药物性阴茎双功能超声对静脉性勃起功能障碍血流循环阻力的评估

本文自１９９５年５月￣１９９６年６月对１６例静脉性勃起功能障碍（ＶＥＤ组）应用药物性阴茎双功能超声检测（ＰＰＤＵ）来观察静脉关闭机制受损所致阴茎血流循环阻力变化。阴茎血流循环阻力监测指标（１）阻力指数（ＲＩ），（２）Ａ／Ｂ比值，（３）搏动指数（ＰＩ）。并以３２例心理性勃起功能障碍（ＰＥＤ组）作对照。研究结果提示ＶＥＤ组ＲＩ〈１，Ａ／Ｂ值〉０。ＰＥＤ组Ｒ１≥１，Ａ／Ｂ比值≤０。ＶＥＤ组ＰＩ平均数低于     

药物性阴茎双功能超声对静脉性勃起功能障碍血流循环阻力的评估

本文自１９９５年５月～１９９６年６月对１６例静脉性勃起功能障碍（ＶＥＤ组）应用药物性阴茎双功能超声检测（ＰＰＤＵ）来观察静脉关闭机制受损所致阴茎血流循环阻力变化。阴茎血流循环阻力监测指标（１）阻力指数（ＲＩ），（２）Ａ／Ｂ比值，（３）搏动指数（ＰＩ）。并以３２例心理性勃起功能障碍（ＰＥＤ组）作对照。研究结果提示ＶＥＤ组ＲＩ＜１，Ａ／Ｂ比值＞０。ＰＥＤ组ＲＩ≥１，Ａ／Ｂ比值≤０。ＶＥＤ组ＰＩ平均数低于ＰＥＤ组，但参数有重叠现象，两组３项阻力指标参数有非常显著性差异（Ｐ＜０．０１）。我们认为静脉关闭机制障碍使海绵体内压下降，并引起阴茎血流循环阻力改变，阻力指标ＲＩ＜１和Ａ／Ｂ比值＞０可作为静脉关闭机制障碍判断标准，而ＰＩ的价值有待进一步探讨。     

多普勒超声技术动态观察血管性勃起功能障碍患者阴茎血流动力学的变化

目的动态观察多普勒超声技术配合阴茎海绵体注射在血管性勃起功能障碍患者诊断中的价值。方法120例疑血管性ED患者在阴茎注射PGE1后5min、10min和20min应用多普勒超声技术测量阴茎血流动力学变化,指标包括:收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、血流阻力指数(RI)。另100例心因性ED设为对照组。第一次注射后勃起不佳的患者3d后增加PGE1剂量重新检测。结果120例患者可以观察到明显的血流动力学变化,其中有动脉性ED者34例,静脉性ED 55例,混合血管性31例。ICI后不同时间的多普勒测量其血流动力学变化有一定差异。结论多普勒超声技术诊断血管性勃起功能障碍有一定意义。阴茎海绵体注射药物后须动态观察阴茎血流动力学的变化。     

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。     

阴茎血管多普勒检查在血管性勃起功能障碍诊断中的应用

阴茎血管多普勒检查．作为一种血管性ED的筛选方法．目前已得到肯定。本文自2002年6月至2005年11月．对门诊初诊为勃起功能障碍进行夜间勃起试验（NPT），筛选出具有器质性勃起功能障碍病人．并对这部分病人进行阴茎血管多普勒检查。具体报告如下。     

阴茎背深静脉栓塞治疗静脉性勃起功能障碍

目的 评价应用无水乙醇栓塞阴茎背深静脉治疗静脉性勃起功能障碍(ED)的有效性.方法 10例静脉性ED患者行阴茎背深静脉栓塞,其诊断依靠阴茎彩超及海绵体造影.分离阴茎背深静脉后插入静脉导管至前列腺静脉丛,监视下按5:1比例注入无水乙醇及造影剂,直至静脉漏显示消失.结果 随访4～24个月,7例术后恢复勃起,2例1:3服万艾可有效,1例无效,6例治愈无复发,均无严重并发症.结论 本研究表明栓塞阴茎背深静脉治疗静脉性ED简单易行、创伤小、安全价廉,有显著的疗效,尚需扩大样本进一步长期随访观察疗效.     

