前列腺素E1与西地那非治疗ED的比较

目的 :比较口服西地那非与阴茎海绵体内注射前列腺素E1(PGE1)治疗勃起功能障碍 (ED)的疗效。　方法 :5 4例ED病人随机分为两组 ,A组口服西地那非 ,B组行海绵体内注射PGE1,均治疗 4～ 9个月 ,平均 6个月。结果 :A、B两组的有效率分别为 80 0 %和 83 3% ,两者差异无显著性 (P >0 0 5 )。A组 6例无效病人经海绵体内注射PGE1治疗 ,2例获得满意勃起 ;而B组 4例无效病人经口服西地那非治疗 ,无 1例勃起。　结论 :口服西地那非与海绵体内注射PGE1对各种病因所致的ED均有良好的治疗作用 ,对西地那非治疗无效者 ,可试用海绵体内注射PGE1,有时也能获得满意的效果     

西地那非治疗前列腺根治术后勃起功能障碍

前列腺根治术后患者常发生勃起功能障碍(ED),部分患者应用阴茎海绵体内注射(IC)治疗后虽有一定疗效,但该方法可造成创伤,且不良反应大。长期使用阴茎海绵体内注射治疗的患者能否改用口服西地那非(万艾可()治疗并获得满意的性生活呢?Raina R等近期发表在Urology[2004,63(3):532-     

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     

前列腺素E1与西地那非治疗ED的比较

目的：比较口服西地那非与阴茎海绵体内注射前列腺素E1（PGE1）治疗勃起功能障碍（ED）的疗效。方法：54例ED病人随机分为两组，A组口服西地那非，B组行海绵体内注射PGE1，均治疗4－9个月，平均6个月，结果：A、B两组的有效率分别为80．0％和83．3％，两者差异无显著性（P＞0．05），A组6例无效病人经海绵体内注射PGE1治疗，2例获得满意勃起，而B组4例无效病人经口服西地那非治疗，无1例勃起，结论：口服西地那非与海绵体内注射PEG1对各种病因所致的ED均有良好的治疗作用。对西地那非治疗无效者，可试用海绵体内注射PEG1，有时也能获得满意的效果。     

320排动态容积CT阴茎海绵体造影诊断静脉性ED的应用价值

目的:通过Toshiba320排动态容积CT动态成像技术,探讨320排CT对诊断静脉性勃起功能障碍(ED)的应用价值。方法:门诊视听刺激检测仪筛查诊断为ED患者33例,阴茎海绵体局部注射酚妥拉明2 mg+罂粟碱30 mg诱发勃起后,先后从静脉、阴茎海绵体注入碘比醇,分别作320排CT动态容积扫描采集动、静脉期阴茎海绵体图像,并进行图像后处理。结果:33例患者中29例有不同程度的异常引流静脉,所显示的静脉漏分为背深静脉漏7例(24.1%)、脚静脉漏6例(20.7%)、背浅静脉漏3例(10.3%)、间静脉漏1例(3.5%)、海绵体静脉漏2例(6.9%)、混合静脉漏10例(34.5%)。10例患者选择手术治疗,行阴茎背深静脉结扎2例、阴茎背深静脉包埋+脚静脉结扎4例、阴茎脚静脉结扎4例。术后8例获3~12个月随访,2例勃起改善,6例勃起功能基本恢复正常。结论:320排动态容积CT动态造影是诊断静脉性ED的可靠方法,可准确显示静脉漏的部位,指导临床治疗;相比于阴茎海绵体造影有更清晰的诊断图像、更少的放射剂量及对比剂量、更短的检查时间。     

西地那非与前列腺素E1治疗勃起功能障碍的疗效比较

目的：比较口服西地那非与阴茎海绵体内注射前列腺素E1（PGE1）治疗勃起功能障碍（ED）的疗效。方法：54例ED患者随机分成两组，一组采用口服西地那非治疗（A组），另一组行海绵体内注射PGE1（B组）。治疗4－9个月，平均6个月。结果：A、B两组的有效率分别为80.0%和83.3%，二者之间差异无显著性意义（P＞0.05)。A组6例无效患者经海绵体内注射PGE1治疗，其中2例获得了勃起满意的疗效，而B组4例无效患者经口服西地那非治疗，无一例有效。结论：口服西地那非与海绵体内注射PGE1对各种病因所致的ED均有良好的治疗作用，对某些西地那非治疗无效者，可试用海绵体内注射PGE1，有时也能获得满意的效果。     

