阿扑吗啡与勃起功能障碍

ED是男科的常见病之一,其一线治疗方法是口服药物。阿扑吗啡(APO)作为中枢多巴胺受体激动剂,其舌下含片几乎对不同程度的ED患者都有效,且起效快、耐受性好、安全性高,特别是对于接受硝酸盐治疗而禁用西地那非的患者。现对其药代动力学、作用机制及疗效、安全性进行综述。     

枸橼酸西地那非治疗勃起功能障碍的疗效和安全性优于盐酸阿扑吗啡

Eardley等进行了一项随机、灵活剂量研究，以评价枸橼酸西地那非和盐酸阿扑吗啡治疗勃起功能障碍（ED）的疗效和安全性。共139例未接受治疗的ED患者入选。试验含2个治疗期，各8周，中间有2周的清除期。     

枸橼酸西地那非治疗ED的疗效和安全性优于盐酸阿扑吗啡

为比较阿朴吗啡舌下给药与口服枸橼酸西地那非治疗男性勃起功能障碍(ED)的疗效和安全性,Pavone C等进行了一项随机、交叉对比的前瞻性研究。共有62例不同病因和严重程度的异性恋ED患者纳入随机分组,但仅有34例患者可供评价有效性和耐受性。研究步骤依次为2～4周的试验期、4周治疗期、4周清除期、4周的替换疗法作为附加治疗期。两种治疗秩序由密封于口袋中的随机     

舌下含服阿朴吗啡在男性勃起功能障碍药物治疗中的应用

近年来，阿朴吗啡(Apomorphine，Ap)作为大脑中枢多巴胺受体激动剂，被用于男性勃起功能障碍(ED)的治疗，因其疗效好，安全性高在口服药物治疗ED方面的作用越来越受到人们的重视。本文将对Ap的药理学、作用机制和临床疗效等作一综述。     

盐酸阿朴吗啡治疗勃起功能障碍的临床经验:最早的107例患者

作者评价了勃起功能障碍患者使用盐酸阿朴吗啡的有效性和安全性。 2 0 0 1年 7月至 11月 ,作者随机抽取因勃起功能障碍就诊的 10 7例患者 ,于性交开始前 2 0min舌下含服盐酸阿朴吗啡 ,5 1例患者的起始剂量为 2mg,5 6例患者的起始剂量为 3mg。结果显示 ,起始剂量 2mg患者的有效率为 2 3.5 % ,3mg患者为2 8.5 % ,药物总体有效率 2 6 .1%。以获得足以进行满意性交的硬度作为阳性反应 ,将剂量从 2mg提高到 3mg的患者中18.5 %达到阳性反应。根据勃起功能障碍的临床表现 ,勃起早期消退的病例疗效最好 ,完全不能勃起的病例疗效最差。总不良反应发生…     

复方玄驹胶囊联合盐酸阿朴吗啡治疗勃起功能障碍的临床研究

目的:观察复方玄驹胶囊联合盐酸阿朴吗啡治疗阴茎勃起功能障碍(ED)的疗效。方法:采用复方玄驹胶囊联合盐酸阿朴吗啡治疗115例ED患者为治疗组,单用盐酸阿朴吗啡治疗111例作为对照组,经连续2个月的治疗后,观察两组的国际勃起功能问卷(IIEF-5)的评分改变情况。结果:治疗组与对照组IIEF-5的评分在治疗前分别为(11.42±2.38)、(11.56±2.65)分,两组比较差异无显著性(P>0.05);治疗后分别为(17.85±2.68)、(13.96±3.25)分,均有明显提高(P<0.01),而治疗组在治疗后的评分明显高于对照组(P<0.01);治疗组的显效率、有效率和总有效率均高于对照组。结论:复方玄驹胶囊联合盐酸阿朴吗啡治疗ED有较好疗效,值得临床推广使用。     

寻找治疗勃起障碍药物的新趋向

男 ,汉族 ,1939年 12月 10日出生于上海市。现任上海第二医科大学附属第九人民医院泌尿外科主任 ,教授 ,主任医师 ,兼外科教研室主任 ,研究生导师。并担任中华医学会泌尿外科学会委员和男科学会委员 ;中华医学会上海分会泌尿外科学会委员和男科学会副主任委员兼秘书 ,上海市男性病专家医疗会诊咨询服务中心副主任 ,《中国男科学杂志》副主编 ,《男科学报》编委等职。     

