舍曲林和伐地那非治疗合并勃起功能障碍的早泄患者的临床观察

目的:评价舍曲林和伐地那非治疗合并勃起功能障碍(ED)的早泄患者的临床疗效和安全性。方法:60例诊断为合并ED的早泄患者随机分为舍曲林组和伐地那非组,每组30例。舍曲林组每天服用舍曲林50 mg,疗程2个月。伐地那非组每次性生活前服用伐地那非10~20 mg,疗程2个月。以治疗前后IIEF-5评分的改变来评价ED治疗效果,以治疗前后阴道内射精潜伏期(IELT)的变化来评价早泄治疗效果。结果:伐地那非组勃起功能改善24例,有效率为80%;而舍曲林组仅8例勃起功能改善,有效率为27%,两者差异有显著性(P<0.05)。伐地那非组早泄改善20例,有效率为67%;而舍曲林组早泄改善12例,有效率为40%,两者差异有显著性(P<0.05)。两组患者中,勃起功能改善者的早泄治疗的有效率均显著高于勃起功能无改善者。两组的不良反应均为轻度,无停药者。结论:对合并ED的早泄患者,改善患者的勃起功能是关键。     

西地那非治疗合并勃起功能障碍的早泄病人的临床观察

目的 :评价枸橼酸西地那非对合并勃起功能障碍 (ED)的早泄病人的临床疗效和安全性。　方法 :45例诊断为合并ED早泄病人 ,以西地那非片可调整用药方案治疗 1～ 3个月。以阴道内射精潜伏期及配偶性交满意度来评价早泄治疗效果 ,并评估ED的总体疗效和治疗满意度 ,比较治疗前后的国际勃起功能指数评分 5 (IIEF 5 )。　结果 :早泄改善者共 2 7例 ,有效率为 6 0 %。勃起功能改善者共 40例 ,改善率为 88.88%。 2 7例早泄有效者均为 5 0mg西地那非改善了勃起功能的病人 ,且满意率为81.48%;18例早泄无效者中ED治疗满意率仅为 5 .5 6 %。在早泄有效者和无效者间比较其治疗前、后IIEF 5评分及增加值 ,差异均有显著性 (P <0 .0 0 1)。不良反应共 9例(2 0 %) ,均为轻度或中度 ,未经特殊处理即自行缓解。　结论 :对合并ED的早泄病人 ,枸橼酸西地那非片能安全有效地改善其勃起功能 ,如获得满意疗效多能使病人早泄得到改善。     

中西药联合治疗早泄合并轻中度勃起功能障碍的多中心、随机对照临床研究

目的评价盐酸达泊西汀联合枸橼酸西地那非及乌灵胶囊联合运用治疗早泄(PE)合并轻中度勃起功能障碍(ED)的安全性和有效性。方法 140例PE合并轻中度ED患者随机分为对照组和治疗组各70例,对照组给予枸橼酸西地那非与乌灵胶囊治疗,治疗组在对照组基础上加用盐酸达泊西汀进行治疗,疗程4周。以国际勃起功能问卷调查表-5(IIEF-5)、阴道内射精潜伏时间(IELT)、早泄诊断量表(PEDT)分别评价患者的勃起功能障碍和早泄的临床疗效,并应用PHQ-9、GAD-7量表评估患者治疗前后的抑郁、焦虑程度。结果治疗过程中治疗组脱落2例,对照组脱落3例,最终有效病例135例,治疗组68例,对照组67例。治疗组、对照组在治疗后IELT、IIEF-5评分较治疗前均明显增加,差异具统计学意义(P0.05);PEDT、PHQ-9、GAD-7评分较治疗前均明显下降,差异具统计学意义(P0.05);组间相比,治疗组与对照组在治疗IIEF-5评分改善方面无显著差异(P0.05),在IELT、PEDT、PHQ-9、GAD-7评分的改善方面,差异具统计学意义(P0.05);不良反应方面,对照组头痛2例,治疗组背部肌肉酸痛1例,头痛2例,均为轻度,可耐受,自行缓解,未做特殊处理。结论盐酸达泊西汀联合枸橼酸西地那非及乌灵胶囊治疗PE合并轻中度ED,可以安全有效地改善患者勃起功能,并进一步改善患者IELT以及缓解其焦虑抑郁情绪。     

