缺氧性ED模型阴茎海绵体微结构改变的研究进展

缺氧是勃起功能障碍(ED)的独立危险因素,其导致ED的机制复杂多样,传统的研究更多关注阴茎海绵体内皮、体内性激素水平的改变,但近年来此方面的研究未有突破性进展。近期研究表明,阴茎海绵体微结构的改变,如收缩型阴茎海绵体平滑肌细胞表型转换、海绵体的纤维化可能是缺氧性ED发生的重要机制。而针对阴茎海绵体微结构改变的一些手段,如基因治疗、干细胞治疗、诱导细胞自噬等有可能为缺氧性ED的治疗带来广阔前景。     

脂肪源性干细胞治疗勃起功能障碍的研究进展

勃起功能障碍(erectile dysfunction,ED)是男性常见疾病,直接影响患者的生活质量.近年来,人们对阴茎勃起机制和ED病理生理学的研究取得一定进展,有了许多治疗ED的方法,如:口服磷酸二酯酶5型(phosphodiesterase 5,PDE5)抑制剂、阴茎海绵体内注射血管活性药物及阴茎假体植入[1]等.     

内皮损伤与勃起功能障碍研究进展

内皮在维护血管稳态、调节血管紧张度及血流、预防血管内血栓形成等方面起重要作用。血管内皮是阴茎勃起过程中的重要角色,ED多数情况下存在不同程度的内皮功能障碍,内皮损伤是ED的重要病理基础。不良生活方式、心血管疾病、氧自由基、炎症因子等均可导致内皮损伤。血管内皮具有自我修复机制,内皮损伤是损伤因素与修复因素失衡的结果。本文就内皮损伤机制、内皮损伤后的修复、内皮损伤与ED关系等方面的进展作一综述。     

经NO-cGMP-PDE5通路治疗勃起功能障碍的中药研究进展

自1990年首次阐明小分子一氧化氮(NO)与阴茎平滑肌松弛之间有紧密联系后,20多年间ED的基础研究取得了很大进展。一氧化氮-环鸟苷酸-磷酸二酯酶5(NO-cGMP-PDE5)通路在ED治疗中的重要作用及相关研究为临床治疗ED提供了坚实的基础。中药治疗ED的历史悠久,目前已阐明部分中药经NO-cGMP-PDE5通路治疗ED的分子生物学机制。本文综述了相关研究。     

中药治疗勃起功能障碍的新进展

勃起功能障碍(ED)是最常见的男性性功能疾病之一,目前首选治疗药物为5型磷酸二酯酶抑制剂(PDE5Is),同时中药在ED的治疗中也起着重要的作用,随着中药在ED治疗上的研究,包括对其有效成分及作用机制的研究不断取得进展,日益受到广泛认可。     

勃起功能障碍的药物治疗

近年来,特别是5型磷酸二酯酶抑制剂———西地那非上市以来,众多学者对勃起功能的生物化学和生理学进行了深入研究,在勃起功能障碍(ED)药物治疗的基础和临床方面取得了许多新的进展。本文综述了多种作用于中枢和外周ED治疗药物的分子及细胞作用机制,为最近ED药物研究和进展中最具争议的领域提供一些详细资料。     

低强度体外冲击波在勃起功能障碍中的应用进展

勃起功能障碍(ED)的发病率和就诊率日益增高,尤其在40岁以上人群,且其发病率与年龄呈正相关,预计2025年全球ED患者可达3亿人左右。目前,对ED病理生理学机制的研究逐渐深入,对其治疗也有了诸多突破性的进展,但鲜有在分子水平上针对ED病理学变化进行治疗及康复的措施。而低强度体外冲击波(Li SWT)作为一种新兴无创的微能量临床疾病治疗模式,不仅有望从根本上修复ED患者阴茎海绵体的病理学损伤,更是在目前诸多西医治疗具有一定局限性的情况下(如对口服磷酸二酯酶抑制剂-5无反应),为ED的治疗开辟了一条新的思路。本文旨在介绍ED诊疗的现状、Li SWT目前在国内外动物研究及临床实验中治疗ED的机制及进展,为罹患有ED的患者带来新的曙光。     

勃起功能障碍的治疗进展

勃起功能障碍（Erectiledysfunction,ED）的治疗方式在近10年获得了飞速的进展,从磷酸二酯酶抑制剂（PDE-5i）的临床广泛应用,新型PDE-5i的市场准入,到阴茎假体的临床应用.从基因治疗到目前热门的干细胞治疗勃起功能障碍的理论提出及治疗方式的初步尝试,为ED的治疗提供了新的研究方向.随着分子生物学对ED病因和形成机制研究的深入,转基因治疗在不久的将来会成为治愈ED最有效的方法之一.     

