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。     

阴茎勃起功能障碍的致病因素及治疗的现状

<正>阴茎勃起功能障碍(ED)是一种较常见的男性疾病,据调查约40%的男性长期或短期承受过ED的苦恼~([1])。阴茎勃起过程涉及神经、内分泌、血管系统、激素水平、心理状态等诸多因素。本文在简介阴茎勃起结构和勃起机制基础上综述了ED的病因及治疗方法的现状。一、阴茎的勃起结构及勃起机制(一)阴茎的勃起结构阴茎的勃起结构是一对阴茎海绵体及一条尿道海绵体。每条海绵体均由致密结缔组织膜(白膜)     

他达拉非治疗ED的概述

勃起功能障碍(ED)是男科常见病、多发病,PDE5抑制剂能竞争性抑制PDE5而抑制cGMP的水解,提高阴茎海绵体平滑肌细胞内cGMP浓度,达到治疗ED的效果。他达拉非可使阴茎海绵体内cGMP水平提高,从而导致勃起。他达拉非可有效改善各种病因和各种程度ED患者的勃起功能;其具有以下特点:有效时间长,安全性高,易于被患者及性伴侣接受,增强性自信、性自尊,性体验更加自然。使患者从生理、心理上最大程度的得到治疗,有效提高性生活质量。因此他达拉非在ED患者的治疗中值得推广。     

通过长期服用西地那非治疗大鼠因阴茎组织纤维化引起的勃起功能障碍

因阴茎组织纤维化引起的勃起功能障碍特点是:血管平滑肌细胞(SMC)凋亡,阴茎海绵体纤维化,海绵体静脉闭塞功能障碍(CVOD)。PDE5抑制剂可通过上调诱生型一氧化氮合酶(NOS2A)来抑制阴茎     

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.     

无创性动态阴茎海绵体测压的临床应用

目的　初步评价应用VISER软件行无创性动态阴茎海绵体测压在阳萎 (ED)诊断中的作用。　方法　采用AquariusXLT型尿动力学仪配置的VISER软件 ,辅助眼镜式影像仪听觉视觉性刺激 (AVSS)或阴茎海绵体内血管活性药物注射 (ICI)进行无创性动态海绵体测压 39例 ,其中ED患者 32例 ,正常对照 7例。　结果　正常对照 7例均可通过AVSS诱发勃起 ;32例ED患者中 ,13例单纯AVSS可诱发勃起 ,占 4 0 % ;19例单纯AVSS无效者 ,给予罂粟碱 10mg海绵体内注射 ,其中 13例出现勃起 ,占 6 8%。结果除ED罂粟碱组勃起平均时间延长外 ,勃起数据和峰值数据中的其他多项指标ED各组均低于对照组 ,尤以勃起和峰值总能量降低明显。　结论　VISER具有精确的动态阴茎海绵体测压功能 ;辅助眼镜式影像仪有助于增强AVSS效果和减少阴茎海绵体血管活性药物注射剂量 ;VISER检查具有无创、准确、便捷等优点 ,有望成为ED诊断的首选方法     

细胞因子治疗勃起功能障碍的研究进展

细胞因子与勃起功能障碍(ED)密切相关。研究发现,4类相关细胞因子和ED发生与治疗有关。促进血管再生的细胞因子可以改善血管内皮功能,促进内皮再生从而改善勃起功能;促进神经再生的细胞因子通过保护海绵体神经改善勃起功能;保护平滑肌功能的细胞因子通过促进平滑肌表达,抑制阴茎纤维化改善勃起功能;炎症相关的细胞因子通过作用于平滑肌上相应受体松弛平滑肌改善勃起功能。与5型磷酸二酯酶(PDE-5)抑制剂相比,细胞因子治疗ED更有针对性。但是,目前的实验模型大多数为大鼠且缺乏大样本的研究,限制了细胞因子进一步应用于临床。所以,虽然血管内皮生长因子(VEGF)、胰岛素样生长因子1(IGF-1)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)等可以显著改善ED动物的勃起功能,但是需要大型动物实验和大样本的实验进一步证实其治疗效果和安全性。     

