万艾可在伴心血管疾病ED患者中的临床应用

目的评价万艾可对伴有心血管疾病患者勃起功能障碍(ED)治疗的有效性和安全性。方法伴有心血管疾病的ED患者85例,其中高血压34例,冠心病19例,心律失常32例。性交前1h口服万艾可25mg,以后根据患者对治疗的满意程度和对药物的耐受性,逐渐增加,最大可达100mg。最大剂量不超过100mg/d。疗程为8周。结果万艾可治疗后,本组IIEF-5评分平均为(18．37±4．05)分,IIEF-5评分增加(8．61±2．35)分,配偶满意度总体评价,满意率达72．9%。结论慢性、稳定的心血管疾病ED患者对应用万艾可治疗有良好的有效性和耐受性。     

万艾可治疗勃起功能障碍的新进展

自1998年上市以来,万艾可已成为治疗男性勃起功能障碍的一线口服药,其疗效和安全性得到广泛的确认。本文对万艾可的疗效、安全性、对阴茎的保健作用及对改善性关系方面的最新研究结果作一个简要综述。     

勃起功能障碍与心血管疾病的关系

随着人口步入老龄化,高血压、冠心病等心血管危险因素逐年增加,心血管疾病与勃起功能障碍(erectile dysfunction,ED)之间的关系越来越受到重视.本文简要综述了两者关系及心血管疾病患者ED的治疗进展.一、ED与心血管疾病关系(一)ED和心血管疾病有共同的危险因子心血管疾病的诸多危险因素(老年、吸烟、糖尿病、脂代谢紊乱、肥胖和少活动等)也是ED的危险因子.1.老年:目前普遍认为ED是一个与年龄相关性疾病.多个流行病学调查均表明ED的患病率随着年龄的增长逐渐增高.患病率可从20岁的0.1％到80岁的75％.北京地区老年男性性生活平均终止年龄及ED的发生率及影响因素的调查研究显示,北京地区男性终止性生活(2年以上无性交)年龄为(68.4±5.2)岁,ED发病率为89.4％,其中轻度6.7％、中度18.6％、重度28.4％和无性生活率35.7％.在严重ED终止性生活的老年男性中,60～64岁组占26.8％,而70岁以上组则超过50％[1].     

万艾可治疗后ED患者勃起硬度改善与情感满意度的关系

为了阐述ED患者的勃起硬度与其他相关结果的关系，King等进行了一项研究，综合分析了对全球27组随机双盲安慰剂对照研究和6组开放性研究。评价主观硬度分级，国际勃起功能指数问卷（erectile dys-function inventory，IIEF）中的硬度与性满意度评分，自尊心和性关系（Self-Esteem And Relationship，SEAR）问卷中的总体评分与性生活评分，勃起功能障碍问卷及治疗的满意度。硬度的改善（在合适的量效关系下达到完全的坚挺状态）与其他指标变化有明确的关联性。西地那非100mg可以成就大部分ED患者达到理想的硬度（完全的坚挺）。理想的勃起硬度，可促进主观上的幸福与满足，西地那非100mg是绝大部分ED患者的合适剂量。     

安特尔联合万艾可治疗中老年勃起功能障碍100例分析

阴茎勃起功能障碍(ED)是指持续出现阴茎不能达到或保持充分勃起,以致不能获得满意的性活动,是中老年男性的常见病。据马萨诸塞州男性增龄研究(MMAS)的资料显示,40～70岁的男性中     

万艾可治疗勃起功能障碍的疗效和安全性

目的 :评估万艾可 (Viagra○R)治疗男性勃起功能障碍 (ED)的有效性和安全性。　方法 :本试验为双盲、随机(安慰剂 :西地那非 ,1:3)、安慰剂对照、剂量可调整 (2 5、5 0和 10 0mg)、持续 12周的临床研究。共有 84名受试者参与本研究。　结果 :对主要疗效指标 (IIEF问题 3、4)的分析结果显示 ,万艾可对ED病人达到和维持勃起能力的改善作用显著优于安慰剂 (P <0 .0 0 0 1) ,万艾可的临床总有效率为 86 % ,显著高于安慰剂 (37% ) ;对心理性、器质性和混合性ED的有效率分别为 83%、79%和 81% (安慰剂组分别为 5 0 %、33%和 30 % )。同时 ,对次要疗效指标评估 (IIEF其余 13个问题、记事表和总评题 )亦显示 ,万艾可改善性生活的作用明显优于安慰剂 ;万艾可组性交成功率平均为71.8% ,显著高于安慰剂组 (17.0 % ) ;有 87.3%的万艾可组受试者认为研究药物改善了其勃起功能 ,显著高于安慰剂组 (36 .8% )。无 1名受试者因不良事件而中断研究 ,万艾可组的不良事件发生率 (33.3% )较安慰剂组高(19.0 % ) ,但绝大多数为轻度、一过性的。　结论 :口服万艾可是一种可治疗各种病因导致的勃起功能障碍安全有效的药物 ,按需服用时能很好耐受。     