糖尿病性勃起功能障碍的超声研究

目的 应用彩色多普勒超声血流显像(CDFI)技术探讨动脉在糖尿病性勃起功能障碍(ED)中的作用.方法 23例糖尿病性ED患者和30例非糖尿病ED患者经阴茎海绵体注射前列地尔注射液(主要成分为PGE1)10 μg诱导勃起后,行CDFI检查双侧海绵体动脉血流动力学指标,包括收缩期最大流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)及内径(R).结果 PSV和R这两项指标在糖尿病性ED和非糖尿病ED患者中存在差异具有统计学意义,EDV和RI在两组患者中的差异没有统计学意义.糖尿病性ED患者中的动脉性ED明显多于非糖尿病性ED.结论 动脉供血不足在糖尿病性勃起功能障碍发病机制中起着重要作用.阴茎海绵体注射血管活性药物后CDFI对血管性ED检查是一种微创而准确的方法.     

彩色多普勒超声检查在血管性勃起功能障碍诊断中的应用

目的 :探讨多普勒超声检查在诊断血管性勃起功能障碍 (ED)的临床价值。　方法 :应用多普勒超声检查阴茎药物诱导勃起前后的血液动力学改变 ,将非血管性ED病人与明确诊断血管性ED病人的多普勒超声变化进行对比 ,寻找血管性ED的特征。　结果 :动脉性ED病人深动脉的最大血流速度 (PSV)明显小于正常组 (P <0 .0 1) ;静脉性ED病人在阴茎完全勃起后背深静脉血流 (VV)仍大于对照组 (P <0 .0 5 )。　结论 :配合药物诱导阴茎勃起 ,多普勒超声检查是临床上筛选血管性ED的有效手段     

勃起功能障碍阴茎血流动力学研究

目的 探讨勃起功能障碍(erectile dysfunction,ED)的病因诊断。方法 130例ED患者通过阴茎海绵体内应用血管活性药物,进行阴茎海绵体血流动力学和海绵体造影检查。观察并记录阴茎一肱动脉血压指数(penile brachial index,PBI)、海绵体内压(intracavermous pressure,ICP)、维持灌流率(maintenance flow rate,MFR),海绵体内压跌差(pressure loss change,PLC)等项指标及阴茎静脉血管形态。结果 130例ED中有39例为静脉漏,其中15例为动脉血供不足伴静脉漏。海绵体造影显示28例为单纯背深静脉漏,其余11例为背深静脉复合阴茎脚静脉漏。结论 阴茎血流动力学检测可作为ED病因诊断的有效方法。     

阴茎背深静脉包埋术治疗静脉性勃起功能障碍

阴茎背深静脉漏是导致血管性ED的原因之一。笔者于2003年2月～2006年3月采用阴茎海绵体白膜包埋阴茎背深静脉手术方式治疗原发静脉性ED9例获得较好疗效，现报道如下。     

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.     

Pathogenetic aspects of erectile dysfunction in patients with the metabolic syndrome

BackgroundAlthough it is well known that the metabolic syndrome is a common cause of erectile dysfunction (ED) the pathogenesis of the latter in this group of patients is poorly understood. The present study aimed to improve our knowledge in this area.MethodsThe study included 385 men with ED (control group) who underwent a full evaluation, including laboratory and ultrasound assessment of endothelial function.ResultsThe full complex evaluation showed that arteriogenic impairment in the cavernosal circulation was the primary pathogenic factor for ED in patients with the metabolic syndrome. The ultrasound-assisted measurement of postocclusive changes in the diameter of the cavernosal arteries, which reflects the local endothelial function, was the most valuable method in the diagnosis of this form of ED. In addition, a considerable number of patients with the metabolic syndrome demonstrated both hormonal and neurological disorders which also contribute to the pathogenesis of ED in this cohort of men.ConclusionThe pathogenesis of ED in patients with the metabolic syndrome is multifactorial in nature: ED is primarily caused by arteriogenic disorders which are combined with neuropathic disorders in almost every second patient and with hormonal factors in every third one. In addition, psychomotor status has an impact on the development of ED in patients with metabolic syndrome.     

