渐进式海绵体内注射血管活性药物治疗勃起功能障碍三年经验总结

作比较了接受海绵体内注射血管活性药物(从简单用药到复杂的联合用药)治疗勃起功能障碍的效果。研究包括625例勃起功能障碍病人，年龄26～85岁。使用四种血管内药物注射方案。方案1：罂粟碱加酚妥拉明；方案2：前列腺素E1；方案3：罂粟碱加酚妥拉明、前列腺素E1；方案4：硫酸阿托品加罂粟碱、酚妥拉明、前列腺素E1。     

阴茎海绵体药物注射治疗勃起功能障碍19年1例报告

阴茎勃起功能障碍(ED)是指阴茎不能勃起和(或)不能维持勃起以达到满意的性生活,是男性最常见的性功能障碍之一.ED的治疗方法多种多样,有第一线的口服药物和负压式辅助装置等;第二线的阴茎海绵体内药物注射(ICI)以及经尿道内给药;第三线的假体植入手术治疗等([1]).     

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。     

多普勒超声在静脉性勃起功能障碍诊断中的应用价值研究

目的：探讨Doppler超声在静脉性勃起功能障碍（ED）诊断中的应用价值。方法：10例静脉性ED者在阴茎海绵体内血管活性药物注射（ICI）后，行Doppler超声检查，并同时海绵体内灌注生理盐水，动态观察不同勃起状态海绵体动脉舒张期血流变化，30例心理性ED者仅ICI后行Doppler超声检查作对照。结果：静脉性ED者在勃起硬度差时，海绵体动脉舒张期表现为前向血流（正值表示），随着海绵体内生理盐水灌注后，勃起硬度逐渐增加，舒张末期血流消失；达正常勃起时，舒张期表现逆向血清（负值表示）。心理性ED者在阴茎膨胀期、海绵体动脉舒张期表现前向血流，正常勃起时，舒张期表现逆向血流。结论：在海绵体动脉供血正常情况下，静脉关闭障碍导致海绵体内压受损，舒张期出现血流动力学异常，前向血流为一特征性表现，因此Doppler超声在静脉性勃起功能障百的诊断中具有一定价值。     

阴茎海绵体内注射血管活性药物后持续勃起10例报告

自1977年Virag应用罂粟碱诱发勃起治疗勃起功能障碍(ED)以来[1],现已广泛应用于临床.最常用的是罂粟碱、罂粟碱和酚妥拉明混合剂、前列腺素E1.     

阴茎血管活性物质及其功能递质在勃起功能障碍发病中的作用

阴茎海绵体是一种特殊的血管结构,勃起功能障碍(ED)的发病常与调节阴茎海绵体各种血管活性物质及其功能递质密切相关。调节阴茎血管的活性物质及功能递质,如血管紧张素和激肽、前列腺素类、内皮素、内皮源性超极化因子、一氧化氮合酶及一氧化氮、Rho激酶等在ED的发生中发挥重要作用,通过对这些活性物质及其功能递质的深入研究,可为ED治疗提供理论基础。     

海绵体神经损伤性勃起功能障碍治疗研究进展

随着前列腺手术的广泛开展和骨盆骨折尿道损伤患者的不断增多,海绵体神经损伤性阴茎勃起功能障碍越来越受到关注。海绵体神经损伤后,阴茎平滑肌和内皮细胞凋亡,NOS阳性神经密度降低,进而出现海绵体平滑肌纤维化。损伤后的神经再生策略一直是ED研究的热点之一。本综述将围绕促进海绵体神经再生的治疗策略,讨论海绵体神经损伤性ED治疗的基础及临床研究现状,既涉及神经营养因子、RhoA/ROCK抑制剂、亲免素配体、促红细胞生成素、干细胞治疗、基因治疗等传统策略,也包含富血小板血浆和低强度体外冲击波治疗等易于临床转化的新的治疗方式。本综述旨在为相关领域学者提供参考,以期开展更多具有较高临床转化意义的研究。     

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。     

Long-term results of dorsal penile vein ligation for symptomatic treatment of erectile dysfunction

