能移植前后无变化,93例(43.9%)有改善,28例(13.2%)移植前勃起功能正常的患者移植后减退。Logistic回归分析确定年龄、贫血、糖尿病、周围神经病变、多次移植是独立和显著影响勃起功能的因素,相对危险度分别为3.01、2.01、3.15、3.89、2.67。结论:肾移植后ED的发生率仍较高。移植术后ED的病因是多方面的,年龄、糖尿病、周围神经病变、血红蛋白水平、多次移植是影响勃起功能的主要因素。     

Significant decrease of the International Index of Erectile Function in male renal failure patients treated with hemodialysis

In order to evaluate the erectile function in male renal failure patients treated with hemodialysis (HD), we investigated the International Index of Erectile Function (IIEF) in patients and healthy controls. The subjects were 174 male patients treated with HD, of whom 43 had diabetes mellitus (DM) and the remaining 131 patients did not have DM. The controls were 1133 healthy males. We evaluated the prevalence of erectile dysfunction (ED) using the erectile function (EF) score, which is one of the five domains of the IIEF, in each age group (upto 39 y old, 40-49 y old, 50-59 y old, 60-69 y old). The severity of ED was classified into five categories using EF in each age group. The univariate logistic regression analysis and multiple variate analysis of IIEF in HD patients were performed. The prevalence of ED in HD patients was significantly higher than that in the controls in each age group. The severity of ED in HD patients was also significantly higher than that in the controls in each age group. In the logistic regression analysis and multiple variate analysis of IIEF in HD patients, DM and age were significant risk factors on sexual dysfunction. ED was more prevalent in male renal failure patients treated with HD than in the controls. In the patient group, ED was more prevalent in older DM patients.     

Erectile function and gonadal hormones levels in men with end‐stage renal disease: It's relevance to duration of haemodialysis

In this study, we evaluated the relationship between haemodialysis (HD) duration and erectile function status and gonadal hormones serum levels in adult men with end‐stage renal disease (ESRD). A total of 118 men with ESRD on chronic HD were eligible for analysis. The erectile dysfunction (ED) was defined and graded according to the international index of erectile function (IIEF‐5) score. The serum levels of follicle stimulating hormones (FSH), luteinising hormone (LH), testosterone (TST), prolactin (PRL) and estradiol (E2) were measured using the standard laboratory technique. The mean age was 48.97 ± 14.68 years and mean duration of HD was 4.58 ± 3.03 years. The overall prevalence of ED was 78.8%; from them 31.2% had severe grade. The prevalence of ED was comparable in HD duration categories [≤5 years (79.7%), 5–10 years (76.5%), >10 years (80.0%); p > 0.05]. The percentage of abnormal serum levels of FSH, LH, TST, PRL, E2 were 5.1%, 1.6%, 18.6%, 90.7% and 0.0% respectively. No significant relationships were observed between HD duration and IIEF‐5 score or gonadal hormones serum levels (p < 0.05). We concluded that HD duration has no effect on erectile function status and gonadal hormones serum levels. Other factors may be relevant to these conditions in this particular group of patients.     

Efficacy and safety of long‐term tadalafil 5 mg once daily combined with sildenafil 50 mg as needed at the early stage of treatment for patients with erectile dysfunction

This study aimed to evaluate the efficacy and safety of long‐term and low‐dose tadalafil combined with sildenafil as needed at the early stage of treatment for erectile dysfunction (ED). We enrolled 180 patients with ED 1 : 1 to tadalafil 5 mg once daily or once‐a‐day tadalafil 5 mg combined with sildenafil 50 mg as needed. The efficacy measures included the 5‐item version of the International Index of Erectile Function (IIEF‐5) and the Sexual Encounter Profile (SEP). The safety was assessed by observing drug tolerability and adverse events. Total IIEF‐5 scores of patients with severe ED in combined medication group were significantly higher than in tadalafil alone group. Question 2 scores of IIEF‐5 of patients with moderate and severe ED in combined medication group were significantly higher than in tadalafil alone group. The significant improvement in question 3 scores of IIEF‐5 existed only in patients with severe ED receiving combined medication. The percentage of ‘yes’ responses to SEP4, SEP5 and partner's SEP3 were improved significantly in combined medication group. There was no difference between two groups in the incidence of adverse events. Our results suggest that combined medication can better improve erectile function, especially for patients with severe ED.     