维持性血液透析患者勃起功能障碍的初步研究

目的 明确维持性血液透析（MHD）男性患者勃起障碍的发病率，及评价西地那非的疗效与副作用。方法 以国际勃起功能指数（IIEF）对22例HD男患者进行评分。勃起障碍者给予西地那非，每次从25mg/d开始，最高为100mg/d，治疗12周，对比治疗前后IIEF分值变化。结果 MHD勃起障碍发病率为72.73%。西地那非总有效率为87.5%。常见的副作用为头痛，面色潮红等。结论 西地那非对于正在接近血液透析治疗的肾衰患者安全性和有效性等同于其它人群。     

Diagnostic steps in the evaluation of patients with erectile dysfunction

PURPOSE: The necessity for a thorough diagnostic evaluation for erectile dysfunction has been questioned after the availability of effective oral therapies. We determined the impact of the different diagnostic steps on the management strategy for erectile dysfunction. MATERIALS AND METHODS: The study included all patients who presented at an andrology outpatient clinic during a 4-year period. Baseline evaluation included medical and sexual history, blood tests, physical examination and intracavernous injection test. Patients with normal initial screening were evaluated with specific diagnostic procedures. The results were analyzed to identify the diagnostic potential of each screening step separately. RESULTS: Overall 1,644 patients presented at the clinic during the study period, of whom 368 (22.4%) were excluded from study due to severe psychiatric (5.2%) or cardiovascular (2.7%) disease, or to a history of erectile dysfunction less than 3 months in duration (14.5%). In the remaining 1,276 patients with a mean age plus or minus standard deviation of 56 +/- 14 years, and a mean duration of erectile dysfunction of 4.9 +/- 3.4 years medical history revealed erectile dysfunction associated medical conditions in 57%, blood tests identified previously undiagnosed medical conditions in 6.2%, and physical examination and the intracavernous injection test were diagnostic in 13.9% and 2.6%, respectively. Initial screening was negative in 259 cases (20.3%), in which specific diagnostic procedures identified an underlying vascular pathology in 165 (12.9%) and unfavorable penile geometry in 16 (1.3%). The remaining 78 men (6.1%) had no evidence of organic disease. CONCLUSIONS: Baseline diagnostic evaluation for erectile dysfunction can identify the underlying pathological condition or erectile dysfunction associated risk factors in 80% of patients. Such screening may diagnose reversible causes of erectile dysfunction and also unmask medical conditions that manifest with erectile dysfunction as the first symptom. Specific diagnostic procedures may be limited in patients with primary erectile dysfunction or those without risk factors. Such clinical data support previously published guidelines for erectile dysfunction management.     

The actual incidence of papaverine-induced priapism in patients with erectile dysfunction following penile colour Doppler ultrasonography

Penile color Doppler sonography is a valuable method for evaluating erectile dysfunction. However, there are some concerns about the safety of this method due to the intracorporeal pharmacological injection, which may cause priapism as a complication, resulting in penile fibrosis. To evaluate the actual incidence of papaverine-induced priapism in patients with erectile dysfunction (ED) who underwent penile colour Doppler sonography and to determine the safety of this diagnostic tool, a retrospective study was conducted using the database of our institution. A total of 672 men with ED underwent penile color Doppler ultrasonography with the intracorporeal injection of 60 mg papaverine hydrochloride. The patient characteristics of priapism cases were retrospectively evaluated. Priapism in 18 of the 672 patients (2.68%) was successfully treated with blood aspiration, irrigation and injection of an α-agonist medication, when needed. Patients with priapism were younger compared with those without priapism; mean age 45 ± 12.51 (20–68) versus 50.93 ± 12.04 (17–78) ( P  < 0.001). Penile Doppler ultrasound is a safe procedure in evaluating erectile dysfunction. The incidence of priapism, which is the most important complication of this procedure, is low and can be managed successfully with conservative approaches.     

The treatment of erectile dysfunction in patients with neurogenic disease

Erectile dysfunction (ED) related to compromise of the nervous system is an increasingly common occurrence. This may be due to the multifactorial nature of ED, the myriad of disorders affecting the neurotransmission of erectogenic signals, and improved awareness and diagnosis of ED. Nevertheless, neurogenic ED remains poorly understood and characterized. Disease related factors such as depression, decreased physical and mental function, the burden of chronic illness, and loss of independence may preclude sexual intimacy and lead to ED as well. The amount of data regarding treatment options in subpopulations of differing neurologic disorders remains scarce except for men with spinal cord injury. The treatment options including phosphodiesterase inhibitors, intracavernosal or intraurethral vasoactive agents, vacuum erection devices (VED) and penile prosthetic implantation remain constant. This review discusses the options in specific neurologic conditions, and briefly provides insight into new and future developments that may reshape the management of neurogenic ED.     

Relationship of asymmetric dimethylarginine with penile Doppler ultrasound parameters in men with vasculogenic erectile dysfunction

Background

Asymmetric dimethylarginine (ADMA), a selective endogenous nitric oxide synthase inhibitor, is elevated in many conditions associated with erectile dysfunction (ED), such as hypertension, diabetes, hyperlipidemia, and renal failure; it is also increased in men with coronary artery disease and ED. The dynamic penile colour Doppler ultrasound is considered the gold standard for the evaluation of penile vascular damage.

