120例阴茎勃起功能障碍病因分析

通过120例阴茎勃起功能障碍(ED)患者的观察并分析其病因,结果表明心理性ED78例(65.0％),血管性ED22例(18.3％),内分泌性ED15例(12.5％),神经性ED5例(4.2％)。并对不同病因的ED进行了讨论。     

阴茎勃起强度测量带在鉴别勃起功能障碍分型中的应用

目的:研究阴茎勃起强度测量带在鉴别心理性勃起功能障碍(ED)和器质性ED的临床应用价值。方法:通过病史、体格检查、国际勃起功能指数问卷(IIEF-5)和夜间阴茎勃起功能(NPT)检测,选取80例以"阴茎持续不能达到或维持足够的勃起以完成满意的性生活"为主诉的患者作为试验组;40例勃起功能正常的健康婚检者作为对照组。根据IIEF-5评分,将试验组分为轻度ED、中度ED和重度ED 3类,同时根据NPT检测结果将试验组分心理性ED及器质性ED。随后应用阴茎勃起强度测量带对所有研究对象连续检测3晚,根据条带断裂结果将试验组分为心理性ED及器质性ED,比较2种诊断方法的符合率。最后以NPT结果为评估标准,统计分析阴茎勃起强度测量带鉴别心理性ED和器质性ED的漏诊率、误诊率及总符合率。结果:NPT检测发现试验组中心理性ED 51例,器质性ED共29例;阴茎勃起强度测量带检测发现试验组中轻度ED患者断带率为95.0%,中度为80.9%,重度为52.8%;NPT检测心理性ED患者应用阴茎勃起强度测量带连续检测3晚,诊断为心理性ED 43例,诊断为器质性ED 8例,2种诊断方法的符合率为84.3%;器质性ED患者应用阴茎勃起强度测量带连续检测3晚,诊断为心理性ED 5例,诊断为器质性ED 24例,2种诊断方法的符合率为82.8%;NPT检测对照组均考虑为正常勃起;阴茎勃起强度测量带连续检测3晚均可见3档全断裂,2种方法诊断符合率为100%。以NPT结果为评估标准,阴茎勃起强度测量带鉴别心理性ED和器质性ED的漏诊率为15.7%,误诊率为17.2%,总符合率为83.8%。Kappa值为0.656,P0.05。结论:阴茎勃起强度测量带可作为鉴别心理性ED和器质性ED的初筛工具。     

脊柱或骨盆损伤后阴茎勃起功能障碍的病因分析

目的 分析脊柱或骨盆损伤后阴茎勃起功能障碍(ED)的可能病因.方法 回顾性分析2005-2009年收治的67例因脊柱或骨盆损伤后ED患者资料.年龄18 ～64岁,平均32岁.伤后时间3～144个月,平均38个月.其中骨盆骨折56例(84％),脊柱外伤11例(16％).患者自诉受伤前性功能正常.患者在未服用或停用PDE-5抑制剂的情况下进行IIEF-5评分、夜间勃起监测(NPT,Rigiscan系统,连续检测3晚)、阴茎彩色多普勒超声(CDU)检查.NPT检测夜间勃起＜3次,每次阴茎头部勃起硬度＜70％,时间＜ 10 min诊断为器质性ED.阴茎Ⅳ度勃起情况下,CDU检查峰收缩期速率(PSV)＜ 25 cm/s诊断为动脉性ED;PSV＞ 25 cm/s,舒张末期速率(EDV) ＞5 cm/s诊断为静脉性ED;排除其他原因的器质性ED诊断为神经性ED.结果 62例患者在6个月内未尝试性生活,5例患者IIEF-5评分5～8分.NPT检测证实62例患者均为器质性ED,其中骨盆骨折患者中神经性ED 24例(43％),动脉性ED 22例(39％),静脉性ED 10例(18％);脊柱外伤患者均为神经性ED.结论 骨盆骨折或脊柱外伤可导致器质性ED.骨盆骨折导致的ED可能合并血管性因素,而脊柱外伤所致ED为神经性.     

血液黏稠度与阴茎勃起功能障碍的相关性研究

目的探讨阴茎勃起功能障碍(Erectile Dysfunction,ED)与血液黏稠度相关指标的相关性,分析其临床意义。方法对73例ED患者和35例阴茎勃起正常对照者血液黏稠度相关指标进行分析。结果 ED组患者全血高切黏度(η100)全血低切黏度(η10)、血浆黏度(ηp)、红细胞聚集指数(CE)、总胆固醇(TC)及低密度脂蛋白(LDL-C)等明显高于对照组(P0.05),在不同病因ED组中,内分泌性ED组患者的CE、TC及LDL-C明显高于心因性、动脉性、静脉性、神经性ED组(P0.05)。结论 ED患者相对于正常人血液黏稠度较高,可能是ED的潜在原因。     