视听性刺激与性教育在西地那非治疗勃起障碍中的应用

目的探讨视听性刺激与性教育对服用西地那非无效的勃起障碍(ED)患者疗效。方法128例服药无效的ED患者,随机分为两组,治疗组64例接受夫妻性教育并服用西地那非100mg后接受视听性刺激诱导勃起。对照组给予常规门诊性教育,指导服药后的性刺激。治疗8周后后对性功能情况再次进行IIEF评分,评定疗效与安全性。结果完成治疗并进行有关检查者120例,治疗组61例,对照组59例。治疗组显效率、总有效率分别为31.12%、81.96%；对照组则为13.33%、62.71%,统计学处理两组有非常显著性差异(P＜0.01)。结论对服用西地那非无效的ED患者,采取性教育和视听刺激诱导勃起,使患者掌握正确的性刺激方法,可明显改善勃起功能,疗效明显优于传统的门诊服药指导。     

522例早泄患者的勃起功能调查

目的 :了解早泄患者的勃起功能评分与其实际勃起能力。　方法 :采用中国男性勃起功能调查表 (CIEF 5 )问卷调查方式。　结果 :5 2 2例中自认为有ED者 341(6 5 .33% )例 ,4 33(82 .95 % )例CIEF评分低于正常值参考标准 ,自认为有无ED与CIEF评分间差异有显著性 ,有无早泄与自认为有无ED间差异有显著性。　结论 :早泄对勃起功能评分的正确性有显著的干扰作用 ,自认为有ED的早泄患者的勃起功能与CIEF 5评分有高度的吻合性 ,自认为无ED的早泄患者的勃起功能与CIEF 5评分存在较大差异 ,其中许多CIEF 5评分轻度降低可能为早泄引起而并非真正的ED者 ,而CIEF 5评分为中重度降低的早泄患者可能为同时合并ED者。对同时存在早泄与ED的年轻患者 ,在采用CIEF 5评分时 ,应特别考虑其主观感觉 ,并排除因早泄对问题 4、5对勃起功能评价可靠性的干扰     

小低频联合手法按摩在产后妊娠纹修复中的应用

分析在产后妊娠纹修复中应用低频神经肌肉电刺激联合手法按摩的效果。方法 选取2022年 1月-2023年2月于黄骅市中医医院行妊娠纹修复的60例患者为研究对象,按随机数字表法分为对照组和观 察组,各30例。对照组采用单纯手法按摩修复,观察组采用低频神经肌肉电刺激联合手法按摩修复,比较 两组修复效果、腹部美观度、不良反应发生情况及复发情况。结果 观察组修复总有效率为96.67%,高于 对照组的73.33%（P＜0.05）;观察组治疗后腹部美观度评分低于对照组（P ＜0.05）;两组治疗后3、6个月 复发率比较,差异无统计学意义（P ＞0.05）;两组不良反应发生率比较,差异无统计学意义（P ＞0.05）。 结论 在产后妊娠纹修复中应用低频神经肌肉电刺激联合手法按摩的效果良好,能有效提升修复效果,改 善腹部美观度,且复发率及不良反应发生率均较低,应用有效性和安全性确切。     