服用小剂量他达那非对动脉性勃起功能障碍患者临床疗效的观察

目的:观察服用小剂量磷酸二酯酶-5(PDE5)抑制剂他达那非对动脉性勃起功能障碍(ED)患者的疗效。方法:对43例动脉性ED患者采用了疗程为4周的隔日小剂量(5 mg)晚餐后口服他达那非的用药方案,在治疗前后进行IIEF-5评分同时用彩色多普勒超声联合阴茎血管活性药物前列腺素(PGE-1)注射实验,检测阴茎双侧海绵体动脉的收缩期最大流速(PSV)。结果:经统计学分析,IIEF-5评分以及阴茎双侧海绵体动脉的PSV在治疗4周后有显著提高(P<0.05)。结论:口服小剂量他达那非能有效提高动脉性ED患者阴茎海绵体动脉的收缩期最大流速,改善患者的勃起质量。     

勃起功能障碍阴茎血流动力学研究

目的 探讨勃起功能障碍(erectile dysfunction,ED)的病因诊断。方法 130例ED患者通过阴茎海绵体内应用血管活性药物,进行阴茎海绵体血流动力学和海绵体造影检查。观察并记录阴茎一肱动脉血压指数(penile brachial index,PBI)、海绵体内压(intracavermous pressure,ICP)、维持灌流率(maintenance flow rate,MFR),海绵体内压跌差(pressure loss change,PLC)等项指标及阴茎静脉血管形态。结果 130例ED中有39例为静脉漏,其中15例为动脉血供不足伴静脉漏。海绵体造影显示28例为单纯背深静脉漏,其余11例为背深静脉复合阴茎脚静脉漏。结论 阴茎血流动力学检测可作为ED病因诊断的有效方法。     

体外冲击波治疗勃起功能障碍及阴茎硬结症的研究进展

阴茎海绵体血管内皮受损、血管舒缩功能障碍、血流量不足是引起勃起功能障碍(ED)的重要病因。目前对ED的治疗主要应用5-型磷酸二酯酶抑制剂(PDE5I),但对部分ED患者无效。由阴茎硬结病(PD)引起的ED除使用PDE5I,还可采取手术、电疗等物理疗法,但疗效难以保证。近年发现低强度体外冲击波治疗(LI-ESWT)能促进血管再生,提高阴茎海绵体血流量,有望成为治疗ED和PD的一项有效的新方法。     

Erectile dysfunction management for the future

The field of erectile dysfunction (ED) management over time has witnessed assorted interventions to enable men to perform sexual intercourse. In recent times, major progress in ED research has led to increasingly effective treatments based on a refined knowledge of the scientific basis for penile erection. Current concepts suggest that therapeutic prospects on the horizon include novel pharmacotherapies, growth factor therapy, gene therapy, and regenerative medicine. The purpose of this review is to present the foundations for future therapies in ED management.     

生长因子与勃起功能障碍的基因治疗

生长因子具有广泛的生物学作用。勃起功能障碍(ED)的基因治疗是ED治疗的新探索,本文就生长因子,尤其是血管内皮生长因子(VEGF)和胰岛素样生长因子1(IGF-1)在ED基因治疗中的作用和价值作一综述。     

Alcohol consumption and erectile dysfunction: meta-analysis of population-based studies