睡前服用西地那非可显著改善阴茎夜间勃起:一项西地那非、安慰剂对照研究的结果

勃起功能障碍(ED)患者尤其是器质性病因者,夜间阴茎勃起往往也受到不同程度的影响,西地那非能显著改善性生活时的阴茎勃起,而对夜间阴茎勃起有作用吗?Montorsi F等人为此进行了一项安慰剂对照研究[Urology,2000,56(6):906-911]。30名ED患者[其中血管性病因者22名(73%);心理性病     

彩色多普勒超声诊断血管性勃起功能障碍

阴茎勃起功能障碍(ED)的病因可分为器质性和精神性。现多数人认为器质性病变是其主要原因,比例可达80％。1984年,Lue首先采用复式多普勒超声技术对动脉性ED进行了检测。之后,又有许多研究者作了相似报道,在阴茎勃起的血流动力学及药理学方面取得了一定的进展,认为其诊断的灵敏度为75～90.2％,特异性为56～95％。从而,作为一种无创伤性检查越来越被临床医师所重视和应用。     

夜间生物电阻抗容积测定对勃起功能障碍的诊断

目的:探讨夜间生物电阻抗容积测定(NEVA)在诊断勃起功能障碍(ED)中的应用价值。方法:对临床怀疑ED的100例患者进行NEVA测定。其中58例怀疑血管性ED,将该测定与阴茎海绵体造影联合彩超检查进行比较。结果:10例糖尿病性ED中有2例夜间阴茎勃起(NPT)正常,2例为动脉供血不足,6例无NPT。4例内分泌性ED患者中,2例NPT正常,2例无NPT。20例心理性ED的患者中,16例NPT正常,1例为动脉供血不足,3例无NPT。58例怀疑血管性ED的患者中确诊者有30例,其中18例为动脉性,12例为静脉性,非血管性ED28例。而应用NEVA发现在30例血管性ED中6例NPT正常,28例非血管性ED中4例NPT异常。8例外伤性ED中,2例腰椎骨折患者的NPT表现为轻度动脉供血不足;3例骨盆骨折患者中2例NPT正常,1例无NPT;3例骨盆骨折并发-后尿道断裂的患者,2例NPT正常,1例NPT提示动脉供血不足。结论:NE-VA对临床上怀疑心理性ED和血管性ED的诊断有较好的参考价值。     

勃起功能障碍患者心理现状调查及心理调适

正勃起功能障碍(erectile dysfunction,ED)是指阴茎勃起的程度不能达到和(或)维持以获得满意的性生活[1]。ED是男科门诊常见病,对男性患者本身及性伴侣的生活质量均造成严重影响。根据病因,临床上将ED分为心理性ED、器质性ED及混合型ED 3类,有研究发现63.1%的ED患者会出现精神性症状[2]。因此,心理与器质性问题的同时考虑治疗,系统分析病因,是成功治疗的关键。本研究采     

NEVA-夜间阴茎勃起测定系统的临床应用(附600例报告)

阴茎勃起功能障碍(ED)是一种常见病，ED的发生可起源于多种不同的病理生理学过程，临床诊治工作需要对每一位ED患者进行病因诊断，目前夜间阴茎勃起测定(NPT)不仅是鉴别心理性和器质性ED的重要方法，而且是用来作为客观分析和评价ED治疗药物以及方法的一种必要研究手段，因此我们使用NEVA-夜间阴茎勃起测定系统对一组ED患者进行检查，现将检查情况报告如下。     

VISER检查鉴别心理性与器质性勃起功能障碍(附320例报告)

目的应用VISER鉴别心理性与器质性ED并利用该方法对心理性ED严重性进行客观分级。方法320例ED患者接受了VISER检查。首先海绵体内注射罂粟硷10mg；未诱发勃起，药物剂量增至30mg。将药物试验阳性者定义为心理性ED，并根据海绵体压力、波幅形态以及药物剂量将心理性ED分为轻、中、重二度。两次检查均失败者，行阴茎彩色多普勒超声和海绵体造影检查。结果本组中，心理性ED占81．9％，其中轻度、中度和重度者分别占19．8％，60．7％和19．5％。在部分病例中，检查结果与Zung氏抑郁量表评分具有一定相关性。33例接受阴茎多普勒超声或海绵体造影检查提示，正常13例，动脉性ED5例，静脉性ED9例，动脉静脉混合性ED6例。结论VISER有助于签别心理性与器质性ED，依据其结果对心理性ED严重程度进行客观分级，便于对患者选择有针对性的治疗。     

Erectile dysfunction and cardiovascular risk factors

There are numerous causes of erectile dysfunction (ED), including psychogenic, organic,and mixed psychogenic/organic. Among the organic causes the most common include vascular, neurogenic, endocrine, structural, drug-induced, and others. Some have estimated that nearly one half of all causes of ED in men over 50 years of age are vascular in nature. This article reviews cardiovascular risk factors of ED.     

