全面康复:勃起功能障碍治疗的新目标

5型磷酸二酯酶(PDE5)抑制剂有效改善勃起功能障碍(ED)患者的勃起功能。枸橼酸西地那非的应用范围不断扩展,肺动脉高压已成为新的适应证。临床研究发现,西地那非能改善多种血管性疾病患者的内皮功能。在ED领域的研究进展包括:动物实验发现,西地那非可以改善海绵体内皮功能,增强磷酸化内皮型一氧化氮合酶(eNOS)蛋白表达,逆转缺血或缺氧导致的海绵体内压(ICP)降低。临床研究证实,西地那非可以使50%以上ED患者阴茎勃起恢复到最充分的硬度(4级勃起);使50%以上保留神经的根治性前列腺切除术后患者勃起功能康复,自发产生足以性交的勃起;使ED患者的自尊心、自信心和性关系满意度等社会心理功能恢复正常。从勃起功能到社会心理功能的全面恢复可能成为今后ED治疗的新目标。

Whole Rehabilitation: a New Goal of Erectile Dysfunction Therapy

Phosphodiesterase type 5(PDE5) inhibitors effectively enhance the erectile function of the patients with erectile dysfunction(ED).The use of sildenafil citrate is expanding to a broader extent.Pulmonary artery hypertension has become a new indication of sildenafil.Sildenafil could improve the epithelial function in several vascular conditions in clinical trials.This article reviews the recent advances on basic and clinical studies of ED and sildenafil.On animal models,sildenafil could resume the cavernous epithelial function,up-regulate the protein expression of phosphorylated endothelial NO synthase(eNOS),reverse the decreased intracavernosal pressure(ICP) induced by pudendal artery blood flow restriction or hypoxia.In clinical studies,over 50% of ED patients receiving sildenafil got a fully rigid erection(grade 4 erection).And the same percentage of post-nerve-sparing radical prostatectomy patients receiving sildenafil obtained penile rehabilitation and spontaneously resumed erection sufficient for sexual intercourse.Sildenafil treatment has contributed to the normalization of self-esteem,confidence and sexual harmony in men with ED.All this suggests that a whole rehabilitation from erectile to psychosocial function may become a new goal of ED therapy.Natl J Androl,2006,12(9):832-835