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.     

Erektionsstatus nach nervenerhaltender radikaler Prostatektomie

The time lapse before recovery of erectile function after nerve-sparing radical prostatectomy is still under debate. Several pathophysiologies are postulated for postoperative erectile function rehabilitation. In prospective studies we measured nocturnal penile tumescence (NPTR) in the acute phase during the first night after catheter removal subsequent to nerve-sparing radical prostatectomy to assess the neuronal organic erectile integrity.Eighteen sexually active patients suffering from local prostate cancer underwent bilateral and unilateral nerve-sparing retropubic radical prostatectomy. All patients completed an IIEF-5 questionnaire concerning erectile function preoperatively. The transurethral catheter was removed 14 days after surgery, and nocturnal penile tumescence was measured with an erectometer (Rigi-Scan) in each patient during the following night. None of these patients received any comedication interacting with erectile function.The preoperative IIEF score was >18 in all patients. After catheter removal, 17 of 18 patients (95%) had nocturnal penile radial rigidity >70% that persisted for >10 min during one night. In a control of four patients without a nerve-sparing procedure, no nocturnal erections were recorded.The measurement of NPTR in the acute phase after nerve-sparing radical prostatectomy showed retained erectile function even during the "first" night after catheter removal. Our findings are important for an appropriate choice of pharmacotherapy for optimal recovery of erectile function. In cases of early penile erections, the cavernous nerve had been well preserved during surgery providing good neuronal integrity, and PDE-5 inhibitors can support organic rehabilitation of the corpus cavernosum. In the absence of early penile erections, the neuronal integrity of the cavernous nerve is presumed to be impaired. In this case, additional injection therapy should be chosen to support recovery of spontaneous erectile function.     

Erectile function and nocturnal penile tumescence in patients with prostate cancer undergoing luteinizing hormone-releasing hormone agonist therapy.

BACKGROUND: Luteinizing hormone-releasing hormone (LHRH) agonists have been widely used as effective agents in endocrine therapy for prostate cancer. Continuous administration of the drug results in profound suppression of testicular androgen production. However, the side effects on erectile function have not been fully investigated. METHODS: We studied the influences of testosterone suppression on male sexual function and nocturnal penile tumescence in nine sexually active patients with prostate cancer who were treated with an LHRH agonist. RESULTS: Following reduction of serum testosterone concentrations to a castration level by the administration of the LHRH agonist, sexual desire, sexual interest and sexual intercourse were totally annulled, with significant changes in frequency, magnitude, duration and rigidity of nocturnal erections observed in all patients. CONCLUSIONS: These results demonstrate that the LHRH agonist strongly suppresses erectile function and sexual activity. Taking into account the quality of sexual function for relatively young and sexually active patients and their partners, it is necessary to establish effective modalities that minimize the adverse effects on sexual function for the treatment of patients with prostate cancer.     

Impotence: a diagnostic approach

A diagnostic approach to erectile impotence using a sexual function questionnaire, nocturnal penile plethysmography, penile blood pressure measurement, cavernosograms, cystometrograms and plasma testosterone levels is presented. Case examples demonstrate the clinical value of these diagnostic tools. Psychogenic impotence should be diagnosed only after nocturnal penile plethysmography has demonstrated the presence of complete erections.     

经尿道前列腺绿激光汽化术对BPH患者阴茎勃起功能的影响

目的:探讨经尿道前列腺绿激光汽化术(PVP)对BPH患者阴茎勃起功能的影响。方法:对128例BPH采用PVP的患者用IIEF-5评分问卷调查和夜间阴茎勃起试验(NPT)测定阴茎勃起强度。结果:随访成功者116例,随访率90.7%(116/128);术前性功能正常的患者均保留性欲和满意性生活;治疗前IIEF-5评分(22.52±1.65)分,治疗后为(21.78±2.62)分,差异无统计学意义;术后勃起强度下降发生率为9.5%。结论:PVP与其他前列腺手术相比对勃起功能功能的影响小;是前列腺增生安全、有效的治疗方式。     