复方玄驹胶囊联合万艾可治疗万艾可渐进性失效勃起功能障碍的临床观察

目的:探讨复方玄驹胶囊联合万艾可治疗万艾可渐进性失效勃起功能障碍(ED)的临床疗效。方法:将符合万艾可渐进性失效ED诊断标准的36例患者随机分成两组,每组各18例。其中治疗组给予复方玄驹胶囊(口服,2粒/次,3次/日)和万艾可50 mg(性生活前1 h口服)口服;对照组单纯口服万艾可100 mg(性生活前1 h口服)。两组性生活频率1～2次/周,观察期2个月,对用药前后患者国际勃起功能评分(IIEF-5)及TSS伴侣评分进行对比分析。结果:两组每次使用万艾可对勃起功能改善的有效率比较,治疗组总有效率94.44%,对照组88.89%,两组对比差异无显著性意义(P>0.05)。IIEF-5评分治疗组治疗前后分别为(13.166 7±3.601 5)和(20.888 9±3.833 1),而对照组治疗前后分别为(13.055 6±2775 4)和(18.777 8±4.008 2),每组治疗前后对比差异有显著性意义(P<0.05);治疗后两组IIEF-5评分及TSS伴侣评分比较,治疗组的效果均比对照组好,且差异具有显著性意义(P<0.05)。结论:复方玄驹胶囊联合万艾可治疗万艾可渐进性失效ED疗效显著。     

他达拉非治疗合并心血管疾病的ED研究进展

勃起功能障碍(ED)是严重影响男性性生活质量的疾病。近来发现,ED与心血管疾病关系密切,它们之间具有许多相似的致病机制和共同的危险因素。他达拉非是治疗ED的有效药物,大量的研究已经证实了其在ED患者中的显著疗效。其独特的长达36 h的时间窗不仅增强了患者的自信心,更改善了患者及其伴侣的生活质量。     

心血管疾病患者并发勃起功能障碍的危险因素分析

目的:调查男性心血管疾病住院患者的勃起功能,探讨心血管疾病中勃起功能障碍(ED)的发生率及其危险因素与勃起功能的关系。方法:自行设计问卷,对西安交通大学第一、第二附属医院心血管内科住院的男性患者进行问卷调查,测量身高、体重、腰围、臀围、血压等数据;收集个人基本信息、既往史(包括吸烟史、饮酒史,高血压、冠心病、心律失常、心绞痛、心肌梗死病史、糖尿病病史等),记录代谢参数检查结果。同时以IIEF-5进行勃起功能评分。采用单变量、多变量Logistic回归分析及比值比(OR)确定ED的危险因素。结果:本研究共纳入有效问卷225份,经统计分析发现在整个调查人群中ED的发病率为66.7%。其中轻度、轻中度、中度、重度ED的发病率分别为15.8%、27.0%、17.6%、6.3%。各组别(18~35岁、36~49岁、50~65岁、65岁)人群ED的发病率分别为13.6%、39.1%、89.2%、91.2%。单变量Logistic回归显示,心血管疾病并发ED的危险因素包括年龄(OR=3.122,95%CI:2.040~4.779)、吸烟(OR=1.768,95%CI:1.209~2.584)、BMI(OR=1.261,95%CI:1.114~1.427)、总胆固醇(OR=1.77,95%CI:1.339~2.34)、TC/HDL(OR=1.715,95%CI:1.349~2.181)、高血压(OR=1.717,95%CI:1.110~2.658)及冠心病(OR=2.235,95%CI:1.169~4.275)。而多变量Logistic回归分析显示,心血管疾病并发ED的危险因素分别为年龄(OR=4.99,95%CI:2.264~10.998)、经济情况(OR=2.804,95%CI:1.127~6.976)、吸烟(OR=2.109,95%CI:1.179~3.772)、BMI(OR=1.414,95%CI:1.136~1.76)和TC/HDL(OR=2.001,95%CI:1.016~3.943)。结论:在我国心血管疾病男性住院患者中ED的发病率很高,并随着年龄的增长而升高。年龄、吸烟、经济情况、BMI、TC/HDL是ED的危险因素,心血管病与ED存在着共同的危险因素,包括年龄、吸烟、BMI、TC/HDL,而经济情况在研究中被证实与ED关系密切,为以后的研究提供了新的思路。     

万艾可治疗老年糖尿病性勃起功能障碍疗效分析

目的:观察万艾可治疗我国老年糖尿病性勃起功能障碍患者的临床安全性和疗效。方法:用国际勃起功能问卷的勃起功能评分、性生活日记的问题2及问题3和总体评价问卷评估452例患者服用万艾可前后勃起功能状况。结果:服药后,患者的国际勃起功能问卷的勃起功能评分提高程度、性生活日记问题2和问题3作肯定回答的患者百分率,以及总体评价问卷回答百分率均显著高于基线值,统计学分析差异有极显著性(P<0.01)。结论:万艾可显著改善糖尿病性勃起功能障碍患者的勃起能力,提高性生活质量。     

