心因性阳痿患者的神经电生理表现

目的 :研究心因性阳痿患者的神经电生理学改变。方法 :对 30例心因性阳痿患者 (心因组 )进行球海绵体肌反射 (BCR)、坐骨海绵体肌反射 (ICR)及阴茎背神经体感诱发电位 (SSEP)的潜伏期、波幅检测 ,并与正常人 (对照组 )进行比较。结果 :病人组与对照组BCR、ICR、SSEP的P4 1波潜伏期比较差异无显著意义 (P >0 0 5 ) ,而病人组P4 1波波幅较对照组明显降低 (P <0 0 5 )。结论 :心因性阳痿患者SSEP的P4 1波幅降低 ,这似乎有助于心因性阳痿鉴别诊断     

阴茎勃起功能障碍药物治疗

勃起功能障碍是中老年男性常见多发病,近几年来其治疗的进展比较快,也引起了广泛关注。目前常用的一线口服治疗药物包括西地那非、伐地那非和他达拉非,临床效果相似但各有其特点。二线治疗包括阴茎海绵体血管注射疗法和尿道内用药,但因使用时有侵袭性而受限。目前所有的治疗方法都存在着不同程度的不良反应,基因治疗可能是未来ED治疗的发展方向。     

Problems of erectile dysfunction prevalence

According to non-clinical studies, erectile dysfunction (ED) seems to be the fastest growing among male sexual problems. Its prevalence range widened from 4%-9% in 1990 to 10%-52% in 2000. The paper is an attempt at understanding this new and rampant "epidemic". Instead of trying to pinpoint its "natural" causes, the author aims to decipher the socially constructed dynamics of the disorder. The approach is based on a qualitative investigation of the scientific conceptualization and measuring of ED. The analysis points out serious shortcomings, which contradict the much-celebrated usefulness of the 1992 NIH Panel's consensus on impotence. More importantly, the observed measurement differences call into question the usefulness of the current research on the prevalence of ED. Using data from the first Croatian study on male sexual dysfunction, the author demonstrates the seriousness of problems stemming from the use of non-standardized measures. In conclusion, the steps for reaching the necessary standardization are outlined.     

Novel therapeutic targets for erectile dysfunction

Erectile dysfunction (ED) is a neurovascular phenomenon modulated by hormonal, local biochemical, and biomechanical/structural factors of the penis. The success of the orally active phosphodiesterase inhibitors for the treatment of ED has boosted research activities into the physiology of the erectile mechanism. Peripheral intracellular signal transduction in the penis as well as central brain and spinal cord pathways controlling penile erection have been investigated and are now better understood. The results of this ongoing research have provided the basis for the development and introduction of several novel therapeutic modalities into the management of ED. Many novel pharmacotherapeutic approaches under development including the use of melanocortins and Rho-kinase inhibitors as well as the introduction of gene therapy and tissue engineering have demonstrated efficacy in animal as well as early human trials. This review describes the major new and evolving pharmacological advances in the field of oral pharmacotherapy for the treatment of male ED.     

The evolutionary role of erectile dysfunction

Biologic processes that affect the ability of an organism to reproduce are subject to heavy evolutionary pressure. Erectile dysfunction (ED), a common condition in elderly males, definitely affects the ability of the organism to reproduce, and therefore, it is expected to play a significant evolutionary role. Whereas oogenesis is limited to young females, spermatogenesis is a lifelong process. As a male gets older, the number of (pre-meiotic) mitotic cell divisions during spermatogenesis increases, as does the risk of de novo gene mutations. In this paper, I examine the hypothesis that ED, in addition to decrease in fertility, are two evolutionary safety mechanisms that reduce the probability of an ovum being fertilized with genetically altered sperm from an aged or sick male. This hypothesis is supported by the parallel rise in the occurrence of ED, infertility, and risk of congenital anomalies with age; by the occurrence of these three processes in the same medical conditions; and by the presence of a theory unifying the etiologies of three processes-the "free radical theory of aging". This hypothesis can predict the occurrence of congenital anomalies under conditions associated with ED and infertility but are presently not known to be associated with congenital anomalies.     

Intracavernous prostaglandin E1 in erectile dysfunction

Summary Prostaglandin E1 (PGE₁) is a naturally occurring substance that is present in a variety of mammalian tissues, including the semen of fertile men. Its use in the diagnosis and treatment of erectile dysfunction has been extensively studied. In doses of 10–20 g, PGE₁ produces full erections in 70–80% of patients with erectile dysfunction. In diagnostic use PGE₁ is employed as a simple office test and in conjunction with various hemodynamic tests. Self-injection of PGE₁, either with the patient or his partner administering the injection, is a minimally invasive and effective treatment for erectile dysfunction in patients with organic or psychogenic erectile dysfunction. Its use is contraindicated in patients with sickle cell anemia, severe coagulopathy, schizophrenia or severe psychiatric disorder, poor manual dexterity, severe venous incompetence, or severe systemic disease. As calculated from data in the published literature, the most frequent side effects are pain at the injection site or during erection (occurring in 16.8% of patients), hematoma/ecchymosis (1.5% of patients), and prolonged erection/priapism (1.3% of patients). The potential for prolonged erection/priapism, the most serious side effect, can be minimized by careful titration of the dose and through patient education. Systemic side effects occur rarely during PGE₁ use. During extended use, patients should be monitored for potential long-term side effects, such as fibrosis and angulation.Abbreviations ED erectile dysfunction - PGE₁ prostaglan-din E₁     

Phantom erectile penis after sex reassignment surgery

Between January 2001 and December 2007, we performed vaginoplasty as sex reassignment surgery in a total of 14 male-to-female transsexual (MTFTS) patients [1]. Several complications occurred such as partial flap necrosis, rectovaginal fistula formation and hypersensitivity of the neoclitoris. Just after the operation, some patients feel that their penises still exist, but by several weeks postoperatively, this sensation has disappeared. Herein we report a case of MTFTS in whom the sensation of a phantom erectile penis persisted for much longer.     

22例糖尿病合并阳萎患者的交感皮肤反应研究

目的：探讨Ⅱ型糖尿病阳萎患者外阴交感皮肤反应（SSR）与肢体SSR和胫神经运动传导速度（MCV）的相关性,以评价其对糖尿病合并阳萎早期诊断防治及疗效的意义。方法：对22例糖尿病合并阳萎患者进行会阴与肢体SSR以及胫神经MCV检测,并以19例非阳萎糖尿病者和28例正常男性作对照。结果：糖尿病合并阳萎患者肢体和会阴SSR潜伏期较非阳萎糖尿病者和正常对照组明显延长,糖尿病合并阳萎患者肢体和会阴SSR波幅面积较非阳萎糖尿病得和正常对照组明显缩小,结论：糖尿病合并阳萎的患者SSR潜伏期延长,MCV减慢,SSR波幅亦明显缩小;肢体与会阴SSR的潜伏期均可反映糖尿病神经性阳萎患者的植物神经病变。因此检测肢体SSR对于防治糖尿病阳萎有重要的临床应用价值。