Sonic hedgehog信号通路与勃起功能障碍的相关研究进展

Sonic hedgehog(Shh)是维持男性勃起功能的重要调节因子,异常的Shh信号可能是导致ED的机制之一。目前关于Shh信号通路与ED的研究主要集中在双侧海绵体神经损伤的神经源性ED,糖尿病导致的内分泌性ED以及老年性ED。本文梳理了不同类型ED中Shh信号通路的改变,阐明了Shh信号通路在ED中的调控机制,以期对今后的相关研究给予启发。     

勃起功能障碍与代谢综合征研究进展

勃起功能障碍(ED)和代谢综合征(MS)都与心血管疾病有着密切的关系,随着研究的深入,人们开始寻找两者之间存在的直接关联并取得了较大进展。MS与ED之间存在密切关系:MS患者的ED发病率明显高于非MS患者,与MS相关的性腺功能减退也会促进ED的发生,而针对MS的饮食和体育锻炼治疗可以有效逆转ED的进程。进一步研究还发现,内皮细胞损伤及血浆炎症反应标志物水平增高等因素可能是MS与ED之间密切联系的机制所在。本文对近年来关于ED与MS关系的研究结果进行归纳阐述,以期为今后MS患者的ED诊疗及进一步开展相关研究提供参考。     

Changes in Penile Morphometrics in Men with Erectile Dysfunction after Nerve-Sparing Radical Retropubic Prostatectomy

There have been anecdotal reports of a decrease in penile size in men with erectile dysfunction (ED) after nerve-sparing radical retropubic prostatectomy (NSRRP). Penile circumference and length measurements are obtained by one physician from 100 men, age 47 to 74, who presented at various intervals (1.7&endash;27.6 months) for the treatment of ED after NSRRP from 1994 through 1997. All patients were asked to complete a brief male sexual function inventory at their initial visit. Penile measurements were obtained both in the flaccid and erect states, with erections being induced with intracorporal injections of Trimix. The sexual inventory scores were compared with those of an age-matched control cohort of 130 men presenting for evaluation of ED during the same time period and 132 age-matched men who completed the inventory at the time of a prostate screening. By self-report, men experiencing ED after NSRRP had better libido but more severe ED than men presenting with ED of other causes. There was a decrease in all penile dimensions after NSRRP. The flaccid and erect measurements of length and circumference decreased 8% and 9%, respectively after surgery (p > 0.05). The most substantial change occurred between the first 4 and 8 months postoperatively. The average change in volume between the first 4 and 8 months was 19% to 22% in the flaccid and erect state, respectively. There is a significant decrease in penile size in men with ED after NSRRP. The etiology may be denervation smooth muscle atrophy, apoptosis, or hypoxia-induced damage to the corpora. Further research is needed to elucidate the nature of these postoperative changes.     

多发性硬化与勃起功能障碍

多发性硬化是一种中枢神经系统慢性炎症性脱髓鞘疾病。一氧化氮、离子通道、细胞因子及睾酮在多发性硬化中起着重要作用。多发性硬化所致阴茎勃起功能障碍(ED)可能与这些因素有关,同时多发性硬化引起的周围神经损伤也参与了ED。通过对这些物质、神经及其功能的深入研究,可为ED的治疗提供理论依据。     

中药治疗勃起功能障碍的分子机制

勃起功能障碍(ED)是临床上男性的常见病和多发病,长期以来中药在我国ED治疗中具有重要地位,随着对勃起功能和ED发生机制的认识深入,目前已阐明部分中药治疗ED的作用机制,这对于中药的推广开发利用具有重要作用。     