Can the International Index of Erectile Function distinguish between organic and psychogenic erectile function?

OBJECTIVE

To define the ability of the International Index of Erectile Function (IIEF) to differentiate between organic and psychogenic erectile dysfunction (ED).

PATIENTS AND METHODS

Patients presenting for the evaluation and treatment of ED who had penile duplex Doppler ultrasonography (DUS) completed the IIEF questionnaire. Accepted ranges of the IIEF EF domain were used to grade baseline severity (severe, moderate and mild ≤11, 11–17, 18–25, respectively). Accepted criteria were used to define normality on DUS (peak systolic velocity >30 cm/s and end‐diastolic velocity <5 cm/s). Patients with documented Peyronie’s disease, hypogonadism and a history of radical prostatectomy were excluded.

RESULTS

In all, 112 patients were enrolled, with a mean (sd ) age and duration of ED of 56 (16) and 2 (0.6) years, respectively. The vascular risk‐factor profile included diabetes in 15%, hypertension in 26% and hyperlipidaemia in 20%. The baseline severity of ED was mild, moderate and severe in 28%, 41% and 32% men, respectively. All patients had normal testosterone levels. Patients also with a normal DUS were diagnosed with psychogenic ED, in 50%, 13% and 17% of men with mild, moderate and severe ED by the IIEF, respectively. No patient with venous leak had mild ED, and 62% of men with venous leak had severe ED.

CONCLUSIONS

These results indicate that the IIEF is not completely accurate in differentiating between organic and psychogenic ED, and that almost a fifth of men in this study population with severe ED by the IIEF had normal erectile haemodynamics. These data have potential ramifications for evaluating the baseline severity of ED in trials of erectogenic agents.     

Severity of erectile dysfunction in married impotent patients: Interrelationship with anthropometry, hormones, metabolic profiles and lifestyle

OBJECTIVE: This study was designed to evaluate the effects of risk factors for erectile dysfunction (ED) or cardiovascular disease on the disease severity in impotent men. METHODS: A total of 87 men, 25-75 years old (mean age, 53.4) were included in the study. Patients were evaluated with anthropometry, hormones, metabolic profiles and lifestyle. Baseline erectile function (EF) was evaluated using the International Index of Erectile Function (IIEF). The severity of ED was classified into the following four grades based on the six-item EF domain of the IIEF: severe (6-10); moderate (11-16); mild to moderate (17-21); and mild (22-25). Patients were deemed to have metabolic syndrome (MS) if they had three or more of five criteria according to National Cholesterol Education Program, with some modification. RESULTS: Of 87 patients, 15 patients (17.2%) had mild, 11 (12.6%) had mild to moderate, 33 (37.9%) had moderate and 28 (32.3%) had severe ED. There was no correlation between scores of IIEF or EF domain and continuous parameters. On the multivariate model used, hypertensive patients had 26-fold higher risk (odds ratio, 26.195; 95% confidence interval, 1.463-46.072; P = 0.027) of severe ED than those without hypertension. Other factors were not significant. CONCLUSION: The results of the study indicate that MS might not influence the severity of ED in impotent men. However, our findings suggest that hypertension plays a role in the disease severity in these patients.     

Preoperative erectile function is one predictor for post prostatectomy incontinence

AIMS: The precise etiology of post prostatectomy incontinence (PPI) is not fully understood and risk factors are not yet comprehensively defined. It has been reported that sparing of the neurovascular bundle during prostatectomy improves postoperative erectile function, whereas the influence on urinary control is unclear. From daily clinical experience we made the impression that patients who are in the best shape have better erections and better continence. We therefore searched our database for a possible correlation between the preoperative erectile function and the incidence of PPI. PATIENTS AND METHODS: Four hundred three patients who underwent radical retropubic prostatectomy between January 2000 and May 2003 were enrolled into this retrospective study. Data of 327 patients (response rate 81%) at a median follow-up of 26 months were analyzed using the validated International Index of Erectile Function (IIEF 5), the validated Urinary Distress Inventory (UDI6) and a standardized urinary symptom inventory. Continence was defined as usage of no or one pad daily. Erectile Dysfunction (ED) was defined as none/mild or moderate/severe with an IIEF 5 score of 17 or more or less than 17, respectively. RESULTS: Univariate and mulitvariate logistic regression analysis including preoperative IIEF 5 scores, age and nerve sparing prostatectomy, identified preoperative erectile function as significant predictor for PPI (P = 0.024), whereas age (P = 0.759) and nerve sparing prostatectomy (P = 0.504) did not predict PPI. CONCLUSION: Erectile function is a predictor of PPI and should be recorded preoperatively.     