Alcohol is long regarded as a risk factor for erectile dysfunction (ED), but epidemiological evidence has been equivocal. We aimed to investigate the ED risk associated with various levels of alcohol consumption by meta-analysis. We searched for population-based studies on ED through Medline, PubMed, PsychInfo, and scanned through reference lists. Eleven cross-sectional studies were included and analyzed with random effects model. We reviewed the results from one cross-sectional study and two cohort studies. Regular alcohol consumption was negatively associated with ED (odds ratio (OR)=0.79; 99% confidence interval (CI), 0.67-0.92; P<0.001). Consumption of 8 or more drinks/week significantly reduced the risk of ED (OR=0.85; 99% CI, 0.73-0.99; P=0.007), but consumption of less alcohol (1-7 drinks/week) was not significant (OR=0.73; 99% CI, 0.44, 1.20; P=0.101). Begg's test and Egger's test detected no significant publication bias. Our estimates (in sensitivity analyses) were rendered nonsignificant when International Index of Erectile Function definition was used and when statistical adjustment was made only for age. Meta-analysis of cross-sectional studies yielded a protective association of alcohol on ED, but the two cohort studies did not demonstrate any significant findings for alcohol consumption. More research is needed to confirm whether alcohol is protective or is unrelated to ED development.     

Impact of various questionnaires on the prevalence of erectile dysfunction. The ENIGMA-study

The prevalence estimates of erectile dysfunction (ED) vary considerably across studies. These differences may be attributed to used definitions of ED. Quantitative data on the effect of different definitions of ED on the prevalence are lacking, because precise information on the used definition and questionnaire is often absent. Aim of this study was to quantify the effect of using different questionnaires for ED on the prevalence estimates. In all, 5721 mail surveys on sexual problems and ED were sent to all men (aged >18 y) in 12 general practices in the middle of the Netherlands of which 2117 were completed. The questionnaire contained Enigma (WHO), International Index of Erectile Function (IIEF), Cologne Erectile Inventory (KEED) and one question (Boxmeer, Krimpen). The prevalence of ED based on the various questionnaires and the effect of these questionnaires on risk factor relationships was compared. IIEF gave the highest age specific and overall ED prevalence, KEED the lowest. The difference in prevalence was 16.8%. The agreement (kappa coefficient) between the various ED definitions varied from 0.52 (IIEF & KEED) to 0.95 (Enigma & Boxmeer). The number of risk factor relations were similar for the Dutch studies, reduced for the IIEF and KEED. This study provides evidence that differences in questionnaires to assess ED have a considerable effect on the (age specific) prevalence estimates and little on the risk factor relations. The number of questions of the survey appears not to be responsible for differences in the prevalence of ED and risk factor relations, however they affect the response rate. Uniform use is strongly recommended, since a 'golden standard' for ED assessment (by questionnaire) is lacking. A short questionnaire with one or two questions is recommended for example the one from the Boxmeer-study. These data may be used to adjust (age-specific) prevalence rates comparing ED prevalence in the open population across studies.     

Should patients with erectile dysfunction be evaluated for cardiovascular disease?

The landmark Massachusetts Male Ageing Study shed new light on the prevalence of erectile dysfunction (ED) and drew attention to ED as a disease of ageing. Over the years, ED has been linked to the development of cardiovascular disease (CVD) in some patients. There is clear evidence that ED and CVD share and have a similar risk factor profile. CVD is one of the most recognizable causes of mortality and early detection coupled with prevention of mortality from CVD has been the prime interest of many researchers. Consequently, there has been a multidisciplinary curiosity regarding the proposal to use ED as a marker for future CVD. In fact, there have been several proposals to use ED as a screening tool for future CVD. We performed a comprehensive search of two main databases-PubMed and Cochrane Library using a combination of keywords such as acute myocardial infarction, coronary artery disease (CAD) and ED. Journal articles from January 2000 to June 2011 were reviewed. We included all articles discussing the relationship between ED and CVD in the English language. All the relevant randomized controlled trials, cohort and retrospective studies, and review articles were included in our overall analysis in an attempt to answer the question whether all patients with ED should be clinically evaluated for CVD. The results showed a link between ED and the development of future CVD in some patients, but ED was not shown to be an independent risk predictor that is any better than the traditional Framingham risk factors. Screening for CVD may, however, be rewarding in younger patients with severe ED and in patients with concurrent CVD risk factors.     