酚妥拉明治疗勃起功能障碍安全性和有效性的多中心评价

目的 :评价甲磺酸酚妥拉明胶囊 (MP)治疗男性勃起功能障碍 (ED)的安全性和有效性。　方法 :采用随机、双盲、安慰剂对照多中心临床试验 ,入选 168例病人 ,分别服用试验药物MP和安慰剂 ,4 0mg/次。观察服药后国际勃起功能指数 (IIEF)得分变化及夜间记录表。　结果 :试验组IIEF观察表中Q3、Q4及Q3+Q4得分增加明显高于对照组 (P <0 .0 0 1) ,试验组治疗ED显效率 10 .12 %、有效率 67.4 2 % ,对照组显效率 0 ,有效率 14 .2 9% (P均 <0 .0 1) ;试验组不良反应率 4 .76% ,对照组为 1.19% (P >0 .0 5 ) ,不良反应均不需特殊处置。　结论 :MP治疗ED安全、有效。     

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.     

动脉性勃起功能障碍患者使用西地那非和阿朴吗啡的安全性和有效性比较

动脉性因素是勃起功能障碍(ED)的常见病因,对于此类ED,西地那非与传统的口服药阿朴吗啡比较有何优势呢?Perimenis P等人对43例动脉性ED患者进行了相关研究。其中,24例口服阿朴吗啡2 mg、19例口服西地那非50 mg,剂量根据有效性和耐受性逐步增高到3 mg和100 mg。安全性的评估根据     

Apomorphine sublingual as primary or secondary treatment for erectile dysfunction in patients with spinal cord injury

OBJECTIVES: To evaluate the effectiveness of apomorphine sublingual (SL) 3 mg, as a primary or secondary treatment for erectile dysfunction (ED) in patients with spinal cord injury (SCI), and to determine possible differences in efficacy considering clinical, urodynamic and neurophysiological findings. PATIENTS AND METHODS: The study included 22 patients with chronic SCI and neurogenic ED who were examined physically and by a video-urodynamic evaluation. A neurophysiological evaluation included somatosensory evoked potentials of the pudendal nerve, palmar and plantar sympathetic skin responses and bulbocavernous reflex recordings. Thereafter the patients received 8 tablets of apomorphine SL 3 mg and were asked to complete the International Index of Erectile Function questionnaire before and after treatment. Side-effects, subjective efficacy compared with other treatments and satisfaction with the SL administration were recorded. RESULTS: Of the 22 men, 11 had upper motor neurone lesions (six complete, five incomplete), eight lower motor neurone lesions (seven complete, one incomplete) and three had mixed lesions. In all, 12 patients took sildenafil citrate and five alprostadil intracavernosally beforehand, and five had used nothing to treat their ED. Seven patients had some response and reported that the drug helped them to obtain an erection, but only two reported erections sufficient for intercourse and would agree to continue apomorphine SL as their standard treatment; all the others reported being disappointed. Nine patients reported side-effects. There were no significant correlations for electrophysiological or urodynamic findings and treatment success. Of the 22 patients 20 preferred SL rather than the normal administration. CONCLUSIONS: Apomorphine SL, a D1/D2 dopamine agonist, facilitates erectile function in a heterogeneous group of patients with no significant relationship with any of the assessed urodynamic or electrophysiological variables. The overall low rates of response either for primary or secondary treatment suggests that apomorphine will have limited applicability in patients with SCI.     

Sublingual sildenafil in the treatment of erectile dysfunction: Faster onset of action with less dose

Background: The aim of the present study was to show the efficacy and safety of sublingual sildenafil and to determine whether lower doses cause the same effect with a faster onset of action in this mode of application. Methods: Fourty consecutive patients with erectile dysfunction for more than three months were included in the study. The mean age was 55 years (range, 25–65). Serum glucose and testosterone levels, lipid profile and erectile function scores were obtained in all patients. Twenty patients received placebos and the other 20 patients received 20 mg sublingual sildenafil in a double blind randomized design. Results: The effect of sildenafil on erection was significantly higher than that of placebo. Sixty‐five percent of patients (13/20) who received sublingual sildenafil achieved satisfying erections and coitus, whereas the rate was 15% in the placebo group (3/20). The mean onset of action with sublingual sildenafil was 15.5 min and lasted for an average of 40 min. Minimal headaches, sweating and flushing were noted as the side‐effects. Conclusions: 20 mg sublingual sildenafil is safe and effective in the treatment of erectile dysfunction. Sublingual administration has some advantages as it is not effected by food ingestion and quickly appears in the circulation. These advantages provide a faster onset of action with a lower dose when compared to oral sildenafil. Sublingual use of sildenafil may be more cost‐effective and possibly provides a more predictable onset of action.     