Sexuality and seeking medical help for erectile dysfunction in young adults with spina bifida

OBJECTIVES: The objectives of this study were to evaluate the correlation between the sexual function of spina bifida (SB) patients and Sharrard classification, touch sensation on the penis, to examine if SB patients who are sexually active have erectile dysfunction (ED) on the International Index of Erectile Function-5 (IIEF5), and to clarify if they seek medical treatment for ED. METHODS: Thirty-six male SB patients aged over 18 years were enrolled. A questionnaire was sent to all patients that included the following items: touch sensation on the penis, psychogenic erection, rigidity at erection, ejaculation, orgasm and experience in sexual intercourse. In addition, patients who had experience in sexual intercourse were asked about ED through the use of the IIEF5 and whether or not they sought medical help for their ED. RESULTS: Twenty-six patients responded. The positive rates of psychogenic erection, rigidity at erection, ejaculation and orgasm were 85%, 54%, 88% and 65% respectively. Psychogenic erection and ejaculation correlated with Sharrard classification. Rigidity at erection and orgasm correlated with touch sensation on the penis. Eleven patients had experience in sexual intercourse and six of them were diagnosed as having ED on the IIEF5. There were no factors correlating with ED. None of the patients sought medical advice and none was treated for ED. CONCLUSIONS: Sexual function of SB patients could be predicted by Sharrard classification and touch sensation on the penis to some degree. However, ED did not correlate with sexual function. Therefore, we should not evaluate the neurological loss but instead provide adequate information.     

Prevalence of erectile dysfunction in patients with metabolic syndrome

AIM: We wished to investigate the relationship between metabolic syndrome and erectile dysfunction (ED). MATERIALS AND METHODS: A total of 268 patients were included in this study. All of the patients were asked to fill in an International Index for Erectile Function (IIEF) questionnaire. The presence of metabolic syndrome was determined when any three or more of the five risk factors were present according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP)-III. The relationship between risk factor for metabolic syndrome and ED status was determined according to logistic regression analysis. RESULTS: Eighty-nine patients (33%) constituted the metabolic syndrome group. IIEF-EF domain scores of patients with and without metabolic syndrome were 17.7 +/- 7.9 and 21.7 +/- 7.5, respectively (P < 0.001). Seventy-four percent of patients with metabolic syndrome and 50% of patients without metabolic syndrome had ED (P < 0.001; odds ratio 2.9; 95% CI 1.7-5.0). Erectile function domain scores significantly decreased as the number of metabolic risk factors increased (P < 0.001). Patients with the risk factor of fasting blood glucose (FBG), waist circumference (WC), or hypertension (HT) had lower erectile function domain scores than the patients with other metabolic risk factors. Logistic regression analysis revealed that FBG and WC were the most important criteria for ED. CONCLUSIONS: Metabolic syndrome seems to be a potential risk factor for ED. We recommend patients with metabolic syndrome should be questioned about ED, and WC measurement might take part in the evaluation of ED.     

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.     

Type 2 diabetes but not metabolic syndrome is associated with an increased risk of lower urinary tract symptoms and erectile dysfunction in men aged <45 years

Study Type – Prognosis (case series)
Level of Evidence 4

OBJECTIVE

To investigate the association of type 2 diabetes mellitus (T2DM) and metabolic syndrome with lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in Taiwanese men aged <45 years.

PATIENTS, SUBJECTS AND METHODS

Voiding and erectile function in 226 men with T2DM, at one diabetes clinic, and 183 healthy men with normal fasting blood glucose levels, were compared. Participants were evaluated using the International Prostate Symptom Score (IPSS), the five‐item version of the International Index of Erectile Function questionnaire (IIEF‐5), and measurements of flow rate and postvoid residual urine volume. The association of metabolic syndrome with LUTS and ED was also evaluated.

