万艾可联合安特尔治疗老年男性勃起功能障碍的前瞻性、随机对照研究

目的 验证万艾可联合安特尔治疗老年男性勃起功能障碍的安全性、有效性。方法 采用前瞻性、随机对照研究方法将60名ED患者分为两个对照组和一个研究组。分别观察、记录治疗前、后1、2、3个月时的IIEF、部分雄激素缺乏(PADAM)症状评分及性激素等变化。结果 IIEF、PADAM评分及有关性激素的变化表明研究组疗效显著优于对照组。结论 联合用药因同时纠正了合并存在的低睾酮水平而显著提高了疗效。对反复服用万艾可无效的老年患者，需进一步评估有无PADAM存在。     

他达拉非对中老年男性LOH患者T、IIEF及SEP影响的临床研究

目的:观察他达拉非联合安特尔治疗中老年男性迟发性性腺功能低下(LOH)的临床疗效。方法:选择125例中老年男性LOH患者随机分为两组,治疗组65例使用他达拉非加十一酸睾酮治疗,对照组60例使用十一酸睾酮胶囊治疗。分别记录治疗前及治疗后4周时的总睾酮(T)、国际勃起功能指数评分(IIEF)、患者性生活日记(SEP)等的变化。结果:治疗后2组T、IIEF及SEP评分均有不同程度改善,与治疗前比较,差异均有统计学意义(P<0.05);治疗组T、IIEF及SEP评分改善更为显著,与对照组比较,差异均有统计学意义(P<0.05)。结论:使用他达拉非联合十一酸睾酮胶囊,可较好地改善中老年男性患者T、IIEF及SEP分数,提高患者性生活满意度及自信心,具有比单纯补充睾酮更好的综合疗效。     

高血压大鼠海绵体平滑肌细胞间连接的变化

目的:比较自发性高血压大鼠(SHR)和正常血压大鼠阴茎海绵体平滑肌细胞间连接改变及与阴茎勃起功能的关系。方法:注射阿朴吗啡(APO)观察14周龄SHR(SHR组,n=5)、W istar-Kyoto大鼠(WKY组,n=5)阴茎勃起情况,用透射电镜观察其阴茎海绵体平滑肌细胞间连接超微结构,RT-PCR测定海绵体平滑肌细胞Connexin 43的mRNA表达,免疫组化观察Connexin 43蛋白表达。结果:SHR组大鼠阴茎勃起次数明显低于WKY组(P<0.05),电镜发现SHR组大鼠阴茎海绵体平滑肌细胞间大量胶原纤维增生,Connexin 43蛋白及其mRNA表达较WKY组显著降低(P<0.05)。结论:高血压影响阴茎勃起功能,阴茎海绵体平滑肌细胞间连接的病理改变可能是高血压性勃起功能障碍的发病机制之一。     

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。     

阴茎勃起功能障碍诊断方法探讨

目的　探讨阴茎勃起功能障碍 (ED)的诊断方法。　方法　对 186例阴茎勃起功能障碍患者分别采取国际勃起功能评分 (IIEF 5 )、阴茎海绵体注射 (ICI)试验、血清性激素 (LH、T、PRL和E2 )测定、阴茎彩色双功能超声、阴茎海绵体造影及球海绵体肌反射潜伏时间等检查。　结果　有186、71、2 8、4 5、2 1和 17例患者分别接受了上述检查 ,诊断心理性ED 4 6例 ,动脉性ED 6例 ,静脉性ED 15例 ,内分泌性ED 3例 ,神经性ED 3例 ,混合性ED 10例 ,原因不明 10 3例。　结论　ED是高度个性化疾病 ,针对患者不同情况采取相应的诊断方法 ,有利于选择高效、经济、安全的治疗方法。     

