勃起功能障碍治疗的现状与进展

勃起功能障碍(erectile dysfunction,ED)是指阴茎经常性的不能达到和保持足以进行满意性交要求的勃起.据报道,40～70岁的男性52%存在不同程度的ED,到2025年,全世界大约有3.22亿男性存在性功能障碍的问题,而大多数ED患者缺乏系统的临床治疗,即先从损害较小的口服药物治疗开始,第二步应用局部药物治疗(如海绵体注射和经尿道给药),最后的选择是外科治疗(阴茎假体置入);另外,血管外科技术对血管源性的ED患者也是一种可尝试的方法,基因治疗和组织工程技术在动物实验研究方面也取得可喜的成果.本文就目前阴茎ED治疗的现状与进展作一综述.     

枸橼酸西地那非治疗抑郁症患者的勃起功能障碍

勃起功能障碍(ED)与抑郁症有较高的相关性和并存率。患有ED与抑郁的男性也可能患有一些其他疾病,如糖尿病、高血压及心脏病。由于ED通常也是服用治疗这些疾病的药物的常见副作用,故这些患者的治疗依从性较差。枸橼酸西地那非对于各种原因所致之ED有效,提示其对抑郁所致的ED及使用5-羟色胺再摄取抑制剂导致的ED也同     

下肢动脉硬化闭塞症的外科治疗

下肢动脉硬化闭塞症(lowerextremityatheroscleroticocclu sivedisease,LEAOD)是血管外科常见病,是导致慢性下肢缺血的主要原因,其发病率随年龄增大而增加,Criqui统计65岁以上的男性约10%患有LEAOD,而75岁以上则有20%的发病率[1];北美60岁以上的高血压患者中有近25%患有慢性下肢缺血[2]。LEAOD是全身动脉硬化的局部表现。在我们的一组158例严重多节段动脉硬化闭塞症患者中,50%以上合并有心脑血管疾病,25%以上合并有糖尿病。严重的合并症是导致临床治疗效果欠佳和死亡率高的主要原因之一。因此,在下肢缺血的治疗中,不仅要注重肢体血管…     

阴茎假体植入术

全球有1亿多不同程度的阴茎勃起功能障碍(ED)患者，在40～70岁的男性中，约有52％的男性患有不同程度的ED；在美国，约有2000万ED患者；在我国，保守估计有800～1000万ED患者。尽管大多数ED患者可通过非侵袭性方法进行有效治疗，但仍有少数患者即使应用各种治疗方法仍难奏效，对于这类患者，     

勃起功能障碍的认知事件相关电位P300及其与心身症状的关系研究

<正>勃起功能障碍(erectile dysfunction,ED)是指阴茎不能达到或维持充分的勃起以获得满意的性生活。随着生活和工作节奏的加快、环境污染、药物滥用以及人口老年化等,ED的发病率有逐年增高的趋势。我国成年男性ED的发病率在10%左右,在美国40~70岁的男性中有一半的人患有不同程度的ED[1]。传统观念认为,ED的发生主要是由心理社会因素引起,认为心理因素导致的ED占90%左右。随着科学技术的发展和ED研究的不断深入,人们发现ED患者     

阴茎勃起功能障碍基础研究新动向

阴茎勃起功能障碍(ED)是指阴茎不能达到或维持充分勃起,以完成满意的性交。据文献报道,全球约有一亿多ED患者,40～70岁的男性中,约有52％的男性有不同程度的阴茎勃起功能障碍。因此,ED是一种影响男性健康的常见疾病。近20年来,人们对ED的发病基础作了大量的研究,通过利用各种ED动物模型,筛选安全有效的、增强阴茎海绵体平滑肌松弛作用的药物,为ED的治疗提供了光明的前景。其中一氧化氮-环磷酸鸟苷(NO-cGMP)通路、离子通道、细胞间通讯、基因治疗是近年来研究的新热点,本文将较详细阐述ED基础研究最新动向。     

糖尿病性阳痿的中医药临床研究

勃起功能障碍(erectile dysfunction,ED)中医俗称阳痿,是糖尿病(diabetes mellitus,DM)患者常见的并发症之一.糖尿病性阳痿病凶比较复杂,目前认为主要与血管、神经病变及生殖内分泌激素的变化有关[1].据临床报道糖尿病性阳痿发牛率为35%～75%,比非糖尿病患者高3倍[2].随年龄和病程的增长明显增加,并且糖尿病性阳痿患者比普通ED患者症状更为严重,无疑是影响糖尿病患者生存质量和生活质量的主要冈素.随着人们对糖尿病及其并发症研究的深入,对糖尿病性阳痿的认识也越来越多.近年来中医药治疗取得了较好的疗效,现就中医治疗糖尿病性阳痿的临床研究进展概述如下.     