RESULTS

The mean (sd , range) age of the patients was 38.9 (6.1, 20–45) years and the mean duration of diabetes was 2.8 (3.1, 0.5–20) years. Compared with controls, men with T2DM had a significantly mean (sd ) higher IPSS, of 6.1 (5.8) vs 4.1 (4.6) (P < 0.001), an increased of odds ratio (95% confidence interval) of having moderate to severe LUTS of 1.78 (1.12–2.84) (P = 0.01), greater voiding volume of 376 (177) vs 326 (102) mL (P = 0.04), a worse IIEF‐5 score of 17.3 (6.4) vs 20.0 (3.8) (P < 0.001), an increased of odds ratio of having moderate to severe ED of 3.5 (2.1–5.8) (P < 0.001) but a similar maximum flow rate and postvoid residual. The IIEF‐5 score was negatively correlated with the IPSS (P < 0.0001, coefficient = ?0.23, 0.35–0.11) and glycosylated haemoglobin (P = 0.02, coefficient = ?0.14, 0.26–0.01). In all, 156 (69%) patients met the criteria for metabolic syndrome. The mean age, duration of diabetes, glycosylated haemoglobin, IPSS, voided volume, maximum urinary flow rate and IIEF‐5 score were similar between patients with and without metabolic syndrome.

CONCLUSIONS

Men with T2DM and aged <45 years had more LUTS but a similar bladder emptying function than the controls. ED was highly prevalent and was associated with the severity of LUTS. Metabolic syndrome did not aggravate the severity of LUTS, emptying function or ED in the early stage of DM.     

伐地那非治疗老年糖尿病性勃起功能障碍疗效分析

目的:观察伐地那非治疗老年糖尿病(DM)性勃起功能障碍(ED)患者的临床疗效和安全性。方法:选择男性科门诊100例老年ED患者,其中DMED40例,非DMED60例。2组均使用伐地那非,首次剂量20mg,以后维持剂量10mg,1次/周,连续8周。采用国际勃起功能问卷勃起功能评分(IIEF-5)和勃起质量量表问卷(EQS)对患者勃起功能状况进行评估。结果:治疗前后,DMED组患者IIEF-5和EQS评分值分别为(8.1±0.5)分,(18.9±0.2)分(P<0.01);(9.1±1.3)分,(25.1±1.4)分(P<0.01);非DMED组患者评分值分别为(10.1±0.3)分,(21.1±0.2)分(P<0.01),(10.1±1.7)分,(34.2±1.2)分(P<0.01),2组间统计学处理差异有显著性(P<0.05)。DMED组显效17例(42.5%),有效9例(22.5%),总有效率65%。非DMED组显效28例(46.7%),有效16例(26.7%),总有效率73.3%。DMED和非DMED2组间统计学处理差异有显著性(P<0.05)。结论:伐地那非治疗能显著改善老年DMED患者的勃起能力,提高生活质量。     

Age-related prevalence of erectile dysfunction in Japan: Assessment by the International Index of Erectile Function

BACKGROUND: The effects of age and concomitant chronic illness on male sexual function were investigated to obtain insight into the prevention of erectile dysfunction (ED). METHODS: A questionnaire from the International Index of Erectile Function (IIEF) was given to 2311 non-institutionalized men aged 23-79 years along with a survey of health status. The study sample consisted of 1517 men who provided complete responses to the questionnaire. For statistical analysis, ANOVA was conducted to evaluate the effect of aging on the sexual functions and a logistic regression model was used to identify significant independent risk factors for ED. RESULTS: There was a significant correlation between age and the scores for erectile function, orgasmic function, sexual desire and intercourse satisfaction. The prevalence of moderate and severe cases of ED were 1.8% and 0% for ages 23-29; 2.6% and 0% for ages 30-39; 7.6% and 1.0% for ages 40-49; 14.0% and 6.0% for ages 50-59; 25.9% and 15.9% for ages 60-69; and 27.9% and 36.4% for ages 70-79 years, respectively. Hypertension, diabetes mellitus, heart disease, chronic hepatitis, disc herniation and cerebral infarction under treatment with anticoagulants were significant independent risk factors for ED. CONCLUSIONS: The results obtained indicated a significant association between aging and chronic diseases and erectile function. Further epidemiologic research and analysis of individual risk factors are required to allow more effective future strategies for the treatment and prevention of ED.     