Oestrogen-androgen crosstalk in the pathophysiology of erectile dysfunction

Ageing in man is associated with a decline in testosterone following changes in the hypothalamo-pituitary-testicular axis. This may offset the physiologic equilibrium between oestrogen and androgen and at some point when the ratio of free testosterone to oestradiol reaches a critical level, the oestrogenic gonadotropin suppressive effect predominates with decreased release of FSH and LH. Adding to this endocrinal complexity is the continued peripheral conversion to oestradiol through aromatisation. Although the androgen deficiency is not the sole cause for impotence in the elderly, there is a gradual decrease in nocturnal penile tumescence (NPT) and spontaneous morning erections with ageing. Despite the age related increase in oestrogen levels, the information on the pathophysiological role of the “female hormone“ in erectile dysfunction has been scanty. Together with our identification of oestrogen receptors within the penile cavernosum, we have delineated dysfunctional changes on male erection mediated by oestradiol.These findings parallel the recent concerns over environmental oestrogens on fertility declines in young men. Oestrogenic activity is also present in plants and thereby in human diet. These phytoestrogens are structurally and functionally similar to oestradiol and more potent than the environmental oestrogenic chemicals such as organochlorine and phenolic compounds. Thus in the light of growing concerns of possible compromising effects on sexuality by endogenous and environmental oestrogens, we are faced with the scientific need to delineate their role on the mechanism of male erectile pathway in health and disease for clinical correlates and prognostics.     

Nervenerhaltende radikale Prostatektomie mit niedrig dosiertem Sildenafil

Objective

The purpose of this study was to evaluate the effect of low-dose sildenafil (25 mg) for rehabilitation of erectile function after nerve-sparing radical prostatectomy.

Patients and methods

In a prospective study, 43 sexually active patients underwent nerve-sparing retropubic radical prostatectomy. Rigiscan® measurement of nocturnal penile tumescence and rigidity (NPTR) was carried out 7–14 days after surgery. A group of 23 patients with preserved nocturnal erections received sildenafil 25 mg/day at night to support recovery of erectile function. A control group of 18 patients underwent follow-up without PDE-5 inhibitors. Evaluation using the IIEF-5 questionnaire was performed 6, 12, 24, 36, 52 and 78 weeks after the operation.

Results

Of 43 patients, 41 (95%) showed 1–5 erections during the first night after catheter removal. In the group receiving daily sildenafil, the mean IIEF-5 score decreased or increased from 20.8 preoperatively to 3.6 at 6 weeks, 3.8 at 12 weeks, 5.9 at 24 weeks, 9.6 at 36 weeks, 14.1 at 52 weeks and 19.3 at 78 weeks after prostatectomy. In the control group, the mean preoperative IIEF-5 score of 21.2 decreased or increased to 2.4 at 6 weeks, 3.8 at 12 weeks, 5.3 at 24 weeks, 6.4 at 36 weeks, 9.3 at 52 weeks and 13.2 at 78 weeks. Statistical evaluation showed significant differences regarding the IIEF-5 score and recovery period of erectile function between the groups (p<0.001), with potency rates of 92 vs 68%.

Conclusion

The measurement of NPTR after nerve-sparing radical prostatectomy showed erectile function as early as the first night after catheter removal. In cases of early penile erections, daily low-dose PDE-5 inhibitors lead to a significant improvement/acceleration of erectile function recovery.     

夜间勃起功能监测结果与他达拉非治疗勃起功能障碍疗效的相关性研究

目的:评价夜间勃起功能监测(NPT)结果与他达拉非疗效的相关性。方法:188例ED患者,根据NPT结果分为NPT正常组(n=136)和NPT异常组(n=52),2组患者均给予他达拉非治疗,3次/周,每次20mg。治疗前及治疗1个月后,分别评价IIEF-5评分、阴茎插入成功率(SEP2)、完成性交成功率(SEP3)以及总体评价问卷(GAQ),比较2组间治疗前后各项指标的变化。结果:2组患者用药后其IIEF-5评分、SEP2、SEP3均显著高于用药前(P<0.01)。NPT正常组患者治疗后的IIEF-5评分、SEP2、SEP3及GAQ均显著高于NPT异常组患者治疗后结果(P<0.05,P<0.01)。结论:经过他达拉非治疗1个月后,NPT正常组患者勃起功能(包括IIEF-5评分、SEP2及SEP3)较NPT异常组改善更为显著,即NPT正常组患者行他达拉非治疗疗效更佳。     