Cavernous smooth muscles: innovative potential therapies are promising for an unrevealed clinical diagnosis

While erectile dysfunction (ED) is highly prevalent worldwide, unrevealed cavernous smooth muscles (CSM) defects can confound the diagnosis of vascular ED and lead to failure of treatments. Currently, the first-line oral treatment for ED is phosphodiesterase type 5 inhibitors (PDE5Is). Patients with diabetes mellitus (DM), those who have undergone a radical prostatectomy (RP), and the elderly population are difficult to treat by the PDE5Is; unrevealed CSM defects can result in corporo veno-occlusive dysfunction (CVOD); and penile veno-ligation surgeries are currently abandoned due to high failure rates. It has been found that gene and stem cell therapies, among others, reduce cavernous tissue apoptosis and fibrosis and can specifically target CSM defects such as the nitric oxide (NO)-mediated signaling pathway, Rho–ROCK system, and transformation growth factor (TGF)-β1/angiotensin II (Ang II) pathway, in several laboratory animals. Current data clarify the need of diagnostic techniques that can provide an initial assessment of CSM. This assessment should be essential before giving a diagnosis of vascular ED and before applying several tests searching for a specific CSM defect to guide the specific therapy. Moreover, while patients with corporal fibrosis would fail the current medical therapies, these patients can benefit from the stem cell-based therapies that induce the internal mechanisms of tissue repair. However, penile elastography can determine the stiffness of tissues and corpus cavernosum electromyography (CC-EMG) can assess the integrated activity of CSM bulk, further refinements are required for these techniques before being considered in the evaluation of patients with ED. In conclusion, on the basis of the current scientific research, it may be possible to formulate new therapies and achieve the appropriate selection of patients who can benefit from these therapies.

     

Epidermal growth factor—Receptors on cultured human meningioma cells

Summary Equilibrium binding assays of EGF were performed on confluent cultures of 12 human meningiomas at early passage. In all meningeomas complete binding curves were obtained and the resulting ED 50 values ranged between 0.5 and 6.3 nM. In four cases (ED 50 values ranging from 1.5 nM to 3.0 nM) where saturation analysis was performed, the sites were saturable at similar levels (7nM). In five cases additional experiments were undertaken to evaluate the biological response of cultured cells to EGF as assessed by³H-thymidine incorporation. In all cases EGF was a potent stimulus and increased³H-thymidine incorporation by 2.5 to 6-fold. Functionally intact EGF receptors appear to be a regular feature of meningiomas in cell culture and appear not to be related to histological classification.Abbreviations EGF epidermal growth factor - FGF fibroblast growth factor - FCS foetal calf serum - TGF transforming growth factor Dedicated to Prof. Dr. Friedrich Loew on the occasion of his 65th birthday and the 25th anniversary of the Homburg Neurosurgical University Clinic, which has been founded and built up by him.     

Hypertension might be a risk factor for erectile dysfunction: a meta‐analysis

The study aimed to evaluate whether hypertension was a risk factor for erectile dysfunction (ED). Databases including PubMed and Embase were retrieved to identify studies related to hypertension in ED patients. Odds ratio (OR) and 95% confidence interval (CI) were used as the effect size. Subgroup analyses stratified by total number of enrolled subjects and research regions were performed. Sensitivity analysis was performed by removing a single study at one time. Egger's test was used to evaluate the publication bias. Totally, 40 studies including 121,641 subjects were included in the meta‐analysis. As a result, hypertension was closely related to ED (OR = 1.74, 95% CI, 0.63–0.80, p < .01). Subgroup analysis indicated hypertension was the risk factor for ED whatever the participants numbers. When stratified by different regions, hypertension was a risk factor for ED in Africa (OR = 3.35, 95% CI, 1.45–7.77, p < .01), Americas (OR = 1.97, 95% CI, 1.68–2.31, p < 0.01), Asia (OR = 1.46, 95% CI, 1.16–1.84, p < .01) and Europe (OR = 1.83, 95% CI, 1.34–2.49, p < .01), but not in Australia. Hypertension may be a potential risk factor for ED.