氟西汀联合真空负压气动按摩治疗早泄的前瞻性研究

本院自2002年11月至2004年7月对100例原发性早泄患者采用SSRI药物氟西汀联合真空负压气动按摩进行治疗，结果疗效较好。现将具体情况总结如下。     

帕罗西汀联合中频穴位电刺激治疗早泄的临床疗效

目的:探讨帕罗西汀联合中频穴位电刺激治疗早泄的临床价值。方法:选取69例符合早泄诊断标准患者为研究对象,随机分为单独帕罗西汀药物治疗组(对照组Ⅰ)、中频穴位电刺激治疗组(对照组Ⅱ)和帕罗西汀联合中频穴位电刺激治疗组(试验组),每组23例,治疗8周,记录各组治疗前后的阴道内射精潜伏期(IELT)、中国早泄患者性功能评价量表(CIPE-5)评分。对比分析3组患者治疗前后的IELT和CIPE-5评分,比较3组的积分变化、有效率、药物不良反应。结果:单独帕罗西汀组1例患者因腹痛、恶心不能耐受,退出试验。试验组组、对照组Ⅰ、对照组Ⅱ均可达到延缓IELT、降低CIPE-5评分的目的。IELT分别由治疗前的(0.91±0.09)、(0.92±0.12)、(0.92±0.11)min,提高为治疗后的(5.31±0.13)、(2.78±0.17)、(4.07±0.11)min(P0.05),CIPE-5评分由治疗前的(13.1±2.8)、(12.8±2.9)、(12.5±3.0)分,提高为(25.2±2.1)、(19.5±1.9)、(22.0±2.0)分,试验组相较其他两组效果更明显(P0.05)。总有效率为95.7%、72.7%、47.8%,差异有显著性(P0.05)。结论:帕罗西汀联合中频穴位电刺激治疗早泄比单独帕罗西汀药物治疗所取得的临床疗效更佳,且能达到减少帕罗西汀用量及药物反应的效果。     

温和灸联合膏摩治疗药物性静脉炎疗效观察

目的：观察温和灸联合冬青膏按摩治疗药物性静脉炎的临床疗效。方法：将60例药物性静脉炎患者随机分为两组,治疗组采用温和灸联合冬青膏按摩治疗,对照组采用50%硫酸镁湿敷治疗,比较两组疗效。结果：总有效率治疗组96.6%,对照组70%,两组疗效比较有显著性差异（P<0.05）。结论：温和灸联合冬青膏按摩治疗药物性静脉炎有较好疗效。     

盐酸丁咯地尔联合穴位针刺治疗椎动脉型颈椎病效果观察

目的 探讨盐酸丁咯地尔静脉滴注联合穴位针刺治疗椎动脉型颈椎病（CSA）的疗效。方法 将80例CSA患者随机分为观察组和对照组各40例，对照组常规行颈部按摩，并行穴位针刺治疗，1次／d，疗程20d。观察组在此基础上行盐酸丁咯地尔静脉滴注。结果 观察组总有效率为95．0％，时照组为80．0％。两组比较，差异有显著性意义（P〈0．05）。结论 盐酸丁咯地尔静脉滴注联合穴位针剌治疗椎动脉型颈椎病疗效显著提高。指导患者正确进行颈部功能训练,做好健康指导可巩固疗效，避免复发。     

Management of premature ejaculation -- a comparison of treatment outcome in patients with and without erectile dysfunction

This study evaluated the problem of premature ejaculation (PE) in patients treated for erectile dysfunction. The aim was to compare the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the management of primary PE and PE associated with sildenefil treatment. Eighty-seven patients with PE seen over a period of 17 months were recruited into this prospective study. They were categorized into two groups: primary PE (GPI) and PE in sildenefil-treated patients (GPII). All patients recruited into GPII had erectile dysfunction (ED) that was successfully treated with sildenefil citrate for at least a year. Both groups of patients were given sertraline 50 mg 4 h before expected time of sex. The minimum follow-up was 6 months. The ejaculation latency before and after treatment of the two groups were compared. The sexual satisfaction scores of the patients in the two groups were also sought and analysed. Twenty-eight percent of patients with ED who were successfully treated with sildenefil developed PE. Subjects in group GPI were younger and have less comorbid factors than those in group GPII. There was no significant difference in the mean ejaculation latency for both groups (46 vs. 34.6 sec for GPI and GPII, respectively). However, there was highly significant difference in the ejaculation latency between the two groups after treatment with sertraline for 6 months (247.2 vs. 111.6 sec for GPI and GPII, respectively). There was also significant difference in the sexual satisfaction score for group GPI post-treatment, but not for GPII. No significant side-effect of sertraline was reported from patients in both groups. Successful treatment of ED could not assure sexual satisfaction. At least a quarter of sildenefil treated ED patients might develop PE which would continue to frustrate these patients sexually. While selective serotonin re-uptake inhibitors (SSRIs) was effective in the management of primary PE, they were not as effective in patients with sildenefil corrected ED.     