Rehabilitative therapy for erectile function after nerve-sparing radical prostatectomy

BackgroundTo date, the time course for recovery of erectile function and the effect of rehabilitative treatment after nerve-sparing radical prostatectomy (RP) is still under debate. The aim of this study was to evaluate the effect of low-dose sildenafil for rehabilitation of erectile function after nerve-sparing RP.MethodsIn a prospective, randomised study, 43 sexually active patients underwent a nerve-sparing retropubic RP. Erectometer measurement of nocturnal penile tumescence and rigidity (NPTR) was carried out 7–14 days after surgery. Some patients (23) with preserved nocturnal erections received sildenafil 25 mg/day at night to support recovery of erectile function. A control of 18 patients underwent follow up without phosphodiesterase type 5 (PDE-5) inhibitors. The International Index of Erectile Function (IIEF-5) questionnaire was given 6, 12, 24, 36, 52 and 78 weeks after operation.ResultsA total of 41 out of 43 patients (95%) showed 1–5 erections during the first night after catheter removal. In the daily sildenafil group, the IIEF-5 score decreased from a preoperative mean score of 20.8 to mean scores of 3.6 at 6 weeks, 3.8 at 12 weeks, 5.9 at 24 weeks, 9.6 at 36 weeks, 14.1 at 52 weeks and 19.4 at 78 weeks after prostatectomy. In the control group, the preoperative IIEF-5 mean score of 21.2 decreased to 2.4 at 6 weeks, 3.8 at 12 weeks, 5.3 at 24 weeks, 6.4 at 36 weeks, 9.3 at 52 weeks and 13.4 at 78 weeks. Statistical evaluation showed a significant difference in IIEF-5 score and time to recovery of erectile function between the groups (p<0.001) with potency rates of 92% vs. 68%.ConclusionsIn this study of men, the measurement of NPTR after nerve-sparing RP showed erectile function even during the “first” night after catheter removal. Sildenafil was efficacious when used in a “daily low dose” treatment and led to a significant improvement in recovery of erectile function.     

Testosterone levels in men with erectile dysfunction

OBJECTIVE: To investigate the frequency of hypogonadism in men with erectile dysfunction (ED) and to assess which factors are related with low testosterone levels. PATIENTS AND METHODS: In all, 165 men with ED were assessed; the evaluation included: hormonal profiles, serum total and free testosterone (using Vermeulen's formula) levels, and self-reported questionnaires on erectile function and desire domains of the International Index of Erectile Function. The frequency of hypogonadism was established using total and free testosterone levels as diagnostic criteria. The factors that might influence testosterone levels were evaluated by univariate and multivariate statistical analysis, and a logistic regression was used to determine which factors can predict free testosterone levels below normal limits (biochemical hypogonadism). RESULTS: Using the total testosterone levels, 4.8% of the men were hypogonadal, whereas when using the free testosterone levels, 17.6% were hypogonadal. In the univariate analyses, not smoking and hypertension were associated with lower total and free testosterone levels. Ageing, absence of nocturnal erections and a lower erectile function score were only associated with lower free testosterone serum levels. There was no association between total and free testosterone levels and desire. In the multivariate analysis, only total testosterone levels were related to hypertension, while free testosterone levels were related to age and nocturnal erections. For biochemical hypogonadism, simple logistic regression analysis selected age, erectile function score and aetiological diagnosis of ED as predictors. In the multivariate analysis only the erectile function score had significant independent prognostic value. CONCLUSIONS: The frequency of hypogonadism is higher when free testosterone levels are used for diagnosis. The total and free testosterone levels were not related to the level of sexual desire in men with ED. The free testosterone levels could be related to the quality and frequency of nocturnal erections, and when ED is more severe, it is more probable that free testosterone levels are below the 'normal' limit.     