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。     

Erectile function after posterior urethroplasty for pelvic fracture‐urethral distraction defect injuries

OBJECTIVE

To determine the specific effect of pelvic fracture‐urethral distraction defect (PFUDD) injuries on erectile function (EF) in men after pelvic fractures, and to compare EF to that found in other studies of men who sustained pelvic fractures, as currently the relationship between erectile dysfunction (ED) and PFUDD has not been elucidated using validated questionnaires.

PATIENTS AND METHODS

With approval from the institutional review board, patients who sustained a PFUDD injury and had a posterior urethroplasty from 1990 to 2004 were identified from a database. Patients were contacted by telephone, and those who were willing to participate were given the International Index of Erectile Function (IIEF) questionnaire. Using unpaired Student’s t‐tests, IIEF scores were compared to normal controls, and to results of other studies of men sustaining pelvic fractures.

RESULTS

In all, 26 men completed the IIEF, among whom EF was compromised in 14 (54%), including eight with severe ED (31%). Orgasmic function and ejaculation was maintained. Men with a PFUDD had significantly worse EF than men in other series with pelvic fractures.

CONCLUSIONS

Men who sustain a PFUDD are at significantly greater risk of ED than those with no urethral distraction injury. Men with PFUDD injuries represent a target population for early penile rehabilitation programmes.     

Erectile dysfunction is predictive of all-cause mortality in patients with prostate cancer treated with permanent interstitial brachytherapy

Study Type – Prognosis (individual cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Cardiovascular disease is a leading cause of death in prostate cancer patients. Pretreatment ED is a surrogate for vascular pathology. Aggressive treatment of medical co‐morbidity in prostate cancer patients may positively impact overall survival.

OBJECTIVE

• ? To evaluate the relationship between pre‐treatment erectile function and all‐cause mortality in patients with prostate cancer treated with brachytherapy.

PATIENTS AND METHODS

• ? In all, 1279 consecutive patients with clinically localized prostate cancer and pre‐implant erectile function assessed by the International Index of Erectile Function‐6 (IIEF‐6) underwent brachytherapy.
• ? Potency was defined as an IIEF‐6 score of ≥13 without pharmacological or mechanical support.
• ? Patients were stratified into IIEF‐6‐score cohorts (≤12, 13–23 and 24–30).
• ? The median follow‐up was 5.0 years.

RESULTS

• ? The 8‐year overall survival (OS) of the study population was 85.1%.
• ? The 8‐year OS for IIEF‐6scores ≤12, 13–23 and 24–30 were 78.0%, 92.8% and 91.4%, respectively (P < 0.001).
• ? Cardiovascular events accounted for a significant portion of deaths in each IIEF‐6 group.
• ? When combined with other risk factors for cardiovascular disease, an IIEF‐6 score of ≤12 had an additive effect on all‐cause mortality (IIEF‐6 score of ≤12 and less than two comorbidities vs two or more comorbidities were 18.2% and 32.1%).

CONCLUSIONS

• ? A pre‐implant IIEF‐6score of ≤12 was associated with a higher incidence of all‐cause mortality.
• ? Pre‐treatment erectile dysfunction is a surrogate for underlying vascular pathology, probably explaining the lower OS in this subset of patients.
• ? Aggressive treatment of medical co‐morbidity is warranted to impactOS.

     

老年男性腔隙性脑梗死患者性功能问卷调查

目的:探讨老年男性腔隙性脑梗死患者性功能改变的特点,以利患者全面康复。方法:38例老年(60~70岁)患者,分为腔隙性脑梗死组20例,非脑梗死组18例,排除明显运动障碍、卒中后抑郁、帕金森病、严重系统性疾病等。于出院时及出院后6个月分别行国际勃起功能评分5(IIEF-5)问卷调查,比较各组之间以及随访前后IIEF-5评分的变化。结果:腔隙性脑梗死组19例(95.0%)发生勃起功能障碍(ED),较非梗死组(15例,83.3%)明显增高,且重度ED的发生率较高(60.0%vs44.4%,P<0.05),两组中合并糖尿病患者的ED程度较重。随访康复治疗6个月后脑梗死患者的IIEF-5评分较出院明显增加(11.2±3.2vs15.6±2.2,P<0.05)。结论:老年男性腔隙性脑梗死后ED的发病明显增加,程度更严重。合并糖尿病的患者ED更严重。卒中后康复治疗有助于患者勃起功能的恢复。     