LUTS: A Risk Factor for Sexual Dysfunction in the BPH Patient

Objective: To present summary data from community surveys, including the recent Multinational Survey of the Ageing Male (MSAM-7) that have examined the relationship between the presence of lower urinary tract symptoms (LUTS) and sexual dysfunction in ageing men.Methods: Studies that have assessed the prevalence and severity of LUTS and predominantly erectile dysfunction (ED), in western ageing men, and MSAM-7 outcomes based on more comprehensive sexual dysfunction assessments, including ejaculation dysfunction (EjD), are reviewed.Results: Maintenance of sexual function is valued highly by ageing men but the presence and severity of LUTS correlates strongly with dysfunction in all sexual domains. The prevalence of EjD approaches that of ED and is bothersome to those affected.Conclusions: The presence of LUTS in men is a significant risk factor for sexual dysfunction, independent of comorbid disease and increasing age. All aspects of men’s sexual functioning should be assessed and considered when evaluating BPH and deciding on treatment.     

A Systematic Review of the Association Between Erectile Dysfunction and Cardiovascular Disease

Context

Erectile dysfunction (ED) is considered a vascular impairment that shares many risk factors with cardiovascular disease (CVD). A correlation between ED and CVD has been hypothesized, and ED has been proposed as an early marker of symptomatic CVD.

Objective

To analyze the relationship between ED and CVD, evaluating the pathophysiologic links between these conditions, and to identify which patients would benefit from cardiologic assessment when presenting with ED.

Evidence acquisition

A systematic literature review searching Medline, Embase, and Web of Science databases was performed. The search strategy included the terms erectile dysfunction, cardiovascular disease, coronary artery disease, risk factors, pathophysiology, atherosclerosis, low androgen levels, inflammation, screening, and phosphodiesterase type 5 inhibitors alone or in combination. We limited our search to studies published between January 2005 and May 2013.

Evidence synthesis

Several studies reported an association between ED and CVD. The link between these conditions might reside in the interaction between androgens, chronic inflammation, and cardiovascular risk factors that determines endothelial dysfunction and atherosclerosis, resulting in disorders of penile and coronary circulation. Because penile artery size is smaller compared with coronary arteries, the same level of endothelial dysfunction causes a more significant reduction of blood flow in erectile tissues compared with that in coronary circulation. Thus ED could be an indicator of systemic endothelial dysfunction. From a clinical standpoint, because ED may precede CVD, it can be used as an early marker to identify men at higher risk of CVD events. ED patients at high risk of CVD should undergo detailed cardiologic assessment and receive intensive treatment of risk factors.

Conclusions

ED and CVD should be regarded as two different manifestations of the same systemic disorder. ED usually precedes CVD onset, and it might be considered an early marker of symptomatic CVD.     

Prevention and management of postprostatectomy sexual dysfunctions. Part 1: choosing the right patient at the right time for the right surgery

Context

Sexual dysfunction is common in patients following radical prostatectomy (RP) for prostate cancer (PCa).

Objective

To review the available literature concerning prevention and management strategies for post-RP erectile function (EF) impairment in terms of preoperative patient characteristics and intra- and postoperative factors that may influence EF recovery.

Evidence acquisition

A literature search was performed using Google and PubMed database for English-language original and review articles either published or e-published up to November 2011.

Evidence synthesis

The literature demonstrates great inconsistency in what constitutes normal EF before surgery and what a man may consider a normal erection after RP. The use of validated psychometric instruments with recognised cut-offs for normalcy and severity during the pre- and postoperative evaluation should be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative erectile dysfunction (ED), the concept of spontaneous or pharmacologically assisted erections, and the difference between “back to baseline” EF and “erections adequate enough to have successful intercourse” clearly emerge as key issues in the eventual understanding of the prevention of ED and promotion of satisfactory EF recovery post-RP. Patient factors (including age, baseline EF, and status of comorbid conditions), cancer selection (unilateral vs bilateral nerve sparing), type of surgery (ie, intra- vs inter- vs extrafascial surgeries), surgical techniques (ie, open, laparoscopic, and robot-assisted RP), and surgeon factors (ie, surgical volume and surgical skill) represent the key significant contributors to EF recovery.

Conclusions

The complexity of the issues discussed throughout this review culminates in the simple concept that optimal outcomes are achieved by the careful choice of the correct patient for the correct type of surgery.     

男性性功能障碍与脊髓损伤及其他神经系统疾病

男性性功能是人与环境之间错综复杂的相互作用过程。性刺激的认识整合和生理反应必须依赖于神经系统的功能。因此 ,中枢或外周神经功能紊乱也许会损伤男性性功能。本文对男性性活动的正常的神经解剖学、流行病学、病理生理学 ,及由于脊髓损伤、脑血管疾病、多发性硬化和帕金森病等引起的性功能障碍进行了综述     

Erectile Dysfunction: The Medical Treatment

Erectile dysfunction (ED) is a problem that affects not only men but also couples and thus families. New effective oral treatments have completely modified the diagnostic and therapeutic approach to ED. This paper reviews the mechanism of action of the different available drugs on the pathophysiology of erection.