中老年男性对性功能障碍认知和态度的相关研究

目的:了解中老年男性在性功能障碍方面的认知和态度,探讨男性健康的现状和需求。方法:采用随机问卷调查方式,对北京西城区阜外街道2 801例中老年男性进行性功能障碍方面的流行病学调查。结果:ED患病率为41.2%,其中仅12.1%去医院就诊过。在性生活和性功能方面:52.4%的受访者认为性活动在男性生活中的地位是重要的;夫妇双方性生活不满意时,55.6%的受访者认为会影响夫妻感情。49.0%的受访者认为ED是正常衰老现象,仅27.4%认为是一种疾病。虽然41.2%的受访者患有ED,但对夫妻间的性生活不满意者仅占9.7%;而配偶对夫妻间的性生活不满意率为14.1%。结论:中老年男性对性功能障碍的认知、态度和需求等方面水平偏低,应进一步加强男性生殖健康的科普宣传教育等方面工作。     

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。     

Erectile dysfunction following radiotherapy and brachytherapy for prostate cancer: pathophysiology, prevention and treatment

Objectives Although detrimental impact on sexual function following radiotherapy (RT) and brachytherapy decreases the quality of life of prostate cancer survivors, the etiology, pathophysiology, prophylaxis and treatment of this condition has not yet been fully clarified. We reviewed the published literature in terms of etiology, treatment and possible prevention of erectile dysfunction (ED) following RT and/or brachytherapy. Method We have reviewed the literature through a MEDLINE search. Prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, treatment and quality of life were used as keywords. Conclusion Both RT and brachytherapy result in high rates of ED. Although arterial damage seems to be the main cause of ED after RT, exposure of neurovascular bundle to high levels of radiation dose has been also implicated in some studies with brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of ED. The most important predictive factor of ED following RT is the treatment modality. Intensity-modulated radiotherapy and vessel-sparing prostate radiotherapy are new techniques but those treatments may not guarantee complete preservation of the erectile function. Patients need to be correctly informed on the possible sequela of radiation-based treatments on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for ED, which may develop in due course.     

Depression and lower urinary tract symptoms: Two important correlates of erectile dysfunction in middle-aged men in Hong Kong, China

AIM: To evaluate the correlates of erectile dysfunction (ED) in Hong Kong middle-aged Chinese men aged 45-64 years. METHODS: A community-based cross-sectional household survey was performed in Hong Kong. The Chinese abridged version of the International Index of Erectile Function (IIEF-5) was used to measure erectile function. The International Prostate Symptom Score (IPSS) was used to measure lower urinary tract symptoms (LUTS) and depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Demographic and lifestyle data were also collected. The association between ED and its correlates was analyzed using bivariate and multivariate analyses. RESULTS: Of the 545 subjects who agreed to participate in the survey, 75 refused to answer questions about their sexual activities and function. Out of those who responded, 118 (22%) subjects were not sexually active (not sexually active over the past 4 weeks). Out of 352 subjects, 60.3% suffered from some degree of ED. Age, presence of depression defined by CES-D and moderate LUTS were associated with increased odds of having ED. In multivariate analysis, depressive symptoms identified by CES-D (OR = 2.3, CI: 1.2-4.6) and moderate LUTS (OR = 3.7, CI: 1.6-8.3) were independently associated with increased odds of having ED. CONCLUSION: ED is an important public health problem in Chinese middle-aged men, with more than half suffering from some degree of ED. Depression and LUTS were significant and important risk factors associated with ED.     

Penile prosthesis implantation in the era of medical treatment for erectile dysfunction

Penile prosthesis implantation, the oldest of the modern treatments for erectile dysfunction (ED), still plays an important role despite the advent of less invasive alternatives. For some men with ED, penile prosthesis implantation is the only effective or acceptable treatment. Penile prosthesis implantation remains a viable option in the contemporary management of ED as evidenced by annual penile prosthesis implantation cases in the United States rising from 17,540 in 2000 to 22,420 in 2009. Improvements in prosthesis design and implantation techniques have resulted in significant increases in device survival and patient satisfaction.     

高血压与勃起功能障碍相互关系研究进展

勃起功能障碍(ED)与高血压之间的关系是男科学研究的重点领域。目前研究认为,这两种疾病拥有相似的病理生理过程,如氧化应激效应造成血管内皮损害以及RhoA/Rho激酶活性上调。两种疾病均为血管功能损害这一病理过程的不同阶段。定期细致而全面评估高血压合并ED患者病情,并予以合理药物治疗显得尤为重要。在高血压患者中,5型磷酸二酯酶抑制剂无论是单用还是联合抗高血压药物使用都取得了令人满意的效果。目前,基因治疗以及脂肪源性干细胞治疗都展现出了良好的前景,通过转化医学方法可使其更好的为临床服务。