Objective

We investigated whether the extent of ultrasonographically documented penile vascular disease is associated with higher ADMA levels.

Design, setting, and participants

One hundred four consecutive ED patients (mean age: 56 ± 9 yr) without manifest cardiovascular/atherosclerotic disease and 31 subjects with normal erectile function matched for age and traditional risk factors were studied.

Measurements

We evaluated penile dynamic colour Doppler parameters of arterial insufficiency (peak systolic velocity) and veno-occlusive dysfunction (end diastolic velocity) and measured systemic inflammatory markers/mediators.

Results and limitations

Compared to men without ED, ED patients had significantly higher ADMA levels (p < 0.001). ADMA was significantly increased in patients with severe arterial insufficiency (PSV < 25 cm/s) compared to subjects with borderline insufficiency and men with normal penile arterial function (p < 0.001, by analysis of variance). Multivariable analysis adjusting for age, mean pressure, other risk factors, high-sensitivity C-reactive protein, testosterone, and treatment showed independent inverse association between ADMA level and peak systolic velocity (p < 0.01). The combination of higher ADMA level with arterial insufficiency showed greater impact on 10-yr risk of a cardiovascular event compared to either parameter alone.

Conclusions

ADMA level is independently associated with ultrasonographically documented poor penile arterial inflow. This finding underlines the important role of ADMA as a marker of penile arterial damage and implies a contribution of this compound to the pathophysiology of generalised vascular disease associated with ED.     

盐酸曲唑酮治疗勃起功能障碍的临床研究(附32例报告)

观察盐酸曲唑酮对勃起功能障碍(ED)患者治疗的有效性和安全性,本组设计ED症状评分表对32例患者进行开放式多中心临床研究,结果获得59.4%的有效率,并发现在勃起时间、性交频率、性交满意度方面用药后均有明显改善,不良反应主要为头晕、嗜睡和口干、疲劳,程度均较轻微.认为在累积更多病例更长时间的观察基础上,本药有望成为治疗ED的选择性用药.     

阴茎勃起功能障碍患者血液流变学分析

目的 探讨阴茎勃起功能障碍（ED）患者血液流变学参数的临床意义。方法 对43例ED患者和20例阴茎勃起正常对照者血液流变学参数进行对照分析。结果 ED组全血低切粘度（η10）、血浆粘度（ηp）、红细胞聚集指数（CE）、全血还原粘度（ηw）、血沉方程K值（K）明显高于对照组（P＜0．05）,内分泌性ED组红细胞刚性指数（IP）明显高 于心理性、动脉性、静脉性ED组（P＜0．05）,心理性EC组红细胞压积（HCT）明显高于内分泌性、静脉性、动脉性组（P＜0．05） ,差别均有显著性意义。结论 ED患者血液呈高粘滞性,降低血液粘稠度可能有助于患者勃起功能的改善。     

Prevalence of Peyronie's disease among patients with erectile dysfunction

PURPOSE: To assess the prevalence of Peyronie's disease (PD) among patients with erectile dysfunction (ED). MATERIALS AND METHODS: A total of 1,440 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function (IIEF). All patients were also screened for socio-demographic data and risk factors for ED that included age, smoking, diabetes, hypertension, dyslipidemia, Ischemic Heart Disease (IHD), and psychological disorders. The diagnosis of PD was based on a palpable penile plaque or acquired penile curvature. Patients underwent routine laboratory investigation in addition to testosterone and prolactin assessment. RESULTS: Mean ages +/-SD were 54.1 +/- 6.9 (range 42-71) and 52.5 +/- 11.9 (range 20-84) years for patients with and without PD respectively. Of the patients, 11.8% had mild, 38.3% had moderate and 49.9% had severe ED. 7.9% of the patients had PD. Significant associations between PD and both the longer duration and the increased severity of ED were detected. There were also significant associations between PD and the following socio-demographic risk factors of ED: age, obesity, smoking, duration and number of cigarettes smoked per day. Concomitant diseases and medical comorbidities such as diabetes, dyslipidemia, psychological disorders and the presence of at least one risk factor were significantly associated with PD in patients with ED. CONCLUSIONS: Peyronie's disease was not rare among the study population. There were significant associations between ED risk factors and PD. Further studies are needed to investigate how much ED and PD influence each other.