Comparison of the clinical efficacy and safety of the on‐demand use of paroxetine,dapoxetine, sildenafil and combined dapoxetine with sildenafil in treatment of patients with premature ejaculation: A randomised placebo‐controlled clinical trial

The aim of the study was to compare the clinical efficacy and safety of the on‐demand use of paroxetine, dapoxetine, sildenafil and combined dapoxetine with sildenafil in treatment of patients with premature ejaculation (PE). In a single‐blind placebo‐controlled clinical study, 150 PE patients without erectile dysfunction (ED) were included during the period of March 2015 to May 2016. Patients were randomly divided into five groups (30 patients each). On demand placebo, paroxetine (30 mg), dapoxetine (30 mg), sildenafil citrate (50 mg) and combined dapoxetine (30 mg) with sildenafil citrate (50 mg) were given for patients for 6 weeks in each group respectively. All patients were instructed to record intravaginal ejaculatory latency time (IELT) and evaluated with Premature Ejaculation Diagnostic Tool (PEDT) and the patient satisfaction score before and after treatment. The mean of IELT, satisfaction score and PEDT in all groups was significantly improved after treatment (p value = .001). Combined dapoxetine with sildenafil group had the best values of IELT, satisfaction scores and PEDT in comparison with other treatment groups (p value <.001). The combined dapoxetine with sildenafil therapy could significantly improve PE patients without ED as compared to paroxetine alone or dapoxetine alone or sildenafil alone with tolerated adverse effects.     

口服万艾可结合行为疗法治疗早泄

目的 :探讨万艾可 (枸橼酸西地那非 )结合行为疗法治疗早泄 (PE)的临床效果。　方法 :6 0例PE患者随机均分为单纯行为疗法组和万艾可 +行为疗法组 ,记录患者治疗前后阴道内射精潜伏期并进行组内和组间比较 ,同时记录夫妻对性生活的满意程度。　结果 :治疗前 ,单纯行为疗法组和万艾可 +行为疗法组阴道内射精潜伏期分别为(0 .80± 0 .2 0 )、(0 .73± 0 .2 4 )min ,治疗后分别为 (1.82± 0 .5 4 )、(3.6 3± 0 .5 5 )min ,差异有显著性 (P <0 .0 1)。在夫妻对性生活满意度方面 ,万艾可 +行为疗法组优于单纯行为疗法组。　结论 :万艾可结合行为疗法可延长射精潜伏期 ,提示万艾可在治疗PE方面也有一定的应用前景。     

Efficacy of tadalafil in the treatment of erectile dysfunction in hypertensive men on concomitant thiazide diuretic therapy

Many men with erectile dysfunction (ED) have hypertension as a comorbid condition. Recent guidelines recommend thiazide diuretics as first-line therapy for hypertension. We analyzed data from 14 randomized, double-blind, placebo-controlled trials (N=2501) to evaluate the efficacy of tadalafil 20 mg for the treatment of ED in men on thiazides. Of the 2501 patients, 163 were on concomitant thiazides (116 tadalafil/47 placebo) and 159 (98%) were reported to have hypertension. The primary efficacy measures were mean change from baseline in the international index of erectile function (IIEF) erectile function (EF) domain and the proportion of 'yes' responses to sexual encounter profile (SEP) Questions 2 and 3. The tadalafil group showed a significantly (P<0.001) greater mean baseline to endpoint improvement on all efficacy outcome measures compared to placebo-treated patients regardless of concomitant thiazide use. More importantly, the responses to tadalafil were similar regardless of concomitant thiazide use. Additionally, responses to tadalafil were comparable between thiazide and nonthiazide users regardless of baseline ED severity (P>0.05).     