海绵体内注射亚甲蓝治疗阴茎异常勃起

20 0 1年 3月～ 2 0 0 2年 6月 ,我们采用海绵体内注射亚甲蓝治疗因注射罂粟碱等血管活性药物而导致的阴茎异常勃起病人 5例 ,疗效满意 ,报告如下。1　资料和方法1.1　临床资料　本组病人 5例 ,年龄 2 9～ 4 8岁 ,平均 4 2 .5岁 ,均因治疗勃起功能障碍 (erectiledisfunc tion ,ED)行阴茎海绵体注射罂粟碱 +酚妥拉明导致阴茎长时间勃起。发病至就诊时间 4～ 9h ,平均 6.4h。其中 2例就诊前于外院行阿拉明海绵体内注射、海绵体穿刺抽吸等无效后转来我院。1.2　治疗方法　先行海绵体穿刺抽吸 ,抽出瘀血30～ 5 0ml,然后将 1%亚甲蓝注射液 (江苏…     

中药振阳煎对动脉性勃起功能障碍患者阴茎血流动力学的影响

目的:通过中药振阳煎对动脉性勃起功能障碍(ED)患者阴茎血流动力学的临床观察,探索对动脉性ED 患者有效的治疗方法。　方法:47例(40～49岁)动脉性ED患者,用中药振阳煎口服治疗1个月,治疗前后均采 用罂粟碱30mg+酚妥拉明1mg进行阴茎海绵体内注射(ICI),并运用双功能彩色多普勒超声检查治疗前后阴茎 左右海绵体动脉收缩期最大血流流率(PSV)。　结果:47例患者经中药振阳煎治疗后,左右两侧海绵体动脉PSV 明显改善(P<0.05)。　结论:中药振阳煎能明显改善动脉性ED患者的阴茎海绵体动脉血流,有效促进阴茎勃起。     

两组药物海绵体内注射治疗勃起功能障碍效果比较

目的 :为临床勃起功能障碍 (ED)治疗时海绵体内注射 (ICI)选药提供临床资料。　方法 :5 6例ED病人 ,随机分 2组 ,每组 2 8例。第 1组用酚妥拉明 2～ 10mg +罂粟碱 10～ 3 0mg ,第 2组用酚妥拉明 2～ 5mg +罂粟碱 10～15mg +川芎嗪 40mg注射液治疗。 　结果 :第 2组勃起时间、勃起硬度足以完成性交例数均优于第 1组 (P <0 .0 5 )。　结论 :ICI合用川芎嗪可延长勃起时间 ,增强勃起硬度 ,减少海绵体内结节发生 ,为一种低价安全的ICI用药     

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。     

Erectile dysfunction after kidney transplantation: our 22 years of experience

AIM: To evaluate the results of treatment of erectile dysfunction (ED) in kidney transplant recipients before and after the advent of sildenafil. MATERIALS AND METHODS: From 1981 through 2002, 971 male patients of mean age 53.4 years received a renal graft. Erectile dysfunction (ED) was investigated in all patients at the first urologic visit posttransplantation. Psycho-sexual support was offered to all patients. Before sildenafil use (1998), our diagnostic approach was complex. From 1998 we tested: serum levels of testosterone, prolactin, and glucose with penile duplex ultrasonography and NPT reserved for selected cases. RESULTS: From 1981 through 1998, 365 male kidney transplant recipients (45%) reported ED. Only 169 patients chose to be treated: 27 responded to psycho-sexual therapy; 3 received testosterone with benefit; 133 had a good results from intracavernosal injection of vasoactive drugs; and 6 received a penile prosthesis. Since 1998, 126 patients reported ED (78.3%). Only 78 chose treatment: 24 patients had a satisfactory response to sildenafil (65% with 50 mg and 35% with 100 mg). PGE1 alone or in combination with papaverine and phentolamine produced a good response in 37 patients; 17 patients did not respond to pharmacotherapy; and 5 received a tricomponent penile prosthesis without complications. The side effects of sildenafil and PGE1 therapy were similar to those reported in the literature. CONCLUSIONS: ED is an important problem in male renal transplant recipients. Cultural resistance to treatment is common. However, treatment with sildenafil citrate and intracavernosal self-injection of PGE1 are well accepted, and prosthetic devices may help in resistant cases.     