About 20% of patients with erectile dysfunction do not react to intracavernous pharmacological treatment (SKAT) because of a cavernous leak. The first attempt to treat venous insufficiency goes back as far as the beginning of the century. Ligature and resection of the superficial and deep veins of the penis (DPVL) were performed in 122 patients (nonresponders to SKAT with a maintenance flow of less than 40 ml min-1). Twenty-four patients suffered from primary dysfunction and 98 from secondary dysfunction. The average age of the patients was 49 years, and the average duration of the preoperative erectile dysfunction 4.4 years. Postoperative follow-up was carried out for 70 months. In 98% of the patients, cavernosography revealed a dorsal leak. Twenty-six per cent had ectopic veins, 38% a leakage through the crural veins and 24% a glandular or spongiosal shunt. After the 70-month follow-up, only 14% of the 122 patients were able to achieve an adequate spontaneous erection and 19% also responded to SKAT. Depending upon the time elapsed since the operation, the rate of spontaneous reaction was reduced. It was found that younger patients with a short history of erectile dysfunction, no arterial cofactor, a maintenance flow of less than 100 ml min-1 and a severe dorsal leakage from a DPVL were the most likely to benefit from this procedure. Since degeneration of smooth muscle cells of the cavernosa is in most patients the cause of the venous leakage, penis vein surgery is to be regarded as symptomatic treatment.     

阴茎海绵体动态测压及造影的检查流程和临床应用

目的:探讨阴茎海绵体动态测压及造影(DICC)的操作流程及其在静脉型勃起功能障碍(VED)诊断中的价值。方法:临床行彩色多普勒超声检查筛选阴茎海绵体注射试验(ICI)阴性、高度怀疑VED的103例ED患者,对其进行DICC,对比观察检查结果维持灌注速度(FTM)和海绵体压力衰退值(PD)。结果:21例检查结果正常,其余VED患者根据其FTM和PD分为可疑静脉漏(5例)及轻度(39例)、中度(25例)、重度(13例)静脉漏;仅4例出现阴茎皮下血肿,3~5 d后均消失,无其他并发症发生。结论:DICC诊断VED微创、可靠、安全、可重复性高,可依据其检查结果将患者做进一步分类。     

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。     

静脉性勃起功能障碍硬度测试仪的表现特点（附247例临床分析）

作者回顾性分析了 2 47例经双核素阴茎海绵体血液动力学动态检查 (Penograme) ,确诊为静脉性勃起功能障碍患者 [阴茎动脉系统显像指数 (PIA) 15 8.8± 6 7.5 ,阴茎静脉系统显像指数 (PIV) - 6 3.7± 12 .4]的硬度测试仪 (Rigiscan)资料。 2 47例中 ,周径变化线或硬度指数高点间连线呈“锯齿波”样变化者 196例 ,其PIA 142 .1± 45 .9,PIV - 5 7.6± 5 .1;呈“斜向降低”者 40例。PIA 145 .9± 5 3.2 ,PIV - 6 4.2± 7.6 ;无变化者 (未勃起 )者 11例 ,PIA140 .4± 47.1,PIV - 6 0 .9± 9.8;三种变化之间 ,PIA、PIV无统计学差异 (P >0 .0 5 )。作者认为 ,“锯齿波”及“斜向降低”样变化是静脉性勃起功能障碍Rigiscan检查的主要表现 ,其机理是因为静脉回流过快导致阴茎海绵体内压力不稳定甚至渐降低所至     

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.     

The evaluation of the effects of renal failure on erectile dysfunction in a rabbit model of chronic renal failure

OBJECTIVE: To determine whether chronic renal failure (CRF) reduces nitrergic relaxant responses in a rabbit model. MATERIALS AND METHODS: Ten rabbits underwent surgery to induce uraemia (CRF rabbits) and a further 10 a sham operation (controls). Corpus cavernosal tissue was prepared and used in organ-chamber experiments, with relaxation assessed against a background of pre-contraction with phenylephrine. At the plateau of contraction, relaxation responses to cumulative concentrations of carbachol or sodium nitroprusside (SNP), to test endothelium-dependent and -independent relaxations, respectively, were assessed. Before electrical-field stimulation (EFS), the tissue was treated with an adrenergic nerve blocker and a muscarinic receptor blocker to eliminate the adrenergic and cholinergic components, and to determine the relaxation responses to the stimulation of nonadrenergic, noncholinergic (NANC) nerves. The relaxation responses in corporal strips obtained from CRF rabbits were compared with those from controls. RESULTS: When tissues were contracted with KCl, tensions were similar in all groups. The impairment in concentration-dependent relaxation with carbachol was significant in CRF rabbits, but SNP- and papaverine-induced concentration-dependent relaxation responses were no different among the groups. EFS-induced frequency-dependent relaxations were significantly lower in CRF rabbits than in controls. CONCLUSION: CRF inhibits the NANC-mediated relaxation of rabbit corpus cavernosum smooth muscle. Changes in NANC-mediated and carbachol-induced (endothelium-dependent) relaxation of corporal smooth muscle in the rabbit are probably caused by uraemia and subsequently, hyperthyroidism, hyperparathyroidism or low testosterone levels in CRF. These results also suggest that if vasoactive agents are to be used for treating erectile dysfunction in uraemic patients, direct-acting vasodilators and phosphodiesterase inhibitors will be useful.     