生物反馈治疗用于早泄的疗效比较

目的 比较生物反馈治疗联合药物治疗、单用生物反馈治疗、单用药物治疗的临床疗效.方法 60例早泄患者被随机分为3组,分别是药物组、生物反馈组和联合组.药物组予以每日两酞普兰（喜普妙）20 mg口服治疗,共治疗6周 生物组予以生物反馈治疗仪治疗,一周3次,连续治疗12次 联合组予以西酞普兰药物联合牛物反馈治疗仪治疗,予以隔天下午口服20 mg喜普妙的同时.一周1次予以生物反馈治疗仪治疗,连续治疗6周.在治疗前后记录各组患者的中国早泄患者性功能评价表CIPE-5评分和射精潜伏期,比较治疗前后各组及各组间的临床疗效.结果 治疗前药物组、生物反馈组和联合组的射精潜伏期分别为（0.70±0.12）、（0.66±0.16）和（0.65±0.13）min 治疗后分别为（1.14±0.75）、（1.85±0.99）和（3.09±1.34）min,与治疗前比较差异有显著的统计学意义（P〈0.01）.治疗前3组的CIPE-5评分分别是（9.00±2.00）、（9.50±2.21）和（8.70±2.05）分 治疗后分别为（12.84±2.89）、（13.90±2.71）和（17.25±4.42）分,分别较治疗前差异有显著的统计学意义（P〈0.01）.治疗后联合治疗组的CIPE-5评分和射精潜伏期与其余两组相比,均有显著的差异（P〈0.01）.治疗6周后药物组、生物组、联合组的有效率分别为73.38％、75.00％、80.00％.结论 喜普妙兰药物治疗、生物反馈治疗及生物反馈联合喜普妙药物治疗对于早泄患者射精潜伏期和CIPE-5评分均有明显提高.而三种治疗方法相比,生物反馈治疗仪联合喜普妙药物治疗有更佳的疗效.     

Beneficial effect of tamsulosin combined with dapoxetine in management of type III prostatitis with premature ejaculation

To evaluate the efficacy and safety of tamsulosin combined with dapoxetine in the treatment of type IIIB chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) that is complicated by premature ejaculation (PE), a total of 251 CP/CPPS patients with PE were recruited from nine hospitals across China and were randomly divided into two groups: one received tamsulosin as a control, and the other received a combination therapy of tamsulosin and dapoxetine. Follow‐up was conducted at four time points, and indicators describing CP/CPPS and PE were compared between the two groups. In all, 223 patients were followed up at least once, and 114 patients completed all of the treatment process. The combination group showed more improvement in the symptoms of both PE and CP/CPPS, including thrust number (50.5 vs. 45), premature ejaculation profile score (11.39 vs. 6.96), intravaginal ejaculation latency time (5.95 min vs. 2.63 min) and the National Institutes of Health Chronic Prostatitis Symptom Index (7.44 vs. 11.81) in comparison with the tamsulosin group. In conclusion, for CP/CPPS patients with PE, tamsulosin combined with dapoxetine provided better therapeutic efficacy in the treatment of not only PE symptoms but also CP/CPPS indicators in comparison with tamsulosin monotherapy.     

An unresolved discussion: presence of premature ejaculation and erectile dysfunction in lumbar disc hernia

Purpose

Premature ejaculation (PE) and erectile dysfunction (ED) are both frequent diseases with several questions about the aetiological factors for these disorders. Lumbar disc herniation (LDH), which can cause both neurological and physiological impairments, may be a causative reason. We prospectively tried to evaluate the presence of PE and ED in patients with LDH and identify the effect of both surgical and physical therapy treatments for LDH on PE and ED.