神经性勃起功能障碍诊断探讨

目的 :探讨神经性勃起功能障碍 (ED)的诊断方法 ,提高该病的诊断水平。　方法 :对 2 0 1例ED病人分别采取全面采集病史、有针对性的体格检查、国际勃起功能评分表 (IIEF 5 )评分、阴茎海绵体注射 (ICI)试验、阴茎彩色双功能超声、球海绵体肌反射潜伏时间等诊断方法。　结果 :有 173、2 0 1、10 6、5 7、2 7例次ED病人分别接受了上述检查 ,诊断神经性ED 13例 (6 .4 6 % ) ,其他原因和原因不明ED 188例。　结论 :神经性ED较常见 ,采取综合诊断方法 ,能提高其诊断水平     

他达拉非治疗勃起功能障碍的疗效和安全性临床观察(附80例报告)

目的:观察他达拉非对勃起功能障碍(ED)患者临床有效性和安全性。方法:采用自身对照研究方法。80例ED患者服药前后分别接受性视频刺激加实时阴茎硬度测试仪(R igiscan)监测,比较服药前后阴茎头、根部胀大周径,勃起硬度,持续时间的变化。结果:患者服药前后阴茎勃起头、根部硬度,持续时间比较差异有显著性(P<0.05);心理性ED患者比器质性、混合性ED患者提高更加显著(P<0.01)。他达拉非对ED患者的总有效率为82.5%,对心理性、器质性、混合性的ED有效率分别为92.3%、68.7%、58.3%。心理性ED患者的显效率与器质性、混合性ED患者相比差异显著(P<0.05);药物相关的不良事件(头痛头晕11例,消化道不适8例,面色潮红5例,肌肉疼痛2例)多为轻度,且可以自行缓解,不需处理。结论:他达拉非明显改善大多数ED患者勃起功能,不良反应较少,耐受性好。     

The etiology of erectile dysfunction and contributing factors in different age groups in Turkey

BACKGROUND: The aim of the present study was to determine the pathophysiological factors which cause erectile dysfunction (ED), as well as the risk factors in different age groups in Turkey. METHODS: A total of 948 patients with ED who were admitted to three andrology clinics were evaluated in terms of etiological factors. They underwent a multidisciplinary diagnostic evaluation. Erectile dysfunction was classified as primarily organic, primarily psychogenic, mixed or unknown in etiology. RESULTS: Psychogenic ED was diagnosed in 65.4% of the patients and organic ED was diagnosed in 34.6% of patients overall. In patients under 40 years, the rate of psychogenic ED was 83% and the rate of organic ED was 17%, but in the patients over 40 years, the rate of psychogenic ED was 40.7% and the rate of organic ED was 59.3%. The causes of organic ED were identified as arteriogenic ED, 40.5%; cavernosal factor (venogenic) ED, 10%; neurogenic ED, 12.5%; endocrinologic ED, 1.8%; mixed type ED, 11.8%; and drug induced ED, 4.5%. CONCLUSION: Our data represent a higher ratio of ED in patients under 40, which are mostly psychogenic, This finding potentially results from local social and cultural differences.     

青壮年男性勃起功能障碍病因分析及个性化治疗(附110例报告)

目的:分析青壮年男性勃起功能障碍(ED)病因,总结个性化治疗的效果。方法:主诉ED的青壮年患者110例,年龄22~39岁,平均28岁,病程6~48个月,平均24个月。通过病史调查、体格检查、实验室检查及勃起功能特殊检查,确定ED病因,并针对病因采用相应治疗方法。结果:诊断为心理性ED 42例(38.2%);器质性ED36例(32.7%);混合性ED 32例(29.1%)。110例ED患者中4例被确诊为精神分裂症转诊,4例外伤性患者放弃ED治疗,其余102例接受不同方法的个性化治疗,平均总有效率为88.2%。结论:明确青壮年男性ED的病因诊断,采用个性化治疗方法,可提高整体疗效。     

Characteristics of erectile dysfunction in Saudi patients

We investigated the characteristics of erectile dysfunction (ED) in ambulatory Saudi patients. A total of 680 male patients were assessed for ED using IIEF. Patients were also interviewed for sociodemographic data, medical history and risk factors for ED. Assessment for penile vasculature using color Doppler ultrasonography and rigidometer was performed. In all, 21.4% of the patients with severe ED were <50 y and 78.6% of them were > or =50 y (P<0.001). Of the patients, 20% had psychogenic, while 80% had organic causes of ED. Of the patients, 10% had mild, 39.3% had moderate and 50.7% had severe ED. There was a significant association between increasing severity of ED and the presence of diabetes, hypertension, dyslipidemia, smoking, increased BMI, increased values of EDV, decreased values of PSV, RI and rigidometer (P<0.001 for each). Moderate to severe ED is common among Saudi patients. This study provides a quantitative estimate of the characteristics of ED in ambulatory Saudi patients.     

Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study

OBJECTIVES: Erectile dysfunction (ED) shares common risk factors with coronary artery disease (CAD). It has been suggested that ED may be considered a clinical manifestation of a generalized vascular disease affecting also the penile arteries. The aim of this prospective study was to evaluate angiographically the incidence of asymptomatic CAD in men with ED of vascular origin. METHODS: Fifty consecutive asymptomatic men, aged 41-74 years, with non-psychogenic and non-hormonal ED were comprehensively evaluated using medical history and examination, exercise treadmill test and stress echocardiography. Patients who had positive one or both of the two non-invasive procedures were referred for coronary arteriography in order to document CAD and evaluate the severity of the disease. RESULTS: The mean time interval between the onset of ED and cardiological assessment was 25 months (range 1-66). Smoking (32 patients/64%), hypertension (31 patients/62%) and hyperlipidemia (26 patients/52%) were the most common risk factors. Moreover, 35 men (70%) had two or more risk factors. Twelve patients (24%) with ED had positive one or both of the two non-invasive procedures and one patient presented with acute myocardial infarction before he completed the non-invasive investigation. Coronary arteriography performed in ten patients (in nine with positive one or both of the two non-invasive procedures [while the other three refused], and in the patient with acute myocardial infarction) demonstrated that one patient had three-vessel disease, two patients had two-vessel disease and six patients had single-vessel disease. CONCLUSIONS: A considerable proportion (9/47 or 19%) of patients with ED of vascular origin has angiographically documented silent CAD. These findings support the strategy that patients with ED should undergo further cardiovascular evaluation.     

Role of RigiScan parameters in differentiation of vascular erectile dysfunction

Male nocturnal penile tumescence and rigidity assessed by RigiScan monitoring device (GOTOP Inc.) is a noninvasive tool to differentiate organic from psychogenic erectile dysfunction (ED). This study aimed to determine the diagnostic value of RigiScan parameters in differentiating arterial ED from veno-occlusive ED. We recruited 102 male patients (mean ± SD, 32.3 ± 6.7 years old) presented with an overall score <21 in the 5-item version of the International Index of Erectile Function scoring system. Baseline data of the included subjects were collected, and the patients were then subjected to RigiScan monitoring, penile colour Doppler ultrasound, and dynamic infusion cavernosometry and cavernosography examination. These patients were allocated into psychogenic, arterial and venous ED group based on the results of these specific examinations. At last, psychogenic ED was identified in 56 out of 102 men, while arteriogenic ED was identified in 31 cases and venogenic ED in 15 out of the overall 102 cases. The erection episodes per night (1.6 ± 0.5 vs. 2.5 ± 0.9 for venogenic vs. arterial ED respectively) and the duration of tip erections ≥60% in the venogenic ED group (21.5 ± 10.5 min) were significantly lower than cases in arteriogenic ED individuals (34.5 ± 17.0 min). Besides, receiver operating characteristic analysis showed that the duration of tip erections with a cut-off value of 12.5 min had 81.4% sensitivity and 100% specificity for predicting a venogenic ED in cases with organic impotence. In conclusion, the duration of tip erection of RigiScan parameters was used to distinguish venogenic from arterial ED.     

Sexual dysfunction after pelvic surgery

Pelvic surgeries are among the most common causes of organic sexual dysfunction in men and women. The impact of nerve-sparing surgery on potency has been well documented in radical prostatectomy. However, its impact on potency needs to be evaluated in other pelvic surgeries. Sexual dysfunction is highly prevalent even after multiple technical advances in the field of oncological surgeries. The prevalence varies from 8 to 82%, depending on the type of pelvic surgery. In females, sexual dysfunction has not been evaluated adequately using validated questionnaires. However, in subspecialized circles, treatment for female sexual dysfunction is becoming routine. Currently, physicians have several options for the treatment of erectile dysfunction (ED) in men. Since the introduction of oral PDE-5 inhibitors, oral therapy has become the first-line treatment option for ED, irrespective of etiology. Currently available treatment options for the female sexual dysfunction include estrogens, androgens, phosphodiesterase inhibitors, and dopamine receptor antagonists. Initial reports regarding the role of early rehabilitation are encouraging and may become the part of routine practice in the management of ED after pelvic surgery. In this article, we summarize the sexual dysfunction following pelvic surgeries and their management.