The incidence and causes of erectile dysfunction after pelvic fractures associated with posterior urethral disruption

PURPOSE: Erectile dysfunction is a common sequel of pelvic fractures, particularly those associated with posterior urethral injury when it can be neurogenic or arteriogenic due to damage to the cavernous nerves or branches of the pudendal arteries. We studied erectile function of patients with posterior urethral injuries due to pelvic fractures. MATERIALS AND METHODS: Patients referred for posterior urethral reconstruction and strictures due to pelvic fractures were evaluated before reconstruction. All patients underwent nocturnal penile tumescence testing, and if those results were abnormal, penile duplex ultrasound with intracavernous injection was performed. Patients with normal vascular function on duplex ultrasound were diagnosed with neurogenic erectile dysfunction. Those patients with abnormal arterial function on duplex ultrasound underwent arteriography to further define the extent and location of arterial damage. RESULTS: The study included 25 consecutive patients with posterior urethral strictures and a mean age of 28.6 years. Of the patients 18 (72%) had erectile dysfunction as demonstrated by nocturnal penile tumescence and all underwent penile duplex ultrasound. Ultrasound confirmed normal vascular response in 13 of the 18 patients and they were diagnosed with probable neurogenic erectile dysfunction. The remaining 5 patients (28%) with erectile dysfunction had an abnormal arterial response, and significant arterial pathology was confirmed by arteriography. CONCLUSIONS: Erectile dysfunction is common in patients with pelvic fractures associated with urethral injury. We believe that erectile function should be assessed and documented in such patients before attempting urethroplasty. In the majority of these patients erectile dysfunction is caused by disruption of the cavernous nerves with sparing of arterial inflow.     

The treatment of erectile dysfunction in patients with neurogenic disease

Erectile dysfunction (ED) related to compromise of the nervous system is an increasingly common occurrence. This may be due to the multifactorial nature of ED, the myriad of disorders affecting the neurotransmission of erectogenic signals, and improved awareness and diagnosis of ED. Nevertheless, neurogenic ED remains poorly understood and characterized. Disease related factors such as depression, decreased physical and mental function, the burden of chronic illness, and loss of independence may preclude sexual intimacy and lead to ED as well. The amount of data regarding treatment options in subpopulations of differing neurologic disorders remains scarce except for men with spinal cord injury. The treatment options including phosphodiesterase inhibitors, intracavernosal or intraurethral vasoactive agents, vacuum erection devices (VED) and penile prosthetic implantation remain constant. This review discusses the options in specific neurologic conditions, and briefly provides insight into new and future developments that may reshape the management of neurogenic ED.     

血管性勃起功能障碍病人阴茎血流动力学的变化

目的分析血管性勃起功能障碍(ED)病人阴茎血流动力学的变化,提高对该病的诊断和治疗水平.方法对52例血管性ED病人分别采取海绵体内注射试验和阴茎彩色双功能超声等检查,分析其血流动力学变化.结果52例血管性ED(动脉性ED 14例,静脉性ED 26例,混合血管性ED 12例)病人在阴茎勃起的充盈、勃起、充分勃起和强直勃起期均有明显不同的血流动力学变化,表现为充盈、勃起期延长,充分勃起和强直勃起减少等.结论血管性ED会发生明显的阴茎血流动力学变化,了解该变化有助于其正确诊断和采取适当的治疗方法.     

糖尿病性勃起功能障碍相关因素分析

目的 研究糖尿病性勃起功能障碍(ED)的发病情况及其影响ED程度的相关因素。 方法 调查90例男性2型糖尿病病人的性功能状态、年龄、糖尿病病程、测量血压,同时测定其糖化血红蛋白(HbA1C)血脂等指标。结果 糖尿病病人中ED患病率为75.6%(68/90),患病率随年龄的增加而增加,在非ED组与不同程度ED组之间,年龄存在非常显著差异(P<0.01),DM病程、HbA1C存在显著差异(P<0.05)结论 糖尿病病人ED患病率高,糖尿病性ED的程度随年龄、DM病程、HbA1C的增加而加重,长期良好的血糖控制有助于延缓糖尿病性ED的加重。     