Methods

A total of 50 patients with LDH and a corresponding control group without LDH at an age of 18–50 years were included in the study. Both PE and ED were evaluated with premature ejaculation diagnostic tool (PEDT) and International Index of Erectile Function. Mean intravaginal ejaculatory latency time (IELT) was calculated at their 5 consecutive intercourse. Physical therapy or microdiscectomy was performed according to indication. After 6 months of follow-up, patients in treatment group were re-evaluated for PE and ED.

Results

Mean age of study and control group was 34.1 ± 3.3 and 34.2 ± 4.0 years, respectively (p = 0.979). In LDH group, IELT was <1 min in 12 (24 %), 1–2 (16 %) min in 8, 2–3 min in 7 (14 %), 3–4 min in 7 (14 %) and 4 or more minutes in 16 (32 %) patients. These numbers were 11 (22 %), 8 (16 %), 5 (10 %), 9 (18 %) and 17 (34 %) in control group, respectively. Mean PEDT score of patients who had IELT < 1 min was 11.9 ± 2.1 and 10.7 ± 2.1 in study and control group, whereas it decreased to 1.0 ± 2.8 and 0.5 ± 1.8 as IELT increased over 4 min, respectively. There were 11 (22 %) patients with ED in LDH group, whereas there were only 2 (4 %) in control group (p = 0.017). Twenty patients with LDH underwent surgery while 30 had been taken into physical therapy. After 6 months, patients with PE significantly decreased in both surgery and physical therapy group (p = 0.025 and p = 0.046). Patients with ED also decreased after treatment, but the numbers were so limited for statistical evaluation.

Conclusion

Although ED was more frequent in patients with LDH, PE was similar in both study and control groups, but the treatment of LDH had positive effects on PE and ED.     

Treatment of premature ejaculation

Premature ejaculation (PE) is the most common male sexual disorder, and it may have a profound negative impact on a man and his partner's lives. Different organizations and societies have no consensus on the definition and classifications of PE. However, most organizations and societies include in their definitions the intravaginal ejaculation latency time (IELT), the control of ejaculation, and the distress or impact of interpersonal difficulties. Evaluation procedures have been standardized in clinical studies by the development of an objective measurement of IELT (using a stopwatch) and by the introduction of patient-reported outcome (PRO) questionnaires on ejaculation control and sexual satisfaction. The identification of four different patterns of PE—lifelong, acquired, normal variant, and premature-like ejaculatory dysfunction—is critical because of different underlying pathogeneses and consequently different management approaches. The optimal treatment for PE should be individualized, based on a patient's symptoms, expectations, and underlying variant causes. Most lifelong PE patients need pharmacotherapy (possibly in combination with psychosexual counseling) as a first-line treatment because of the underlying neurobiological etiology and the impact of PE on the couple's relationship. The management of acquired PE is etiologically specific and may include pharmacotherapy for erectile function management in men with comorbid erectile dysfunction (ED). Men with natural variable PE complain of early ejaculation in situational or coincidental conditions; the ejaculation is inconsistent and occurs irregularly. Psychoeducation and reassurance are indicated for men with this type of PE. Psychotherapy or sex counseling is the first choice of treatment for men with premature-like ejaculatory dysfunction. All pharmacotherapies such as long-term selective serotonin reuptake inhibitors (SSRIs) or on-demand topical anesthetics are off-label indications, The benefits of pharmacotherapy toward improving ejaculation times should be weighed against their safety profiles. The development of the short-acting selective serotonin reuptake inhibitor (SSRI) dapoxetine hydrochloride (30 mg and 60 mg) for oral on-demand use opened a new era of PE treatment. Other potential pharmacotherapies such as tramadol, lidocaine/prilocaine spray, and phosphodiesterase inhibitors are still under development. Their safety and efficacy profiles should be further evaluated and supported by additional clinical studies.