An open-label, randomized, flexible-dose, crossover study to assess the comparative efficacy and safety of sildenafil citrate and apomorphine hydrochloride in men with erectile dysfunction

Two papers in this section deal with well‐known pharmacological agents used to treat male erectile dysfunction. In the first of these, authors from the UK compared the efficacy and safety of sildenafil and apomorphine in such patients. This open‐label crossover trial suggested that sildenafil was better than apomorphine, where the primary endpoint was the erectile function domain of the International Index of Erectile Function. The second paper is an update on the efficacy and safety of tadalafil. It describes the results of its use in a large number of men with erectile dysfunction, compared to placebo. Once again, the erectile function domain was one of the primary endpoints. Tadalafil was an effective and well tolerated treatment for this condition.

OBJECTIVE

To compare the efficacy and safety of sildenafil and apomorphine in the treatment of men with erectile dysfunction (ED).

PATIENTS AND METHODS

In all, 139 men with ED who were naïve to treatment were entered into an open‐label crossover trial with two treatment periods, each of 8 weeks, separated by a 2‐week washout period. Men were randomized to receive either sildenafil then apomorphine or apomorphine then sildenafil, and were allowed to titrate the dose on both drugs. The primary endpoint was the erectile function (EF) domain of the International Index of Erectile Function (IIEF), and other endpoints included diary data, the other domains of the IIEF, overall assessment questions and the Erectile Dysfunction Index of Treatment Satisfaction (EDITS) questionnaire.

RESULTS

The EF domain score after treatment was 25.2 for sildenafil and 15.9 for apomorphine. The treatment difference of the adjusted means was 9.3 points (95% confidence interval 7.6–11.1; P < 0.001). After sildenafil the successful intercourse rate was 75%, vs 35% for apomorphine (P < 0.001), and the EDITS scores were 82.5 for sildenafil and 46.8 for apomorphine (P < 0.001). Of the men, 96% expressed a preference for sildenafil as a treatment for their ED. The side‐effect profiles for both drugs were in keeping with published data.

CONCLUSION

By all measurable endpoints sildenafil was superior to apomorphine in this open‐label crossover study of men with ED who were naïve to therapy

     

Dopamine D2 receptors in the basolateral amygdala modulate erectile function in a rat model of nonorganic erectile dysfunction

Nonorganic erectile dysfunction is a problem with unknown central mechanisms. Changes in brain activity in the amygdala have been observed in human patients. This study aimed to investigate the dopamine system in the basolateral amygdala of male rats with nonorganic erectile dysfunction. We applied chronic mild stress to induce nonorganic erectile dysfunction. After exposure to chronic mild stress, the sucrose consumption test, sexual behaviour test and apomorphine test were used to select depression‐like rats with erectile dysfunction as nonorganic erectile dysfunction model rats. The sexual behaviour of these rats after central infusion of a dopamine D1/D2 receptor agonist/antagonist was observed. The expression levels of dopamine D1/D2 receptors and tyrosine hydroxylase in the basolateral amygdala were also measured. The result of the sucrose consumption test, sexual behaviour test and apomorphine test indicated a successful nonorganic erectile dysfunction model. Central infusion of a dopamine D2 receptor agonist increased intromission ratio in model rats. Lower expression levels of tyrosine hydroxylase and the dopamine D2 receptor in the basolateral amygdala were observed in rats with nonorganic erectile dysfunction. These results suggest that impairment of the dopamine D2 receptor pathway in the basolateral amygdala may contribute to the development of nonorganic erectile dysfunction.     