Psychosomatic aspects in the diagnosis and treatment of erectile dysfunction

After a critical review of prevalence data, psychosocial determinants and psychosomatic aspects in the diagnosis and treatment of erectile dysfunction are discussed (with reference to age-related changes). Widely used laboratory assessments are responsive to psychological factors (e.g. anxiety). Inclusion of the partner in the diagnostic process may change the clinical picture and the treatment recommendations considerably. As illustrated by penile prosthetis treatment and self-injection of vasoactive substances, acceptance and success of widely used surgical and medical treatments depend largely upon the patient's expectations, and the adaptation of the couple to the procedure. Even in cases with a clear organic pathology, fluctuations in erectile functioning may be attributable to psychological influences. As recent psychotherapeutic and psychoeducational approaches underscore, erectile failure is best conceived as a final common pathway of somatic, lifestyle, psychological and partnership determinants. These should be taken into account in comprehensive diagnostic and treatment formulations if the goal of therapy is not only to produce rigid erections, but to increase sexual satisfaction.     

Prevalence of erectile dysfunction in Thailand

A study of the prevalence rate of erectile dysfunction (ED) in the Thai population has never been done previously, except for a small study in the hospital. The project was carried out across the whole country, including in the north, south, eastern and central plains, and there were representatives from one small and one large province and the Bangkok metropolitan area. There were 250 males in each area, giving as total of 1250 males. The interviews were carried out in urban areas, so that the questions and answers could produce good data. The interviewer was trained by one of our EDACTT members, before going to the interview locations, and the supervisor were also onsite to clarify any the questions that might occur. The questions and pretest were carried out stringently, to help in term of statistics.
All the health questions were asked taking care to accommodate the interviewee's feelings, so as not to cause embarrassment. The interviews were held individually and strictly privately, so that the interviewees could speak freely The interviewees were between 40 and 70-years old, to match with MMAS. The rate of ED in this age group is increasing gradually, and the relationship between ED and hypertension, diabetics or heart disease, and lifestyle factors, including smoking habits, alcohol consumption, caffeine and risk factors is of interest.¹     

IIEF-5与NEVA检测在阴茎勃起功能障碍诊断中的意义

目的探讨应用国际勃起功能评分5(IIEF-5)问卷表结合夜间阴茎勃起测定系统(NEVA)筛选勃起功能障碍(ED)的可行性及意义。方法148例门诊ED病人,应用IIEF-5问卷表评分,再通过NEVA测定仪监测夜间阴茎勃起情况,次日数据输入主机回放并分析。结果93例为心理性ED;在19~69岁的5个年龄组中,重度ED的比例由11.8%到55.0%,NEVA中度异常者IIEF积分(12.98±2.58)分,NEVA重度异常者IIEF积分(7.32±1.04)分。结论NEVA能有效地鉴别心理性与器质性ED,IIEF-5评分值与NEVA检测阴茎勃起时血容量变化值有相关性。IIEF-5与NEVA检测结合,能提高诊断和评估ED的可靠性。     

NEVA在不同原因勃起功能障碍诊断中的应用

目的探讨NEVA在不同原因勃起功能障碍(ED)诊断中的作用。方法应用NEVA分别对15例勃起功能正常、18例心理(ED)性、16例阴茎动脉供血不足及8例阴茎静脉瘘者进行NPT监测。结果正常组夜间勃起血容量(?)分比228.5±14.0,勃起持续时间42.8±4.0min。心理性ED组分别为224.4±20.1及40.8±4.4,二项参数与正常组无显著性差异异(P>0.05)。阴茎动脉供血不足组,这两项指标分别为160.1±12.4及22.9+3.0,阴茎静脉瘘组分别为124.4±10.2及18.0±2.5,器质性ED这两项参数低于正常组与心理性ED组,呈显著性差异(P<0.01)。结论在筛选ED和诊断血管性ED中,NEVA是有效、易被病人接受的一种NPT检查工具。