The effects of testosterone on the cavernous tissue and erectile function

Summary A review of the current literature is conducted to explore the developmental aspects, animal and human experiences and the effects of pharmacological manipulation to explain the role androgens play in sexual function with special emphasis on erectile function and the erectile tissue. This review reveals that androgens are necessary for the normal development of the penis and their deficiency results in significant structural abnormalities. Although androgen receptors in the penis decrease after puberty, they usually do not disappear completely. Animal data show that androgens support erectile function through a direct effect on the erectile tissue. Experimental castration results in impaired erectile response to central and peripheral stimulation and decrease in penile tissue concentration of nitric oxide synthase-containing nerves. Testosterone replacement reverses these abnormalities. In the rat penis, apoptosis is induced by castration and new DNA synthesis is induced by testosterone replenishment. Human data are less clear than animal data. Castration results in loss of libido and in erectile dysfunction. However, these effects are not universal. Testosterone enhances libido, frequency of sexual acts and sleep-related erections. Its effects on erotic erections are not clear.     

Penile fracture in Kermanshah,Iran: the long-term results of surgical treatment

OBJECTIVE: To determine the long-term outcome of the surgical management of penile fracture. PATIENT AND METHODS: In all, 170 patients (mean age 27 years, sd 13, median 24, range 13-80) with penile fracture undergoing surgery between April 1990 and December 2000 were reviewed. In addition to a history, physical examination and hospital records, long-term potency (> 6 months after surgery) was evaluated using the patients' self-rated assessment of erectile function and the International Index of Erectile Function (IIEF-5) questionnaire. The results were correlated with the surgical findings. A control group of 200 men also self-rated their erectile function and completed the IIEF-5. For those patients who presented with their partners, the partner's satisfaction with erections was also evaluated. The mean (median, range) follow-up after injury was 53 (61, 6-132) months. RESULTS: Satisfactory and painless erectile function with a soft straight penis was reported by 162 patients (95.2%). Complications occurred in eight patients (4.7%), of whom seven developed a mild (four) to moderate (three) penile curvature; five had penile nodules and four reported mild paresthesia over the scar line. Mild and moderate erectile dysfunction (ED) was reported by five and three patients, and four and five of controls, respectively (P > 0.05). There was no difference between the surgical findings of six patients with complications and those of the remaining 162. However, in the two remaining cases extensive injury was associated with moderate ED after surgery. Of eight patients with ED, seven responded to intracavernosal injection with papaverine/phentolamine. Erectile function returned within a mean (range) of 2 (1-5) days and coitus was possible approximately 2 weeks after the repair. Of the patients' partners, 94.1% reported satisfaction with erections and only one reported de novo dyspareunia. Penile fracture was not associated with an increased risk of ED (odds ratio 0.95; 95% confidence interval, 0.35-2.53). In sexually active participants, the mean (sd, range) IIEF-5 score for 162 patients was 23.2 (2.7, 13-25) and not significantly different from that for the 194 controls, at 22.8 (2.1, 11-25). However, patients had higher scores than controls for erectile firmness and maintenance ability (P < 0.05). CONCLUSIONS: Surgery for a fractured penis is safe and effective, restoring erectile function to that of controls. Surgical treatment is very satisfactory for patients and partners. Considering these encouraging results, surgical intervention is strongly recommended.     

肾移植与血液透析治疗对尿毒症患者阴茎勃起功能影响的临床对照研究

目的:研究对比男性尿毒症患者接受肾移植与接受血液透析治疗勃起功能的变化及与生殖激素水平变化的关系。方法:收集2009年5月至2012年1月在我院门诊进行随访的肾移植男性患者35例、血液透析治疗的尿毒症患者30例,应用国际勃起功能指数(IIEF-5)调查表、夜间勃起功能(NEVA)测定仪评估阴茎勃起功能,同时测定生殖激素水平。结果:接受肾移植手术者勃起功能障碍(ED)患病率为51.4%,血液透析者ED患病率为73.3%(P<0.05);肾移植后的ED患者发病情况要明显轻于单纯血液透析的ED患者;肾移植中重度ED患者(25.7%)要明显少于单纯血液透析者(46.6%);肾移植组中ED患者夜间阴茎勃起次数、勃起强度及持续时间均强于单纯血液透析组ED患者(P<0.05);接受肾移植患者较单纯血液透析血清睾酮水平上升[(4.32±1.37)vs(2.53±1.12)ng/ml,P<0.05],雌二醇[(19.57±2.29)vs(43.38±5.58)pg/m)]和催乳激素[(8.59±1.19)vs(17.22±3.31)mIu/ml]明显下降(P均<0.05)。结论:肾移植受者肾功能良好时其总体勃起功能要优于单纯血液透析的尿毒症患者。     