Endocan is markedly overexpressed in severe erectile dysfunction

This study aimed to measure the serum endocan level of patients with erectile dysfunction (ED) and to investigate the possible association between this and vasculogenic severe ED. We performed a prospective analysis of 86 consecutive patients affected by ED. Patients were divided into severe ED (IIEF‐5 score < 7) and mild or moderate ED (IIEF‐5 score > 7). A strong negative correlation was found between serum endocan levels and peak systolic velocity (p < .001 and r = ?.665) in men with severe ED. Univariate logistic regression analysis demonstrated that tobacco consumption (p < .05), serum total 25‐hydroxyvitamin D (p < .01), serum endocan levels (p < .01), peak systolic velocity (p < .01), hypertension (p < .001), dyslipidaemia (p < .001), metabolic syndrome (p = .026) and a history of a cardiovascular event (p < .001) significantly increase the risk of severe ED. In the multivariate logistic regression model, we also found that age, hypertension, metabolic syndrome, cardiovascular events and higher serum endocan levels were independently associated with severe ED. Circulating endocan may be used in daily practice as a new marker that correlates with cardiovascular risks and the severity of ED disease.     

持续气道正压通气对睡眠呼吸暂停综合征合并勃起功能障碍的治疗

目的 :探讨经鼻持续气道正压通气 (nCPAP)对睡眠呼吸暂停综合征 (SAS)合并勃起功能障碍 (ED)患者勃起功能的影响。　方法 :SAS合并ED患者 2 7例 ,随机分为治疗组 15例和对照组 12例 ,治疗组使用BIPAP呼吸机以nCPAP治疗 1个月 ,比较两组治疗前后睡眠呼吸暂停低通气指数 (AHI)、最低SaO2 和勃起功能国际问卷 5 (IIEF 5 )评分的变化。　结果 :两组患者治疗前AHI、最低SaO2 、勃起功能、IIEF 5评分无明显差异 ,治疗组在治疗后比治疗前、对照组均有明显改善 ,差异均有显著性 (P <0 .0 5 )。而对照组在治疗前后上述指标无明显变化 (P >0 .0 5 )。结论 :nCPAP可改善SAS合并ED患者的勃起功能。     

Efficacy and safety of sildenafil for treating erectile dysfunction in patients on dialysis

OBJECTIVE: To assess the efficacy of sildenafil for erectile dysfunction (ED) in patients on haemodialysis (HD) or peritoneal dialysis (PD), as men with end-stage renal disease (ESRD) often have sexual dysfunction (up to 82% among those on chronic dialysis). PATIENTS AND METHODS: Forty-one patients with ED and in ESRD participated in an open-label prospective study. Thirty patients on HD and 11 on PD were asked to complete the International Index of Erectile Function (IIEF) and Fugl-Meyer life-satisfaction scale before and after sildenafil treatment. A total score in the erectile function domain of < or = 25 was accepted as indicating ED. All patients were started on a 25-mg dose, which was increased to 50 mg if there was no response after two trials. In addition, the overall efficacy question was used to evaluate satisfaction, and patients reported any side-effects during treatment. RESULTS: The erectile function and intercourse satisfaction domains improved significantly in both groups (P < 0.01). After sildenafil treatment, two-thirds of those on HD (20/30) and nine of the 11 on PD recovered their erectile function. The pretreatment scores on the IIEF and four domains (except sexual desire) of those responding were significantly higher than in those not responding (P < 0.05). The satisfaction rate on the overall efficacy question was 80% and 82% for the HD and PD groups, respectively. At least one side-effect was seen in 17 patients (43%); one had severe hypotension in the PD group. Overall, mild headache (seven patients, 18%) and flushing (12, 30%) were reported most often. CONCLUSIONS: Sildenafil is a safe and satisfactory drug for improving erectile function in patients with ESRD. Patients were satisfied whether treated by HD or PD. Pretreatment scores on the IIEF may be useful for predicting the success of treatment.