尿道外伤患者勃起功能障碍相关因素的临床研究

目的研究尿道外伤患者勃起功能障碍相关因素。方法对40例外伤所致尿道损伤患者采用IIEF-5量表、夜间阴茎勃起监测、血管活性药物注射下阴茎血流彩超检查并进行统计学分析。结果40例中,11例存在明显勃起障碍,3例有血管病变依据。所有患者受伤前后IIEF-5评分有显著性差异(P<0．05);耻骨联合有分离病人较不分离者在IIEF-5评分变化上幅度更大(P<0．05);两组患者在背深动脉收缩期流速上显示出统计学差异(P<0．05)。后尿道损伤患者在阴茎勃起长度变化、周径变化以及勃起持续时间上较前尿道损伤患者明显变小,且ED概率更高。背深静脉流速>5 cm／s患者的比率在两组人群中有显著性差异(P<0．05)。而静脉流速>5cm／s人群主要集中在30-40岁。结论尿道外伤患者发生勃起功能障碍与损伤部位尤其是耻骨联合分离与否、前后尿道损伤位置、神经受损受伤年龄相关,与心理因素也有一定关系。     

Coronary artery risk factors in patients with erectile dysfunction

PURPOSE: We evaluated the risk factors of coronary artery disease in patients with erectile dysfunction (ED). MATERIALS AND METHODS: A total of 417 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. All patients were also screened for sociodemographic data and risk factors for ischemic heart disease (IHD), including age, smoking, diabetes, hypertension, dyslipidemia and psychological disorders. Patients underwent routine laboratory investigation plus testosterone and prolactin assessment. All patients were referred to a cardiologist for IHD evaluation. RESULTS: Mean age +/- SD was 59.1 +/- 10.3 years. Of the patients 27.3% were younger than 50 years, 37.2% were current or former smokers, and 27.6% had mild, 30% had moderate and 42.4% had severe ED. Of the patients 26.9% had different degrees of IHD, of whom 84.8% were older than 50 years. There was a significant association between age and IHD (p <0.05). There were significant associations between IHD, and the increased severity and progressive course of ED (each p <0.05). Furthermore, higher degrees of IHD were significantly associated with severe ED. Diabetes, hypertension, dyslipidemia and psychological disorders were present in 75.1%, 39.3%, 45.6% and 8.2% of the patients, respectively. Overall 92.1% of the patients with ED had 1 or more coronary artery risk factors. The presence of at least 1 risk factor is significantly associated with ED in patients with IHD (p <0.05). CONCLUSIONS: Coronary artery risk factors are significantly associated with erectile dysfunction. A significant association between higher degrees of IHD and the increased severity of ED was detected.     

脊柱或骨盆损伤后阴茎勃起功能障碍的病因分析

目的 分析脊柱或骨盆损伤后阴茎勃起功能障碍(ED)的可能病因.方法 回顾性分析2005-2009年收治的67例因脊柱或骨盆损伤后ED患者资料.年龄18 ～64岁,平均32岁.伤后时间3～144个月,平均38个月.其中骨盆骨折56例(84％),脊柱外伤11例(16％).患者自诉受伤前性功能正常.患者在未服用或停用PDE-5抑制剂的情况下进行IIEF-5评分、夜间勃起监测(NPT,Rigiscan系统,连续检测3晚)、阴茎彩色多普勒超声(CDU)检查.NPT检测夜间勃起＜3次,每次阴茎头部勃起硬度＜70％,时间＜ 10 min诊断为器质性ED.阴茎Ⅳ度勃起情况下,CDU检查峰收缩期速率(PSV)＜ 25 cm/s诊断为动脉性ED;PSV＞ 25 cm/s,舒张末期速率(EDV) ＞5 cm/s诊断为静脉性ED;排除其他原因的器质性ED诊断为神经性ED.结果 62例患者在6个月内未尝试性生活,5例患者IIEF-5评分5～8分.NPT检测证实62例患者均为器质性ED,其中骨盆骨折患者中神经性ED 24例(43％),动脉性ED 22例(39％),静脉性ED 10例(18％);脊柱外伤患者均为神经性ED.结论 骨盆骨折或脊柱外伤可导致器质性ED.骨盆骨折导致的ED可能合并血管性因素,而脊柱外伤所致ED为神经性.     

Management strategy of vascular injuries associated with pelvic fractures.