褪黑素抗氧化治疗糖尿病大鼠阴茎勃起功能障碍的研究

目的 观察褪黑素对糖尿病大鼠阴茎勃起功能的影响,探讨氧化应激在糖尿病性勃起功能障碍发病机制中的作用.方法 一次性腹腔注射STZ建立糖尿病大鼠模型,随机分为糖尿病组、褪黑素(MT)治疗组以及对照组.8周后通过电刺激各组大鼠勃起神经来检测海绵体内压,评价勃起功能;采用硫代芭比妥酸法检测阴茎海绵体组织中丙二醛(MDA)含量,黄嘌呤氧化酶法测超氧化物氧化酶(SOD)活性;免疫组化染色半定量分析各组大鼠阴茎海绵体中平滑肌及内皮的含量.结果 与正常对照组相比,阴茎海绵体组织中MDA含量显著增加(P＜0.01),SOD活性降低(P＜0.05),最大海绵体内压(ICP)亦显著降低(P＜0.05);与糖尿病组相比,MT组大鼠海绵体MDA含量明显降低(P＜0.05),其SOD活性和ICP显著升高(P＜0.05);且其海绵体平滑肌及海绵窦内皮细胞含量明显提高.结论 MT可通过改善组织中氧化应激水平,促进阴茎海绵体平滑肌和内皮组织修复,提高勃起功能;抗氧化治疗可能为糖尿病性勃起功能障碍的防治提供新的策略.     

阴茎勃起功能障碍患者与正常人群的阴茎形态学比较

目的:拟明确阴茎勃起功能障碍患者与正常人群的阴茎长度与周径有无差异。方法:测量80例阴茎勃起功能障碍患者与87例正常男性疲软状态和海绵体注射诱导阴茎勃起时的阴茎长度与周径。结果:80例阴茎勃起功能障碍患者疲软状态阴茎长度与周径分别为(7.55±0.77)cm、(8.74±0.86)cm,于海绵体注射诱导阴茎勃起时长度与周径分别为(10.97±1.21)cm、(10.58±1.05)cm;87例正常男性疲软状态时阴茎长度与周径分别为(8.08±0.80)cm、(8.03±0.80)cm,阴茎勃起状态下分别为(10.46±0.91)cm、(10.18±1.26)cm。本次实验人群中疲软状态时阴茎长度与周径分别为(7.83±0.78)cm、(8.37±0.83)cm,而勃起状态时则分别为(10.70±1.06)cm、(10.37±1.16)cm,阴茎勃起功能障碍患者与正常人群的阴茎长度与周径差异无统计学意义。结论:阴茎勃起功能障碍患者尚未发现阴茎长度与周径的改变。     

雄激素与勃起功能障碍

雄激素对维持性欲是必不可少的,它通过中枢和外周两个层面,以多种机制控制着阴茎勃起的启动、维持和终结.雄激素缺乏不但导致性欲减退,还可造成阴茎的组织结构损害及勃起相关活性物质发生明显改变,如阴茎海绵体平滑肌含量减少、结缔组织增多及白膜下脂肪细胞沉积等.阴茎勃起时,海绵体组织的上述改变可致静脉闭塞不全而发生静脉漏,出现勃起功能障碍(ED).对性腺功能减退的ED患者补充睾酮可收到良好的治疗效果.睾酮替代治疗期间需密切观察,避免不良反应的发生.     

中电导型钙依赖钾通道在糖尿病大鼠阴茎海绵体中的表达及意义

目的 探讨糖尿病对大鼠阴茎海绵体中电导钙激活性钾通道蛋白(IKCa)表达的影响以及意义.方法 选用SD雄性大鼠35只,随机选择25只用于制作糖尿病动物模型,剩余10只用于空白对照.造模成功后饲养8周,注射阿朴吗啡(APO),观察大鼠阴茎勃起,同时采用逆转录-聚合酶链反应(RT-PCR)和Western blot技术检测IKCa mRNA和蛋白在大鼠海绵体的表达.结果 DM组大鼠阴茎勃起和IKCa mRNA及蛋白表达均显著低于STZ组和NDM组(P<0.05),STZ组和NDM组之间大鼠阴茎勃起情况和IKCa mRNA及蛋白表达无统计学意义(P>0.05).绪论糖尿病可降低大鼠阴茎勃起功能,IKCa在糖尿病大鼠海绵体表达明显降低.糖尿病对大鼠阴茎勃起功能的影响与阴茎海绵体IKCa表达减少密切相关.     