A long-term, prospective study of the physiologic and behavioral effects of hormone replacement in untreated hypogonadal men.

This study describes sexual activity, nocturnal penile erections, and mood states as a function of serum levels of androgens in previously untreated hypogonadal men before and during hormone replacement, selected infertile men (elevated serum follicle-stimulating hormone levels), and normal men. Nocturnal penile tumescence and rigidity were measured with a portable monitor, and sexual activity and mood were assessed by prospective, self-reported written forms. Nocturnal erections were absent or of very low amplitude and duration in the untreated hypogonadal men compared to the infertile and normal men. Nocturnal erections increased steadily during hormone replacement and were in the normal range within 6 to 12 months of treatment. In contrast, serum testosterone concentration rapidly reached the upper range of normal. During treatment, the hypogonadal men reported increases in several aspects of sexual activity, including sexual interest and the number of spontaneous erections. On mood inventories, the untreated hypogonadal men scored significantly higher in ratings of depression, anger, fatigue, and confusion than did infertile and normal men. During hormonal replacement therapy these scores decreased, although the hypogonadal men continued to score higher in "depression" than did infertile and normal men. In most instances, the men with infertility and the normal men were statistically indistinguishable in nocturnal penile tumescence and rigidity parameters, self-reported sexual activity, and mood state. These data support the hypothesis that androgen treatment increases nocturnal and spontaneous erections, and sexual interest, and has some capacity to improve mood.     

Effect of sildenafil on nocturnal erections of potent men

We try to evaluate the effect of sildenafil on nocturnal penile erections of potent men. We recruited 22 potent men (eight medical students and 14 urology residents) 23-29 years old into the study. A disorder-free medical and sexual history and normal erectile functions were the only inclusion criteria. All subjects completed three sessions of consecutive nights using the RigiScan Plus device. After a first night of adaptation, night 2 recordings were their baseline values whereas they received sildenafil 100 mg on night 3. We observed statistically significant improvement with regard to those NPT parameters at the nights with sildenafil: number of erectile episodes; duration of tip rigidity >60%, RAU tip, RAU base and TAU tip (P<0.005). Although the duration of erectile episodes (min) and TAU base were greater during the sildenafil night, these did not reach statistical significance. In conclusion, our study showed that sildenafil can improve nocturnal erectile quality not only in patients with erectile dysfunction as previously published but also in potent males.     

Nocturnal tumescence: a parameter for postoperative erectile integrity after nerve sparing radical prostatectomy

PURPOSE: The exact process and time required for rehabilitation of erectile function after nerve sparing prostatectomy remain unclear to date. Different theories of the pathophysiology of postoperative erectile dysfunction are currently being discussed. In a prospective study we performed recordings of nocturnal penile tumescence and rigidity during the acute phase after nerve sparing radical prostatectomy, ie in the first night after removal of the catheter, to assess the organic penile integrity. MATERIALS AND METHODS: In 27 patients with local prostate carcinoma who had been sexually active before the intervention, we performed unilateral or bilateral nerve sparing radical prostatectomy. Preoperative sexual function of all patients was evaluated by the International Index of Erectile Function-5 questionnaire. On the day of catheter removal (postoperative day 7 to 14) an NPTR recording was performed on the following night with an erectometer (RigiScan). RESULTS: All patients had a preoperative IIEF score greater than 18. After removal of the catheter 25 of 27 patients (93%) showed 1 to 5 nocturnal rigidity increases by greater than 70% for at least 10 minutes. In a control group of 4 patients who underwent radical prostatectomy without nerve sparing, no nocturnal erections were recorded. CONCLUSIONS: NPTR recording during the acute phase after nerve sparing radical prostatectomy showed residual erectile function as early as the first night after catheter removal. These results are significant for selecting adequate pharmacological treatment for optimal therapy and rehabilitation of satisfactory erections and sexual function. In cases of early nocturnal tumescence, application of a PDE5 inhibitor can support successive organ rehabilitation. However, if tumescence does not occur, penile injection therapy is recommended.     