To establish the frequency of major vascular trauma, facilitate recognition of potential injury based on fracture pattern, and formulate a systematic approach to evaluation and management, we studied 429 consecutive patients with acute blunt pelvic fracture. Fracture patterns were grouped as non-ring brakes (n = 43), anterior pelvic ring (n = 197), posterior pelvic ring (n = 104), or acetabular (n = 85) involvement. Mean age was 31 (range 2 to 90); 55% were male. Injuries resulted primarily from motor vehicle accidents (31%), pedestrian injuries (26%), and motorcycle accidents (19%). The fracture pattern was correlated with the occurrence of documented vascular injury, modality of management, transfusion greater than or equal to 10 units in the first day, associated injuries, and outcome. Laparotomy was performed in 22 patients (5%), but helpful only if associated visceral injuries were encountered. There were no instances of iliac or femoral vascular injuries. Hemodynamically unstable patients (BP less than 90) with major pelvic fractures and no other documented source of bleeding underwent pelvic angiography. Posterior ring disruption was associated with vascular injury requiring intervention (p less than 0.001). The occurrence of associated injuries (p less than 0.001), need of greater than 10 units of blood transfusion in the first 24 hours (p less than 0.005), and death (p less than 0.01) were consequences of posterior ring disruption. Based on this experience we conclude that: (1) aortoiliac and femoral arterial as well as iliofemoral venous injuries are a very rare consequence of pelvic fracture; (2) pelvic fracture with posterior ring disruption has a higher incidence of vascular injury necessitating intervention, associated injury, major transfusion requirement, and death; (3) early interventional radiology is efficacious in the control of arterial disruption caused by pelvic fracture; and (4) a tailored management strategy using the expertise of the vascular and orthopedic surgeon as well as the radiologist is required for recalcitrant hemorrhage.     

心血管疾病患者并发勃起功能障碍的危险因素分析

目的:调查男性心血管疾病住院患者的勃起功能,探讨心血管疾病中勃起功能障碍(ED)的发生率及其危险因素与勃起功能的关系。方法:自行设计问卷,对西安交通大学第一、第二附属医院心血管内科住院的男性患者进行问卷调查,测量身高、体重、腰围、臀围、血压等数据;收集个人基本信息、既往史(包括吸烟史、饮酒史,高血压、冠心病、心律失常、心绞痛、心肌梗死病史、糖尿病病史等),记录代谢参数检查结果。同时以IIEF-5进行勃起功能评分。采用单变量、多变量Logistic回归分析及比值比(OR)确定ED的危险因素。结果:本研究共纳入有效问卷225份,经统计分析发现在整个调查人群中ED的发病率为66.7%。其中轻度、轻中度、中度、重度ED的发病率分别为15.8%、27.0%、17.6%、6.3%。各组别(18~35岁、36~49岁、50~65岁、65岁)人群ED的发病率分别为13.6%、39.1%、89.2%、91.2%。单变量Logistic回归显示,心血管疾病并发ED的危险因素包括年龄(OR=3.122,95%CI:2.040~4.779)、吸烟(OR=1.768,95%CI:1.209~2.584)、BMI(OR=1.261,95%CI:1.114~1.427)、总胆固醇(OR=1.77,95%CI:1.339~2.34)、TC/HDL(OR=1.715,95%CI:1.349~2.181)、高血压(OR=1.717,95%CI:1.110~2.658)及冠心病(OR=2.235,95%CI:1.169~4.275)。而多变量Logistic回归分析显示,心血管疾病并发ED的危险因素分别为年龄(OR=4.99,95%CI:2.264~10.998)、经济情况(OR=2.804,95%CI:1.127~6.976)、吸烟(OR=2.109,95%CI:1.179~3.772)、BMI(OR=1.414,95%CI:1.136~1.76)和TC/HDL(OR=2.001,95%CI:1.016~3.943)。结论:在我国心血管疾病男性住院患者中ED的发病率很高,并随着年龄的增长而升高。年龄、吸烟、经济情况、BMI、TC/HDL是ED的危险因素,心血管病与ED存在着共同的危险因素,包括年龄、吸烟、BMI、TC/HDL,而经济情况在研究中被证实与ED关系密切,为以后的研究提供了新的思路。     