香烟烟雾对雄性大鼠性功能影响的实验研究

目的:研究香烟烟雾对雄性大鼠性功能的影响。方法:30只SD雄性大鼠随机均分为两组,吸烟组制备大鼠吸烟模型,使用市售红金龙过滤咀香烟(每支焦油含量13mg),吸烟组每日使其被动吸烟4次,每次两支,每次30min持续60d;对照组正常饲养。实验结束前1周两组动物笼中分别放入5只雌性大鼠,采用24h监控录像监测观察骑跨动作1周,60d后处死取标本。测定大鼠血中睾酮水平及阴茎海绵体组织一氧化氮合酶(NOS)的活性,行阴茎海绵体组织的Masson染色图像分析。结果:吸烟组大鼠骑跨动作次数减少,血中睾酮水平明显降低(P<0.05),阴茎海绵体组织NOS活性及平滑肌面积显著降低(P<0.05),胶原纤维明显增加,海绵窦血管腔有明显变化。结论:吸烟组大鼠阴茎勃起功能受到明显影响,睾酮水平降低及阴茎海绵体组织NOS活性降低、阴茎海绵体平滑肌面积的减少可能是其重要的发病机制。     

负压勃起装置治疗前列腺癌根治术后的勃起功能障碍

目的:探讨负压勃起装置(VED)治疗前列腺癌根治术(RP)后勃起功能障碍(ED)的有效性和安全性。方法:开放性RP术后ED患者6例,3例于术后3个月内(A组),3例于术后12个月以上(B组)分别进行VED康复治疗,比较两组在VED治疗前,治疗后3个月和6个月的IIEF-5评分的差异,治疗6个月后的阴茎长度和周径变化的差异。评价VED应用的安全性,以及患者和性伴侣的满意度。结果:6例患者VED治疗后3个月和6个月的IIEF-5平均评分均较治疗前提高(P<0.05)。A组患者VED治疗后3个月IIEF-5评分(8.7±0.6)分,治疗后6个月IIEF-5评分(13.0±1.0)分,均高于B组患者[(6.7±0.6)分;(8.3±1.5)分](P<0.05)。VED治疗后6个月,A组患者阴茎长度缩短(0.4±0.1)cm,周径缩短(0.2±0.1)cm,B组患者阴茎长度缩短(1.7±0.4)cm,周径缩短(0.9±0.3)cm,两组相比均有显著差异(P<0.05)。VED治疗后6个月的患者及性伴侣性生活满意率分别为83.3%和50.0%。VED治疗期间,1例患者诉阴茎皮肤发暗,2例诉性交僵硬麻木感,其余无明显不良反应。结论:RP术后ED患者早期进行VED康复治疗,能显著改善勃起功能,减少阴茎萎缩。     

Assessment of penile blood flow by duplex ultrasonography in 44 men with normal erectile potency in different phases of erection.

Duplex ultrasonography is important in the diagnosis of vasculogenic erectile dysfunction. We measured the ultrasonographic parameters of cavernous blood flow in different phases of penile erection. We examined 44 volunteers with normal erectile potency. Doppler spectra of the cavernous artery were obtained in a time-dependent manner after intracavernous administration of papaverine. Following intracavernous pharmacological stimulation, the Doppler spectrum alters according to a specific pattern indicating the different hemodynamic phases of erection. Peak flow velocity and acceleration time, measured in the early post-injection phase, may be used to grade arterial inflow. The difference between resistance index in the pre-injection and late post-injection phases may be used to estimate veno-occlusive function. References values are defined.     