万艾可治疗伴高血压ED患者的有效性、安全性及疗效预测

勃起功能障碍(ED)在男性高血压患者中比较常见,治疗ED的一线口服药万艾可对此类人群的疗效及安全性如何呢?MartinezJabaloyasJM等人对此进行了相关研究。共有114例伴高血压的ED患者入选。评估指标包括病史、体格检查、血脂、血糖和性激素检测,此外还有阴茎海绵体注射前列腺素E1、阴茎彩色多谱勒血流图检测。男性性功能健康问卷(SHIM)和全球性功能评估问卷用于疗效评估,同时记录不良反应。分别应用单因素和多因素变量分析治疗结果及影响因素。共有103例患者完成了该项研究,总有效率为59.2%,其中心理性和器质性ED的有效率分别为75%和50…     

2020年糖尿病足基础及临床研究进展

糖尿病足是长期高血糖导致的外周神经病变、血管病变与多致病因素相互作用而引发的复杂难治性疾病.患者病程长,创面经久难愈,极容易并发感染,严重时危及患者生命[1].糖尿病相关的足部溃疡在全球具有高发病率及病死率,每年影响全球约2600万人,造成极大的医疗负担[2-4].调查显示,中国18岁以上成年人中有11.2％患有糖尿病...     

勃起功能障碍基因治疗研究进展

近年来基因治疗被尝试用于勃起功能障碍(ED)治疗的动物实验,许多研究发现基因治疗方案对各种类型的ED均有一定的治疗作用。特别是在左旋精氨酸-一氧化氮-环磷酸鸟苷通路、离子通道、勃起神经和海绵体血管内皮细胞的修复保护等方面的基因治疗研究显示,基因治疗ED有一定的疗效。但应用基因治疗来治疗ED患者,目前仍有较多的困难,暂时无法应用于临床。本综述旨在对该领域的最新研究进展做一个简单的介绍和展望。     

上海市1582例中老年男子勃起功能障碍流行病学调查

为调查我国中老年男性人群勃起功能障碍的患病率及其高危因素.本文用描述流行病学方法,采用多阶段抽样方法在城市一般人群中抽取上海市区40岁以上的男性居民1582例,完成勃起功能障碍自答问卷.结果1582例中ED患病率为73.1%,且随其年龄增长而上升,60岁以上者上升幅度尤为明显.影响ED患病率的有关因素是年龄、心理性、器质性疾病等.其中,内分泌疾病(糖尿病),心血管病变、泌尿生殖器官疾病患者中,ED发病率较高.经济收入状况与ED患病率有显著相关性,而教育文化程度与ED患病率无相关性.     

Prevalence of erectile dysfunction in France: results of an epidemiological survey of a representative sample of 1004 men

OBJECTIVE: Several recent studies have reported prevalence rates for erectile dysfunction (ED) displaying considerable variation from country to country. We report here the results of a survey carried out in France in 2001. METHODS: This study was carried out by means of telephone interviews, on a representative sample of 1004 men aged 40 years or over. The prevalence of ED was determined from the patient's self-evaluation and International Index of Erectile Dysfunction 5 (IIEF-5) score. RESULTS: We found that in France in men aged 40 years and over, one man in three (31.6%) presented ED, of essentially mild or moderate severity (according to IIEF-5 score). We also found that the majority of men suffering from ED expressed dissatisfaction with their relations with their partner. Finally, a large proportion of men stated that they were ready to consult a doctor. CONCLUSION: This survey confirms that the prevalence of ED is high in France. This condition, which represents a source of distress that remains difficult to express and to assess, should be evaluated more effectively by rigorous and standardised methods, particularly as oral and effective treatments are now available.     

北京市社区中老年男性性功能调查报告:BPC-BPH研究结果

目的 调查北京市社区中老年男性性欲低下、勃起功能障碍(ED)、射精障碍的患病情况.方法 采用分层多阶段整群不等比例随机抽样方法选择北京市15个社区1656名年龄≥50岁男性作为调查对象,分别记录国际勃起功能问卷(IIEF-5)评分及男性性功能问卷(O'Leary 1995),应用χ~2检验分析结果.结果 符合标准的调查对象共1644人.年龄50～93(64.5±9.8)岁.平均IIEF-5(9.4±8.6)分.以IIEF-5评分0～21诊断为ED,总ED患病率90.45%,性欲低下60.04%,射精障碍38.81%.各年龄组(10岁/组)间ED、性欲低下、射精障碍患病率差异有统计学意义(P＜0.0001),各年龄组间不同程度ED患病率差异有统计学意义(P＜0.0001).趋势检验表明随年龄增加,ED、性欲低下、射精障碍患病率逐渐增加(Z=10.1,P＜0.0001),与年龄呈正相关性.结论 随年龄增加ED、性欲低下、射精障碍的患病率逐渐增加.ED患病率最高.     