勃起功能障碍患者阴茎血流检测及心理测评结果分析

目的:对行阴茎海绵体注射血管活性药物试验(ICI)联合阴茎彩色多普勒超声检查(CDDU)的ED患者进行症状自评量表(SCL-90)和艾森克人格问卷(EPQ)评估,分析心理因素对ED患者阴茎供血的影响。方法:选择2018年8～11月在男科门诊就诊的106例ED患者进行研究,患者行ICI联合CDDU检查前进行SCL-90和EPQ评估,将CDDU检查结果分为正常组与异常组,各组患者SCL-90各因子分及总分与全国常模结果进行t检验分析,同时对EPQ评估人格类型在各组的分布差异进行χ~2检验分析。结果:①ICI联合CDDU检查结果异常者64例,正常者42例;CDDU异常组左右侧动脉最大收缩期血流速度(PSV)[(19.39±5.07)、(18.98±4.57) cm/s]较正常组[(30.90±6.83)、(30.74±7.00) cm/s]明显下降(P0.01),左侧动脉舒张末期血流速度(EDV)明显上升[(3.21±2.78) cm/s vs(1.77±2.38)cm/s,P0.01];①与SCL-90全国常模比较,106例行ICI联合CDDU检查的ED患者抑郁[(1.70±0.64)分vs(1.50±0.59)分,P0.01]、焦虑[(1.62±0.56)分vs(1.39±0.43)分,P0.01]、强迫[(1.86±0.61)分vs(1.62±0.58)分,P0.01]、敌对[(1.65±0.66)分vs(1.48±0.56)分,P0.01]、恐怖[(1.33±0.45)分vs(1.23±0.41)分,P=0.02]、精神病性[(1.61±0.55)分vs(1.29±0.41)分,P0.01]因子评分和总分[(1.61±0.48)分vs(1.44±0.48)分,P0.01]明显增高,其中CDDU检查结果正常组焦虑[(1.60±0.53)分,P0.01]、强迫[(1.83±0.63)分,P=0.02]和精神病性[(1.61±0.48)分,P0.01]因子评分明显增高, CDDU检查结果异常组抑郁[(1.73±0.65)分,P0.01]、焦虑[(1.64±0.59)分,P0.01]、强迫[(1.88±0.60)分,P0.01]、敌对[(1.68±0.75)分,P0.01]、恐怖[(1.35±0.44)分,P=0.02]、精神病性[(1.61±0.59)分,P0.01]因子评分和总分[(1.63±0.51)分,P0.01]明显增高;③CDDU检查结果正常组与异常组SCL-90各因子分和总分均不存在显著性差异(P0.05);④EPQ评估的人格类型在CDDU检查结果正常与异常组间分布未见显著性差异(χ~2=1.12,P=0.77)。结论:ED患者人格类型主要为粘液质与抑郁质,且其患病后存在一系列心理问题,包括抑郁、焦虑等,同时阴茎供血不足患者心理问题表现更为严重。     

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture

This study was conducted to determine the preoperative and intraoperative risk factors of ED and the underlying penile vascular abnormalities among patients with penile fracture treated surgically. In all, 180 patients with penile fracture were treated surgically and followed up in one center. None of our patients had ED before the penile trauma and only two of them had risk factors for systemic vascular diseases, such as diabetes mellitus (one patient) and hypertension (one patient). After a mean follow-up of 106 months, 11 patients (6.6%) developed ED, 7 had mild ED and 4 had moderate ED. The main risk factors for subsequent ED were aging, >50 years, and bilateral corporal involvement. Among the 11 patients with ED, color Doppler ultrasonography (CDU) showed normal Doppler indices in 4 (36.4%), veno-occlusive dysfunction in 4 (36.4%) and arterial insufficiency in the remaining 3 (27.2%) patients. CDU assessments from the injured and intact sides were comparable. ED of either a psychological or vascular origin can be encountered as a long-term sequel of surgical treatment of penile fracture. Aging, >50 years, at presentation and bilateral corporal involvement is the main risk factors for subsequent development of ED.     

Prevalence of erectile dysfunction in male stroke patients, and associated co-morbidities and risk factors