Sildenafil citrate vs intracavernous alprostadil for patients with arteriogenic erectile dysfunction: a randomised placebo controlled study

We compared the effectiveness of sildenafil citrate and alprostadil in improving arterial penile inflow (peak systolic velocity (PSV)) and penile rigidity in 55 patients with erectile dysfunction caused by atherosclerosis. A total of 35 patients with pure vasculogenic impotency were randomly assigned to alprostadil (Av group; n=11), sildenafil (Sv group; n=12), or placebo (P group; n=12), and 20 patients with nonvasculogenic impotency were randomly assigned to alprostadil (A group; n=10) or Sildenafil (S group; n=10): Av and A used alprostadil injection (capable of giving a full erection) once a week for 1 month, Sv and S took daily oral sildenafil (25 mg) for 1 month, and P took daily oral placebo for one month. The PSV was measured with Duplex sonography and penile rigidity was assessed using the IIEF-15 questionnaire, both of which were administered before and after treatment. Although both treatments improved penile rigidity, they increased PSV only in the Av and Sv groups. Our results suggest that alprostadil and oral therapy should be the starting therapy in men with vasculogenic impotency, whereas alprostadil should be avoided as the first-line approach in men with nonvasculogenic impotency.     

New concept parameters of RigiScan in differentiation of vascular erectile dysfunction: Is it a useful test?

BACKGROUND: The aim of this study is to investigate the value of new nocturnal penile tumescence recording parameters, such as tumescence activity unit and rigidity activity unit values, total erection number and erection times, in differentiating between psychogenic erectile dysfunction and organic erectile dysfunction. We also aimed to determine the role of these parameters in differentiating arterial erectile dysfunction from veno-occlusive dysfunction. METHODS: Eighty-seven consecutive patients were allocated into three groups as psychogenic, arterial and venous erectile dysfunction after investigations. Nocturnal penile tumescence recording parameters between psychogenic and vascular erectile dysfunction and arterial and veno-occlusive dysfunction were compared. Mann-Whitney U-test, Pearson's chi2 test and correlation coefficient tests were used for statistical analysis. RESULTS: Depending on intracavernous injection, penile Doppler ultrasonography and cavernosometry tests, 37 patients (43%) had psychogenic impotence while 50 (57%) had organic pathologies. Of the 50 patients diagnosed with vascular impotence, 29 (48%) had arterial failure and 21 (42%) had veno-occlusive dysfunction. Nocturnal penile tumescence recording revealed psychogenic erectile dysfunction in 34 patients (39%) and vascular erectile dysfunction in 53 patients (61%). Nocturnal penile tumescence recording has been regarded as the gold standard and, in our series, it showed 90.6% sensitivity and 88.2% specificity in differentiating the cause of erectile dysfunction. Values of rigidity activity unit and tumescence activity unit were significantly higher in patients with psychogenic impotence (P < 0.001), when compared with vascular impotence. In patients with a vascular cause, no difference was found between arterial failure and veno-occlusive dysfunction with regard to tip tumescence activity unit, base tumescence activity unit, tip rigidity activity unit, base rigidity activity unit and erection time (P > 0.001). However, patients with arterial failure had less erection than patients with veno-occlusive dysfunction (P < 0.001). CONCLUSION: New recording parameters of nocturnal penile tumescence can differentiate organic and psychogenic erectile dysfunction more precisely. However, these recording parameters cannot distinguish subgroups with a vascular cause of erectile dysfunction.     

The effect of topically applied vasoactive agents and testosterone versus testosterone in the treatment of erectile dysfunction in aged men with low sexual interest.