The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction

The purpose of this research was to determine the prevalence of erectile dysfunction (ED) in a non-selected population using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool. In a non-institutionalized population and during a free screening program for prostate cancer (Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil), from 26 to 30 July 1998, all men who were attending were invited to complete a sexual activity questionnaire (the abridged 5-item version of the International Index of Erectile Function-IIEF-5) as a diagnostic tool for ED. The possible scores for the IIEF-5 range from 5 to 25, and ED was classified into five categories based on the scores: severe (5-7), moderate (8-11), mild to moderate (12-16), mild (17-21), and no ED (22-25). Of the 1071 men who participated in the program, 965 (90.1%) were included in this study. Of the responding men 850 were Caucasian (88%) and 115 were black (12%). The mean age of the men was 60.7 y, ranging from 40 to 90 y old. In this sample the prevalence of all degrees of ED was estimated as 53.9%. In this group of men, the degree of ED was mild in 21.5%, mild to moderate in 14.1%, moderate in 6.3%, and severe in 11.9%. According to age the rates of ED were: 40-49 (36.4%); 50-59 (42.5%); 60-69 (58.1%); 70-79 (79.4%), and over 80 y (100%) showed ED (P<0.05). The Pearson coefficients between the variables age and IIEF-5 showed a statistically significant inverse (negative) relation (r=-0.3449; P<0.05). ED is highly prevalent in men over 40 and this condition showed a clear relationship to aging, as demonstrated in other studies published. The simplified IIEF-5, as a diagnostic tool, showed to be an easy method, which can be used to evaluate this condition in studies with a great number of men.     

广西南宁、玉林地区阴茎勃起功能障碍发病率调查报告

目的 探讨阴茎勃起功能障碍的发病率。方法 对广西南宁、玉林地区5504例人群随机进行问卷勃起功能障碍调查。结果 30岁以上壮族人群阴茎勃起功能障碍发病率高于汉族人群,统计学差别有显著意义（P＜0．01）。40岁以上人群勃起功能障碍发病率与其他年龄段相比显著升高,差别有显著意义（P＜0．01）。40岁－和50岁－年龄段发病率高于20岁－和30岁－年龄段（P＜0．01）。而40岁－和50岁－年龄段、20岁－和30岁－年龄段之间差别无显著性意义（P＞0．05）。结论 勃起功能障碍发病率在40岁以前并未随年龄增高而增加,40岁以后则逐渐增加。壮族发病率高于汉族。勃起功能障碍在人群中有较高的发病率。     

Erectile dysfunction and the heart–what''s new?

Erectile dysfunction (ED) and vascular disease often co-exist, especially in men over 40 years of age. Endothelial dysfunction is recognised as being the common denominator. Since the endothelium is present throughout the arterial tree, dysfunction at one point that is symptomatic (erectile dysfunction) may be a marker for silent problems elsewhere (coronary arteries). The literature linking ED to silent vascular disease has grown with a consistent message – a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proved otherwise. ED precedes a chronic or acute cardiac presentation of chest pain by an average of 2–3 years. Since ED shares the same risk factors as coronary disease, the opportunity to use ED as a reason for aggressive risk factor reduction is now the focus of further study – can a man with ED have his coronary event avoided?     

Patient Choice is Critical in Managing Erectile Dysfunction

Erectile dysfunction (ED) is a highly prevalent condition that has been reported to affect over 50% of men 40–70 years of age. The broad spectrum of causes of ED that exist as well as the significant number of patients involved imply that the treatment of ED is not a simple matter. The recent development of oral therapy has facilitated an increased treatment of the condition. However, it is timely that we should consider the patients’ perspective of treatment in order that the optimal drug can be developed. Data suggest that the most important features of an oral therapy are ease of use, provision of an erection of sufficient quality and duration for satisfactory sexual intercourse and reliability. Spontaneity is also considered an important feature enabling sexual intercourse to take place in a natural setting.     

Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire

PURPOSE: To assess prevalence and risk factors for erectile dysfunction (ED) by using the International Index of Erectile Function- 5 (IIEF-5) in men undergoing a health investigation. METHODS: Men aged 20-80 years participating in a health-screening project in the area of Vienna completed the IIEF-5 for evaluation of ED. In parallel, all men underwent a detailed health examination including physical assessment, evaluation of various life-style factors, medical history and a blood analysis. RESULTS: A total of 2869 men were analysed. According to the IIEF-5 score, 32.2% reported on any degree of ED (IIEF-5 score <22), 23.7% had mild ED (IIEF-5 score 17-21), 5.0% mild to moderate ED (IIEF-5 score 12-16), 2.2% moderate ED (IIEF-5 score 8-11) and 1.3% severe ED (IIEF-5 score 5-7). The proportion of men with ED remained stable from 20 to 50 years (26-29%) and increased thereafter to 37.5% (51-60 years) and to 71.2% in those 71-80 years of age. Severe ED (IIEF-5 score 5-7) increased from 0.4% (20-30 years) to 0.5% (41-50 years), 1.3% (51-60 years) and to 9.6% in those aged 71-80 years. Risk factors for ED were age, diabetes (OR: 3.0; 95%CI: 1.53-5.87), hyperlipidemia (OR: 2.29; 95%CI: 1.42-3.7), lower urinary tract symptoms (OR: 2.2; 95%CI: 1.76-2.76), hypertension (OR: 2.05; 95%CI: 1.61-2.6), psychological stress (OR: 1.68; 95%CI: 1.43-1.98) and low physical activity (OR: 1.35; 95%CI: 1.15-1.6) (all, p < 0.05). CONCLUSION: Overall, 32.2% of men in our study had ED according to the IIEF-5. Apart from age, most important risk factors for ED were diabetes, hyperlipidemia, lower urinary tract symptoms, hypertension and psychological stress.     

Prevalence of erectile dysfunction in Colombia,Ecuador, and Venezuela: a population-based study (DENSA)

The purpose of this study was to estimate the prevalence of erectile dysfunction (ED) in Colombia, Ecuador, and Venezuela. A 49-item questionnaire was completed by 1946 men aged 40 years and older. The age-adjusted combined prevalence of minimal, moderate, and complete ED for all three countries was 53.4%, with 19.8% of all men reporting moderate to complete ED. Age was the variable most strongly linked to ED; the prevalence of complete ED increased markedly in men older than 79 y of age (31.9%) and 70-79 y (17.2%) compared with men aged 40-49 y (<3%). Several medical conditions, such as hypertension, benign prostatic hyperplasia, and diabetes, and the use of medications to treat these conditions were correlated with the prevalence of ED. This study corroborates earlier studies demonstrating that ED is very common, increases dramatically with age, and has multiple correlates, including some that are also risk factors for cardiovascular disease.     

Effect of lower urinary tract symptoms on the incidence of erectile dysfunction

PURPOSE: We determined the effect of lower urinary tract symptoms (LUTS) on the incidence of erectile dysfunction (ED). MATERIALS AND METHODS: The target population consisted of all men 50, 60 or 70 years old residing in Tampere area, Finland in 1994. Questionnaires were mailed to 3,143 men in 1994 and to 2,864 men 5 years later. The followup sample consisted of the 1,683 men who responded to baseline and followup questionnaires. We estimated the effect of LUTS and bother on the incidence of ED during the 5-year followup among the 1,126 men free from ED at baseline. ED was assessed by 2 questions on subject ability to achieve and maintain erection sufficient for intercourse and LUTS assessed by the Danish Prostatic Symptom Score. Logistic regression model was used in the multivariate analysis. RESULTS: The incidence of ED increased with the presence and with the intensity of urinary symptoms and bother at baseline. Compared with men with LUTS score 0, the incidence of ED was 2.7 (95% CI 1.3-5.5) times higher among men with score 7 to 11, and 3.1 times with score 12 or more. The incidence of ED increased by 5% for each 1-point increment in LUTS score, while it increased by 12% and 11% for 1-point increment in cumulative symptom or bother score, respectively. Men with cumulative symptoms or bother score 4 or more were significantly 2.0 to 2.7 times at higher incidence of ED relative to those who were free from symptoms or bother at baseline. Only overflow incontinence (OR = 2.2) and incomplete emptying (OR = 1.8) independently increased the incidence of ED. CONCLUSIONS: Lower urinary tract symptoms and bother independently increase the incidence of erectile dysfunction.