BACKGROUND: Sexual problems have been a common finding in chronically ill and physically disabled patients such as those with cerebrovascular accidents. Previous studies have supported the association between stroke and erectile dysfunction (ED). OBJECTIVES: The aim of this study was to investigate the prevalence of ED and its severity in male stroke patients in Qatar and to assess the co-morbidities and risk factors associated with ED. DESIGN: This was a cross-sectional study. SETTING: The study was conducted from January to December 2006 at the Hamad General Hospital, Hamad Medical Corporation (HMC). SUBJECTS: Eight hundred Qatari and non-Qatari patients 35-75 years of age were invited to participate in this study; 605 patients gave their consent, which was a response rate of 75.6%. METHODS: Face-to-face interviews were based on a questionnaire that included socio-demographic factors. The classification of the type of stroke was made according to the criteria of stroke by the World Health Organization (WHO). All patients completed a second questionnaire addressing their general medical history, type of treatment and co-morbidity with other diseases or risk factors. Sexual function was evaluated with the International Index of Erectile Function (IIEF). RESULTS: The mean age of subjects was 56.1 +/- 9.8 years. Approximately 48.3% of the studied population reported some degree of erectile dysfunction. Of the stroke patients with ED, 36% had severe ED, 32.9% had moderate ED and 31.2% had mild ED. More than half of the stroke patients (59.6%) with ED were in the age group 60-75 years. The prevalence of ED increased with increasing age. The co-morbidities and risk factors were significantly more prominent in ED patients than in those without ED for hypercholesterolemia (P < 0.001), diabetes (P = 0.002), and hypertension (P = 0.031). Medication taken for these diseases also had a significant association with ED. CONCLUSIONS: Our study findings revealed a greater prevalence of ED in stroke patients in the population of Qatar. The most important co-morbid factors for ED in stroke patients were diabetes, hypertension and hypercholesterolemia, and the risk factors were smoking and obesity.     

肾移植患者勃起功能障碍的相关因素研究

目的 研究男性肾移植患者术后勃起功能障碍 (ED)的相关影响因素.方法 随机选择25～57岁、术后半年以上、血肌酐133μmol/L以下的已婚男性肾移植受者50例,采用勃起功能国际问卷(IIEF-5)对其肾移植前后勃起功能进行评估,并应用多因素Logistic回归分析,确定对勃起功能有影响的相关因素.结果 肾移植术前有41例(82%)被诊断为不同程度的ED,移植术后26例被确定为ED(52%),术前与术后比较差异有统计学意义(P<0.05).Logistic回归分析表明,年龄、血液透析时间、移植肾动脉吻合方式和以环孢素(CsA)为基础的免疫抑制剂治疗是影响勃起功能的独立和显著因素(P<0.05),相对危险度分别为3.06、2.03、3.93、2.74.结论 成功的肾移植术可改善患者的勃起功能,但仍有着较高的ED发生率,年龄、血液透析时间、术中移植肾动脉吻合方式、以CsA为基础的免疫抑制剂治疗是影响勃起功能的主要因素.     

Prognostic factors for the vascular components of erectile dysfunction in patients on renal replacement therapy

A total of 76 male patients on renal replacement therapy (RRT) were investigated. Erectile dysfunction (ED) was defined as insufficient erection during visual erotic stimulation (VES) or during sleep as measured with Rigiscan and Erectiometer. Data on medical history, physical examination, and laboratory variables were collected. Furthermore, penile pharmacological duplex ultrasonography (PPDU) was performed. Univariate and multivariate logistic regressions were used to determine prognostic values and to develop prognostic models. Independent prognostic factors for ED were the number of cardiovascular events, waist-hip ratio, body mass index, and acceleration time (AT) as measured with PPDU. Independent prognostic factors for an abnormal AT (>100 ms) were number of cardiovascular events, age category, and the presence of carotid bruits. Independent prognostic factors for insufficient veno-occlusion during PPDU were number of cardiovascular events and supine diastolic blood pressure. The vascular contribution to ED in patients on RRT is substantial. Data from medical history, limited physical examination, and PPDU contribute to the prediction of the vascular contribution to ED.     

Dietary factors in erectile dysfunction

The role of dietary factors in erectile dysfunction (ED) has never been addressed. In the present case-control study, we investigated the relation of the Mediterranean diet with ED. A total of 100 men with ED were compared with 100 age-matched men without ED. A scale indicating the degree of adherence to the Mediterranean diet was constructed: the total Mediterranean diet score ranged from 0 (minimal adherence to the Mediterranean diet) to 9 (maximal adherence). The percentage of physical inactivity was greater in the ED group (35 vs 19%, P=0.04), whereas the diet score was lower (4.7+/-0.5 vs 5.4+/-0.5, P<0.01), indicating a reduced adherence to the Mediterranean diet. In analyses adjusted for the prevalence of associated risk factors (hypertension, hypercholesterolemia), body mass index, waist, physical inactivity and total energy intake, the intake of fruits and nuts, and the ratio of monounsaturated lipids to saturated lipids remained the only individual measures associated with ED. In conclusion, the results of the present study show that dietary factors may be important in the development of ED: adoption of healthy diets would hopefully help preventing ED.