Surgical niche for the treatment of erectile dysfunction

Penile erection implicates arterial inflow, sinusoidal relaxation and corporoveno-occlusive function. By far the most widely recognized vascular etiologies responsible for organic erectile dysfunction can be divided into arterial insufficiency, corporoveno-occlusive dysfunction or mixed type, with corporoveno-occlusive dysfunction representing the most common finding. In arteriogenic erectile dysfunction, corpora cavernosa show lower oxygen tension, leading to a diminished volume of cavernosal smooth muscle and consequential corporoveno-occlusive dysfunction. Current studies support the contention that corporoveno-occlusive dysfunction is an effect rather than the cause of erectile dysfunction. Surgical interventions have consisted primarily of penile revascularization surgery for arterial insufficiency and penile venous surgery for corporoveno-occlusive dysfunction, whatever the mechanism. However, the surgical effectiveness remained debatable and unproven, mostly owing to the lack of consistent hemodynamic assessment, standardized select patient and validated outcome measures, as well as various surgical procedures. Penile vascular surgery has been disclaimed to be the treatment of choice based on the currently available guidelines. However, reports on penile revascularization surgery support its utility in treating arterial insufficiency in otherwise healthy patients aged <55 years with erectile dysfunction of late attributable to arterial occlusive disease. Furthermore, it is noteworthy that penile venous surgery might be beneficial for selected patients with corporoveno-occlusive dysfunction, especially with a better understanding of the innovated venous anatomy of the penis. Penile vascular surgery might remain a viable alternative for the treatment of erectile dysfunction, and could have found its niche in the possibility of obtaining spontaneous, unaided and natural erection.     

硅胶银丝阴茎假体置入治疗勃起功能障碍

目的:探讨硅胶银丝阴茎假体在勃起功能障碍患者中的应用,特别是在置入三件套可膨胀阴茎假体后出现机械并发症的患者中的应用.方法:选用AMS(American Medical Systems)公司生产的AMS Malleable 650TM阴茎假体治疗13例勃起功能障碍患者,其中6例是由于置入的三件套可膨胀性阴茎假体出现机械性并发症后,要求更换阴茎假体.结果:13例患者切口均Ⅰ期愈合,平均随访12个月,除2例出现阴茎疼痛及1例出现假体过短外,其余患者夫妻双方性生活满意,未发现其他并发症.结论:对于一些经济困难的患者及部分置入三件套可膨胀阴茎假体后出现机械故障的患者而言,硅胶银丝阴茎假体仍不失为一个理想的选择.     

心身俱治是治疗勃起功能障碍的关键

勃起功能障碍(ED)被公认为是一种极具代表性的心身疾病。社会心理因素在ED的发病过程中起到了关键性作用。ED对患者及其伴侣的社会心理健康以及人际关系也会产生重大影响。治疗上既包括性心理治疗,又需要适当的药物等治疗,"心身同治"是其治疗的核心。而随着健康医学模式的发展,ED的治疗目标也随之发生了巨大变革,不再单单追求阴茎勃起的硬度和维持时间,更为注重重建患者和伴侣之间自然和睦的性生活以及亲密无间的伴侣关系。新型5型磷酸二酯酶抑制剂他达拉非可有效提高各种病因和程度的ED患者勃起功能,同时明显降低患者的性时间顾虑,并很好地满足了患者及其伴侣的治疗预期,使患者及其伴侣回归正常、自然的性生活,给患者和伴侣带来巨大的社会心理收益。     

Concomitant use of sildenafil and a vacuum entrapment device for the treatment of erectile dysfunction

PURPOSE: Men not entirely satisfied with erectile function after separate use of sildenafil or a vacuum entrapment device (VED) are usually given more invasive alternatives. This prospective study was designed to evaluate the efficacy of concomitant use of sildenafil and a vacuum entrapment device in men not satisfied with erectile function while using each of these treatment modalities separately. MATERIALS AND METHODS: A total of 161 patients suffering from erectile dysfunction for at least 6 months were evaluated and treated with 100 mg sildenafil and a VED each as monotherapy. The 41 patients not satisfied with erectile function while using either modality alone were treated with concomitant use of sildenafil and a VED. The International Index of Erectile Function and global assessment question about satisfaction from treatment were used to evaluate satisfaction before and after each treatment. RESULTS: All 41 patients stated on the global assessment question that they had a greater level of satisfaction with the results of combined treatment than with each treatment alone (p <0.0001). Older (age greater than 60 years) participants reported better overall satisfaction. There was no correlation between treatment outcome and erectile dysfunction etiology or between satisfaction from treatments and the order in which they were given and the pretreatment scores for the International Index of Erectile Function domains. CONCLUSIONS: Combined use of sildenafil and a VED may be offered to patients not satisfied when either treatment is used alone.