Research progress on erectile dysfunction following brachytherapy for prostate cancer

前列腺癌近距离治疗与前列腺癌根治行切除术都能对早期前列腺癌患者起到根治的疗效,但前者发生勃起功能障碍的发生率较低.勃起功能障碍(ED)的定义为持续或反复不能达到并维持阴茎勃起状态而影响性生活,常使用国际勃起功能评分.其发生的原因可分为血管源性及非血管源性.前列腺癌近距离治疗后勃起功能障碍的治疗,是药物治疗、物理治疗及心理咨询相结合的综合性治疗.5型磷酸二酯酶抑制剂( PDE5)抑制剂和前列地尔是目前治疗前列腺近距离治疗后ED的一线用药.     

勃起功能障碍基因治疗研究进展

ED发病率较高，现有多种治疗手段存在诸多弊端，分子生物学技术的应用使ED基因治疗初显成效。本文综述了在腺病毒、腺相关病毒、逆转录病毒载体与非病毒载体等介导下，转导一氧化氮合酶基因、血管内皮细胞生长因子基因、反义核酸基因、maxi-k+基因、Ca2+通道相关调节基因、降钙素基因相关肽基因、SOD基因等治疗ED的研究进展。     

心理疏导疗法治疗勃起功能障碍临床研究

勃起功能障碍(Erectile Dysfunction,ED)是成年男性常见多发病,据统计在40～70岁男子中有52%患有不同程度的ED[1],20世纪70年代前后,美国著名性学家Masters和Johnson倡导和运用性感集中训练治疗本病,达到了35%～80% 的治疗效果,证明心理治疗是一种治疗勃起功能障碍的有效方法.后来,Kaplan在继承了前人工作的基础上,把精神分析和行为治疗有机地结合起来,创立"新性治疗法"(又名心理分析倾向的性治疗),开创了性功能障碍治疗的新局面[2].研究和运用有中国特色的心理治疗方法治疗中国人的勃起功能障碍具有更大的现实意义和迫切性.2002年7月～2003年1月,笔者在导师指导下,运用心理疏导疗法治疗勃起功能障碍,临床疗效满意,现将结果报道如下.     

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。     

频繁的性行为可免于勃起功能障碍

据美国BIOCOMPARE科技新闻网（200S／7／10）报道，发表在7月号的《美国医学协会期刊》（The American Journal of Medicine）中的一份芬兰的研究发现，不行使勃起功能的男性会失去这个功能。     

一氧化氮合酶与阴茎勃起功能障碍相关研究进展

勃起功能障(erectile dysfunctio,ED)是指阴茎不能达到和(或)维持足够的勃起以完成满意的性交,且病程至少持续6个月以上[1].     

前列腺手术与勃起功能障碍的研究概况

前列腺手术后常常导致患者不同程度的勃起功能障碍,长期以来该并发症不仅影响患者的生活质量,同时也一直困绕着临床医生。如何避免或减少前列腺手术后勃起功能障碍的发生一直是男科学领域探讨的热点。本文从形态学角度论述了前列腺及其周边结构、前列腺增生手术与勃起功能障碍、前列腺癌手术与勃起功能障碍之间的关系,旨在为临床手术方式的选择提供参考。     

糖尿病性勃起功能障碍大鼠模型的建立

目的探讨理想糖尿病性勃起功能障碍(ED)大鼠模型的制备方法。方法90只SD大鼠,随机分为Ⅰ、Ⅱ、Ⅲ组,每组再分为正常组(CN)和糖尿病组(DM),每组各15只,糖尿病组腹腔注射链脲佐菌素(STZ,65 mg/kg)诱导糖尿病大鼠模型,成模8、12及16周注射阿朴吗啡(APO,80μg/kg)观察大鼠阴茎勃起情况,制备糖尿病性ED大鼠模型。结果DM组在8、12、16周注射阿朴吗啡后勃起次数分别为1.0±0.0、1.0±0.0、1.0±0.0,勃起率分别为33.3%、21.4%、14.3%,ED发生率分别为66.7%、78.6%、85.7%,CN组勃起次数分别为2.2±0.8、2.3±0.8、2.0±0.7,勃起率均为100%,ED发生率为0。组间差异有统计学意义(P0.01)。结论采用STZ 65 mg/kg腹腔注射建立糖尿病大鼠模型方法安全有效,颈部皮下注射APO 80μg/kg筛选糖尿病ED大鼠可行可靠。     