The objective was to evaluate the efficacy and safety of topically applied cream containing testosterone, isosorbide dinitrate and co-dergocrine mesylate compared to testosterone cream in the treatment of erectile dysfunction in aged men with low sexual interest. A randomised double-blind crossover trial was performed over two months. The subjects were 42 men with erectile dysfunction and low normal or slightly depressed testosterone level randomly allocated to two equal groups. Polypharmacy cream containing testosterone 0.8%, isosorbide dinitrate 0.5% and co-dergocrine mesylate 0.06% was applied for one month, and testosterone 0.8% cream for another month. The serum level of total testosterone was measured before and after each phase of treatment. Response to each therapy was assessed by a sexual questionnaire, measurement of tumescence and repeat penile duplex ultrasonography. Twenty-eight patients reported full erection and satisfactory intercourse with the polypharmacy cream. Thirteen men reported full erection and satisfactory intercourse with either cream. Polypharmacy cream increased penile arterial flow (P<0.001) and induced tumescence in 34 patients in lab. No patient in either phase of the study has tumescence or a significant increase in cavernous arterial peak systolic velocities after the application of testosterone cream. Serum level of total testosterone increased in all patients (P<0.05). Sexual desire was improved in 85% and 62% of patients during the treatment with polypharmacy cream and testosterone cream, respectively. No marked side effects were reported after either of them. Topical treatment with cream containing testosterone and vasoactive agents may represent a new effective treatment for erectile dysfunction associating with aging.     

Effect of incision and saphenous vein grafting for Peyronie's disease on penile length and sexual satisfaction

PURPOSE: We determined the effect of incision and saphenous vein grafting on penile length, erectile function and overall sexual satisfaction in men with Peyronie's disease. MATERIALS AND METHODS: A total of 24 consecutive men underwent plaque incision and saphenous vein grafting with postoperative daily use of a vacuum erection device. Erect penile length, pain, curvature and erectile function were assessed before and after surgery, and overall sexual satisfaction was scored from 1 to 5 by a validated instrument. RESULTS: Of the 22 patients in whom adequate followup data were available mean penile length was increased 2.1 cm. as a result of surgery (p <0.001). Median score of overall satisfaction with sex life was 4 or moderately satisfied. Of the 86% of men who achieved sexual intercourse after surgery 54% used no erectile aids and 32% required sildenafil or intracavernous injection. Complete erectile dysfunction was present in 14% of cases. Patients who reported erectile difficulty preoperatively were significantly more likely to have erectile dysfunction postoperatively that required erectile aids. Arterial insufficiency on duplex Doppler ultrasound was associated with a higher likelihood of complete erectile dysfunction. Complications in 33% of patients included complete erectile dysfunction in 3 and significant persistent penile curvature in 1. CONCLUSIONS: Incision and venous grafting of plaque leads to statistically and clinically significant increases in penile length in men with Peyronie's disease. Preoperative erectile dysfunction and cavernous arterial insufficiency were associated with a higher risk of postoperative erectile dysfunction. Nevertheless, patients reported a high degree of satisfaction with their overall sex life.     

Functional evaluation of penile hemodynamics

A multidisciplinary study was performed on 200 consecutive patients with erectile dysfunction more than 1 year in duration, which included a standardized intracavernous injection of a vasoactive substance mixture (15 mg. per ml. papaverine plus 0.5 mg. per ml. phentolamine). The multidisciplinary findings correlated well with the intracavernous dose needed for full erection. The group without pathological hemodynamic findings (36 patients) needed an average of 0.67 ml. and the group with pathological inflow (107) needed an average of 1.07 ml. In the venous insufficiency group (57 patients) only 18 achieved full erections with an average of 2.1 ml. (39 achieved tumescence only to 3 ml.). The results show that standardized intracavernous injection of a vasoactive substance mixture is a useful method to evaluate penile hemodynamics. This pharmacological test appears to be effective in the differential diagnosis of nonvascular and vascular erectile dysfunction.     