从更好的勃起到更好的性生活:万艾可研究进展

万艾可(枸橼酸西地那非)起效快,使患者达到和维持坚硬的勃起,已被证实为首选的勃起功能障碍(ED)治疗药物。近年来,有关万艾可疗效的研究越来越多地关注其对整体性生活的改善,即对患者心理因素的影响。通过应用心理学评价工具,如勃起功能障碍治疗满意度量表、自尊心和性关系问卷、勃起功能障碍心理影响评分等,研究发现万艾可显著改善以下心理性因素:ED患者及其伴侣对性交和性关系的满意度、患者的自信心和自尊心、与伴侣亲近和进行性交的欲望等。服用万艾可的ED患者性交尝试次数显著增加,健康相关的生活质量显著提高。因此,万艾可产生更好的勃起,进一步促进更好的性生活良性循环。     

Structured interview on erectile dysfunction (SIEDY): a new,multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction

The aim of the present study is the definition of a brief structured interview (SI) providing scores useful for identification and quantification of pathogenetic factors of erectile dysfunction (ED). A SI was developed and applied to a consecutive series of 320 ED patients. A 13-item SI, with three-factor analysis-derived scales, was identified and applied for validation to an independent consecutive series of 194 ED patients. PGE(1) (10 microg) intracavernosal injection, penile duplex ultrasound (PDU), blood hormones, PSA, glycemia, and lipids were used for the assessment of an organic component (OC), and Middlesex Hospital Questionnaire (MHQ) modified for psychological disturbances. Scale 1, dealing with OC, showed a positive correlation with age, BMI, blood pressure, glycemia, and inverse correlation, with testosterone, PGE(1) and several parameters derived from PDU. Scale 2, related to partner's relationship, was not correlated with organic parameters. Scale 3, which measures psychopathological traits was correlated with MHQ scales. Scale 1 (>3) had a sensitivity of 67.9% and a specificity of 67.6% for OC. SIEDY((c)) provides information on ED pathogenesis and might assist physicians in diagnostic and therapeutic choices.     

Long-term efficacy and safety of self-intracavernous injection of prostaglandin E1 for treatment of erectile dysfunction in China

The study evaluated the long-term efficacy and safety profiles of self-intracavernous injection of prostaglandin E1 (PGE1) for erectile dysfunction (ED). Four hundred and sixteen ED patients were treated with self-intracavernous injection of PGE1 from January 1998 to December 2007 in our outpatient service. Follow-up was made to investigate the efficacy and side effects of this treatment. It was found that 261 patients (62.7%) felt satisfied and kept using this treatment due to its advantages of satisfactory efficacy and reasonable expense. Twenty-seven of them (6.5%) got rid of PGE1 treatment after five times injections and did not need any other drugs to maintain satisfactory sexual lives. Two hundred and fourteen (51.4%) patients kept using this treatment for over 1 year, 26 (6.2%) over 5 years, 12 (2.9%) over 8 years and 7 (1.7%) over 10 years. The major complications of self-intracavernous injection of PGE1 include fibrosis of corpus cavernosum (three cases), ecchymosis associated with vascular injury due to injection (23 cases) and pain associated with injection (295 cases). There were no patients displaying priapism. It is concluded that self-intracavernous injection of PGE1 is a safe and effective treatment for ED with various aetiologies and a broad range of severity, and no serious complications were observed after long-term application.     