神经电生理检测对勃起功能障碍的诊断价值

勃起功能障碍(ED)是男性常见疾病，指持续性的不能达到或不能维持充分的勃起以获得满意性生活的状态，发病时间至少长于6个月。阴茎背神经体感诱发电位(DNSEP)和球海绵体肌反射(BCR)对评价骶神经或骶丛损伤和性功能障碍有一定的临床意义，但国内相关报道较少。本文对不明原因ED患者的DNSEP和BCR检测结果进行分析，以探讨神经电生理检测在ED病因诊断中的应用价值。     

男性勃起功能障碍患者体内生殖激素水平分析

目的：探讨男性勃起功能障碍（ED）患者生殖激素水平的改变和相互间关系。方法：应用化学发光免疫分析测定患者血清生殖激素（LH、FSH、T、P、E2和PRL）水平。结果：ED患者体内的LH、FSH、PRL、E2水平明显高于正常对照组（P〈0．01），T水平有显著降低（P〈0．01），P水平在两者间变化不明显。结论：睾丸存在病变可能是大多数ED患者的主病因。ED患者存在下丘脑-垂体-性腺轴功能紊乱。生殖激素检测在男性性功能评价上有着十分重要的意义，尤其是对ED患者病因诊断和治疗。     

A Randomized,Double-Blind,Placebo-Controlled Crossover Study of Cappra? for the Treatment of Mild or Mild to Moderate Erectile Dysfunction in Thai Male

Erectile dysfunction (ED) is one of the major health concerns affects the quality of life among Thai male. The treatment of ED by the first-line drugs is limited to a certain group of patients due to their side effects and costs. Alternative medicine can be beneficial for the treatment of ED. This is a randomized, double-blind, placebo-controlled, crossover study aimed to assess the efficacy and safety of Cappra^®, a traditional herbal medicine which was used in Thailand for decades, for the treatment of mild and mild to moderate ED in Thai patients. A total of 63 patients with mild or mild to moderate ED were randomized to receive Cappra^® or placebo for two weeks in the first period, followed by one week washout period. The patients were switched to the alternative treatment in the second period. The efficacy was assessed by the International Index of Erectile Function (IIEF) questionnaire and adverse events. Sixty one patients completed the study. There was an improvement of IIEF score for all domains in Cappra^® group compared with placebo group. The mean change of IIEF score from baseline for erectile function domain of Cappra^® was significantly higher than placebo (4.87 vs 3.44, p = 0.032). The most common adverse events were dizziness (13.3% Cappra^®, 9.6% placebo), face numbness (1.6% Cappra^®, 0% placebo), and tachycardia (1.6% Cappra^®, 0% placebo). The results from this study demonstrated that Cappra^® is effective and well-tolerated and can be used as alternative therapy for mild and mild to moderate ED.     

单纯治疗慢性前列腺炎对其合并ED的影响

目的探讨单纯治疗慢性前列腺炎对其合并阴茎勃起功能障碍(ED)的影响。方法选择415例前列腺炎继发ED的患者进行单纯针对前列腺炎的治疗,通过前列腺炎症状评分(NIH-CPSI)、前列腺液常规评价前列腺炎的治疗效果,采用国际勃起功能评分问卷(IIEF-5)评分评价ED的治疗效果。结果慢性前列腺炎经综合治疗2个月后,患者的NIH-CPSI评分及前列腺液白细胞计数均显著降低(P0.05)。前列腺炎治愈或好转后,IIEF-5评分显著增加,部分患者勃起恢复正常,中、重度ED患者显著减少,性欲下降患者明显减少,少数有射精障碍的患者得到改善。其差异均具有显著性(P0.05)。结论单纯治疗慢性前列腺炎可使大部分患者并发的ED明显改善,而对少数前列腺炎好转后ED症状改善不明显者,可联合应用PDE5i等药物治疗。     

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.     

改良阴茎海绵体压力测定方法在建立糖尿病性ED大鼠模型中的应用研究

目的　评价改良阴茎海绵体压力（intracavernous pressure, ICP）测定方法在建立糖尿病性勃起功能障碍（erectile dysfunction, ED）大鼠模型中的应用。 方法　将40只8周龄雄性SD大鼠随机分为糖尿病组及正常对照组,检测大鼠ICP及颈动脉压力（arterial pressure, AP）,改良法采用带倒刺的穿刺针刺入阴茎脚。 结果　在糖尿病组及正常对照组中,与传统方法比较,采用改良阴茎海绵体压力测定方法所测的ICP与AP结果均无统计学意义（P ＞ 0.05）,但改良法穿刺针不易脱出,保证了实验顺利进行,成功率大大提高（传统法成功率75%,改良法100%）。 结论　改良的带倒刺的穿刺针刺入阴茎脚测定大鼠阴茎海绵体压力具有稳定、准确、方便和不易脱出的特点,对筛选糖尿病性ED大鼠动物模型、评价大鼠阴茎勃起功能具有重要意义。     