Effect of phentolamine on venous return in human erection

A group of 25 patients underwent Doppler penile blood examination and cavernometry before and after 5 mg of phentolamine injected intracavernously. The organic or psychogenic nature of impotence was determined by psychological testing, the intracavernous injection of papaverine, hormonal evaluation, neurological examination, Doppler penile blood flow measurement and cavernometry for vascular investigations. The intracavernous injection of phentolamine had no effect on the venous return and it provoked penile arterial dilatation. The erectile angle, which was also measured, was less evident than after the injection of papaverine. The results confirmed the fact that an increase in arterial inflow alone is not sufficient to induce a rigid erection in man.     

症状性良性前列腺增生患者的性功能调查

目的:调查伴有下尿路症状(LUTS)的良性前列腺增生(BPH)患者治疗前性功能障碍的程度,并分析性功能障碍与LUTS、年龄的相关性。方法:88例具有典型LUTS的BPH患者,年龄49~86(67.90±7.59)岁。所有患者均进行了国际前列腺症状评分(IPSS)、勃起功能障碍国际问卷-5(IIEF-5)、简明性功能问卷(BSFI)调查,并同时检测尿流率、前列腺总体积和血清睾酮。应用多元逐步回归分析方法和一元相关回归分析评价各检测变量间的相关性。结果:本组患者IPSS评分2~33(18.4±7.79)分。IIEF-5评分1~25(8.50±8.98)分,其中勃起功能障碍(ED)患者76例(86.36%)。BSFI中性欲部分评分0~8(1.92±2.21)分,其中性欲低下患者65例(72.86%);勃起功能部分评分0~16(4.18±4.96)分,其中ED患者70例(79.55%);射精部分评分0~8(2.55±3.57)分,其中射精障碍患者60例(68.18%);问题部分评分0~12(10.44±3.57)分;满意度部分评分0~4(1.90±1.37)分。统计学分析表明:年龄只与BSFI中勃起功能有显著的相关性(γ=-0.552,P=0.000),同样IIEF-5与年龄有显著的相关性(γ=-0.567,P=0.000),IPSS评分与年龄有显著的相关性(γ=0.213,P=0.047)。IPSS评分与BSFI中勃起功能和满意度有显著的相关性(γ=-0.332,P=0.002;γ=-0.302,P=0.005)。IIEF-5与BSFI中性欲、勃起功能和射精部分评分具有一致的相关性(P<0.05)。血清睾酮与年龄、IIEF-5和BSFI评分间无明显相关性(P>0.05),同样最大尿流率和前列腺总体积与IPSS、IIEF-5和BSFI评分间无明显相关性(P>0.05)。结论:年龄和LUTS是性功能障碍的危险因素,LUTS的严重程度与性功能障碍的发展密切相关。     

Nocturnal penile tumescence activity unchanged after long-term intracavernous injection therapy

PURPOSE: Anecdotal evidence suggests that some men have restored erectile function after long-term intracavernous injection therapy for erectile dysfunction. We objectively assessed this phenomenon using nocturnal penile tumescence testing. MATERIALS AND METHODS: In our retrospective study 19 men with a mean age of 53.5 years who had organic erectile dysfunction underwent nocturnal penile tumescence testing before and after prostaglandin E1 based intracavernous injection at least 6 months in duration. The nocturnal penile tumescence parameters measured included the number of erectile episodes, base and tip tumescence, and percent of time with rigidity greater than 70% at the penile base and tip. A 5-item questionnaire was given to all patients after the intracavernous injection period to assess subjective changes in erectile quality. RESULTS: Mean time on intracavernous injection was 2.42 years and mean injection frequency was 3.74 times monthly. Prostaglandin E1 only, and combined prostaglandin E1, phentolamine and papaverine were used in 7 and 9 cases, respectively. Nine patients believed that unaided erection improved after intracavernous injection and 6 achieved intercourse without injection who were unable to do so before injection. No statistically significant changes were noted in any of the 5 objectively measured nocturnal penile tumescence parameters. CONCLUSIONS: Long-term prostaglandin E1 based intracavernous injection may provide subjective improvement in erectile function in some men. However, as measured by nocturnal penile tumescence testing, no objective improvement in spontaneous erectile function occurs.