糖尿病并勃起功能障碍的中西医结合治疗

目的：观察糖尿病并勃起功能障碍的中西医结合治疗临床疗效。方法：将120名患者随机分为两组,观察组使用万艾可加中药治疗,对照组使用万艾可治疗。分别记录治疗前及治疗后3个月时的国际勃起功能指数评分（IIEF）及睾酮（T）的变化。结果：观察组IIEF评分及T的变化显著优于对照组（P〈0．05）。结论：通过辨证论治,利用中药偏性,施以六味地黄汤加减进行中西医结合治疗,可较好地改善患者睾酮水平及IIEF指数。     

Testosterone and Erection: Practical Management for the Patient with Erectile Dysfunction

Although erectile dysfunction (ED) and testosterone deficiency syndrome are two independently distributed disorders, there is a degree of overlap between them. Testosterone replacement therapy, either alone or combined with other treatments such as a phosphodiesterase type 5 (PDE5) inhibitor, may therefore be useful in some men with ED. Corrective treatment of ED includes sex therapy, risk factor modification, chronic usage of PDE5 inhibitors, and testosterone replacement. Studies have shown that testosterone replacement in men with hypogonadism improves libido and erectile function in a significant proportion of cases. If corrective treatment fails or is not indicated, symptomatic treatments such as oral PDE5 inhibitors or intraurethral/intracavernous therapy are available. PDE5 inhibitors are an excellent first-line choice, although a significant proportion of men still fail to respond to monotherapy. Testosterone deficiency may be overlooked in some men with ED and, because this may be associated with lower expression of PDE5 in the penis, it could result in failure of PDE5 inhibitor therapy. Recent recommendations, therefore, suggest the need for combination therapy in some patients. In conclusion, all men presenting with ED should have their testosterone levels checked, and testosterone replacement should be considered in those with low levels. Testosterone replacement should also be considered in hypogonadal men with ED not responding to PDE5 inhibitors. If erections remain insufficient after 3 mo, a combination of testosterone and a PDE5 inhibitor may be beneficial.     

Objective penile vascular response to intraurethral prostaglandin E2 (dinoprostone)

PURPOSE: Intraurethral prostaglandin E2 (PGE2) administration is a noninvasive treatment modality for erectile dysfunction. The purpose of this study was to evaluate the objective effects of this agent by measuring peak systolic velocities of cavernosal arteries after intraurethral PGE2 administration and comparing with the results obtained with an intraurethral placebo gel and intracavernous papaverine injection. MATERIALS AND METHODS: The study group consisted of 22 consecutive impotent volunteers with a mean age of 46 years who had normal penile arterial responses as determined by penile arterial responses on papaverine-stimulated penile duplex ultrasonography. The peak systolic velocity in cavernosal arteries was recorded after intracavernous injection of 60 mg of papaverine. All patients received 1 mg of intraurethral PGE2 gel and placebo at 15-day intervals. The peak systolic velocities were recorded after each treatment. RESULTS: Mean peak systolic velocity achieved by intraurethral administration of PGE2 gel (25 +/- 8 cm/s) was less than that achieved by intracavernous papaverine (40 +/- 6 cm/s) but higher than that obtained by placebo (15 +/- 4 cm/s). Twelve patients had erections, while 9 had partial and 1 had no erection with intraurethral PGE2. Placebo did not cause any erections. No serious side effects were observed. CONCLUSION: Intraurethral administration of PGE2 appears to be an effective and simple method for increasing penile arterial flow and can be used during penile Doppler ultrasonography to stimulate the penile arterial system.     

安特尔对糖尿病患者阴茎勃起功能障碍的影响

目的:探讨安特尔治疗糖尿病患者阴茎勃起功能障碍的效果。方法:将80例阴茎勃起功能障碍、且经万艾可治疗无效的2型糖尿病患者,随机分为两组。安万组:40 例,在用万艾可治疗的同时加用安特尔(120mg/d);维万组:40例,在用万艾可治疗的同时加用维生素E(30 mg/d)。两组均治疗1 个月,观察患者治疗前后血清睾酮水平、IIEF 5评分和阴茎海绵体血流量的变化。结果:安万组较治疗前血清睾酮明显升高(P<0.01),IIEF 5评分显著提高(P<0.05),阴茎海绵体血流量明显增加(P<0.05);其中30例(75%)患者性交时阴茎能满意地勃起;未出现任何不良反应。维万组治疗前后上述指标无明显变化(均P>0.05)。结论:安特尔能显著改善经用万艾可治疗无效的糖尿病患者的阴茎勃起功能,且安全性好。