氧化应激与诱导性一氧化氮合酶在糖尿病性阴茎勃起功能障碍中的作用

目的:探讨氧化应激与诱导性一氧化氮合酶(iNOS)在糖尿病性阳茎勃起功能障碍(ED)中的可能作用。方法:注射链脲佐菌素建立糖尿病大鼠模型,分别在注射8周和12周后观察阴茎勃起次数、取大鼠阴茎和血浆,测定血清丙二醛(MDA)水平、总抗氧化能力(T-AOC)、一氧化氮合酶(NOS)和iNOS活力以及用免疫组织化学ABC方法检测阴茎iNOS的表达。结果:糖尿病大鼠的阴茎勃起次数明显低于对照组,并随病程延长降低;糖尿病大鼠血清MDA、iNOS水平明显高于对照组;糖尿病大鼠T-AOC水平明显低于对照组;与对照组比较,糖尿病组阴茎内iNOS阳性细胞数和平均光密度值随病程延长而升高。结论:糖尿病性阴茎勃起功能障碍与氧化应激水平、血清iNOS活性以及阴茎iNOS的表达升高相关。     

Complementary and alternative medicine (CAM) for sexual dysfunction and erectile dysfunction in older men and women: an overview of systematic reviews

Older patients with sexual dysfunction (SD) and/or erectile dysfunction (ED) often use complementary and alternative medicine (CAM). The aim of this overview of systematic reviews is to critically evaluate the evidence for or against the effectiveness of CAM. Six electronic databases were searched to identify all relevant systematic reviews (SRs). Their methodological quality was assessed independently by two reviewers using the Oxman score. Four SRs met our inclusion criteria. They evaluated: acupuncture, ginseng, maca and yohimbine. The methodological quality of all of the SRs was good. However, the primary studies were often associated with considerable risk of bias. Cautiously positive conclusions were drawn for yohimbine and ginseng as treatment options for ED. For acupuncture and maca the evidence was insufficient for ED and SD respectively. It is concluded that there is some encouraging evidence but more and better studies are required to establish the value of CAM for SD and ED.     

糖尿病大鼠阴茎的氧化应激与阴茎勃起功能障碍的关系

目的 探讨氧化应激在糖尿病性阴茎勃起功能障碍（ED）中的作用。 方法 注射链脲佐菌素建立糖尿病大鼠模型,分别在注射8周和12周后观察阴茎勃起次数;取大鼠阴茎,测定阴茎丙二醛水平、总抗氧化能力,免疫印迹法检测阴茎核因子E2相关因子2(Nrf2)蛋白量的变化。 结果 糖尿病大鼠的阴茎勃起次数明显低于对照组,并随病程延长降低;糖尿病大鼠阴茎丙二醛水平明显高于对照组,总抗氧化能力水平明显低于对照组;与对照组比较,糖尿病组大鼠阴茎内Nrf2蛋白量随病程延长而降低。 结论 糖尿病性阴茎勃起功能障碍与阴茎氧化应激水平升高相关。     

Asymmetrical dimethylarginine and severity of erectile dysfunction and their impact on cardiovascular events in patients with acute coronary syndrome

Introduction

Coronary artery disease (CAD) and vascular erectile dysfunction (ED) are related to endothelial dysfunction. Elevated asymmetrical dimethylarginine (ADMA) levels and ED are common in patients with increased cardiovascular risk. Our aim was to investigate whether ADMA has a predictive role for major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS). The secondary aim of this study was to investigate whether severity of ED predicts MACE in these patients.

Material and methods

Follow-up data were available for severity of ED in 71 patients with ACS. Plasma ADMA levels were determined by ELISA in 57 patients. Erectile dysfunction was assessed by the International Index of Erectile Function-6 (IIEF-6) score. Major adverse cardiovascular events (reinfarction, all-cause hospitalisation, stroke and all-cause death) was evaluated after a median of 10 months.

Results

Severe ED had no significantly increased hazard ratio for cardiovascular events compared with mild, mild to moderate, and moderate ED (0.259 [95% CI 0.041–1.6], p = 0.147; 0.605 [95% CI 0.095–3.8], p = 0.594; 0.980 [95% CI 0.233–4.1], p = 0.978; and 0.473 [95% CI 0.052–1.3], p = 0.508). The patients who had ADMA levels ≥ 0.32 µmol/l had no significantly increased hazard ratio for cardiovascular events compared with patients who had ADMA levels < 0.32 µmol/l (2.018 [95% CI 0.615–6.6], p = 0.247).

Conclusions

Severity of ED and ADMA did not increase the risk of cardiovascular events in follow-up patients with ACS in our study. Larger prospective studies are necessary to evaluate whether ADMA predicts cardiovascular events in patients with ACS.