Age‐stratified cut‐off points for the nocturnal penile tumescence measurement using Nocturnal Electrobioimpedance Volumetric Assessment (NEVA®) in sexually active healthy men

The current nocturnal penile tumescence (NPT) measurement is based on standard cut‐off levels defined regardless of age. This study was conducted to provide age‐stratified cut‐off points for NPT measurement. Forty sexually active healthy men between 20 and 60 years old were enrolled and divided equally into four groups defined by age (20–29, 30–39, 40–49 and 50–60 years.). None of the candidates had sexual dysfunction or sleep disturbance or used supportive medication to enhance sexual function. Erectile function was evaluated by using the 5‐item version of the international index of erectile function (IIEF‐5). NPT was observed using the nocturnal electrobioimpedance volumetric assessment (NEVA^®). The NPT values of healthy men aged 20–60 years varied from 268.7% to 202.3%. The NPT differed significantly between age groups (P < 0.0009); however, no significant differences between men aged 30–39 and 40–49 (P = 0.593) were observed. Age was weakly associated with IIEF‐5 scores (P = 0.004), whereas a strong and negative correlation between age and NPT (P < 0.0001) was found. IEF‐5 scores were not significantly associated with NPT (P = 0.95). Therefore, the standard values for NPT testing should be considered in the evaluation of the nocturnal penile activity of men of all ages.     

Erectile dysfunction after transurethral resection of the prostate: incidence and risk factors

It is known that a proportion of patients who undergo transurethral resection of the prostate (TURP) will develop erectile dysfunction (ED). This study examined the incidence of ED after TURP using objective and subjective parameters and risk factors for the development of ED. All benign prostate hyperplasia (BPH) patients who were indicated for TURP had to meet the criteria of the International Index of Erectile Function (IIEF) 5 scores of more than 16, and with normal nocturnal penile tumescense (NPT) which had at least one episode of nocturnal erections with both base and tip rigidity exceeding 55% for at least 10 min. The patients nocturnal erection were measured using Rigiscan, over two consecutive nights, approximately 3–4 days preoperatively and 3 months postoperatively. A total of 63 patients were eligible for the study; the mean age was 63.3 years (range 49–85 years). Nine (14%) patients were found to have postoperative ED. Patients who developed ED postoperatively had a lower IIEF-5 score and NPT parameters preoperatively (for all parameters, P<0.0001). For risk factors, diabetes mellitus were found to be a significant independent risk factor. The incidence of ED post-TURP using objective parameters was 14%. Without taking note of the risk factors, TURP is a safe procedure with regard to sexual function.     

小剂量服用他达拉非对阴茎夜间勃起作用的研究

目的:探讨他达拉非对阴茎夜间勃起的作用。方法:14例器质性勃起功能障碍(ED)患者予以小剂量他达拉非(10mg/3d)治疗,睡前口服,1个月后用夜间生物电阻抗容积测定(NEVA)监测患者阴茎夜间勃起情况。结果:14例器质性ED患者小剂量他达拉非治疗1个月后,其勃起功能比治疗前有明显改善(P<0.05)。结论:小剂量服用他达拉非可改善器质性ED患者夜间勃起。     

Analyses of factors contributing to the erectile dysfunction with aging by nocturnal penile tumescence, penile blood pressure index and papaverine test

To evaluate the factors contributing to the decline in erectile function with age, we performed measurement of nocturnal penile tumescence (NPT) and penile vascular examinations in 407 men. The following results were obtained. 1) The penile circumferential increment during NPT measured by an erectometer was gradually decreased with age, especially markedly after 60 years of age. The percentage of subjects in whom the NPT was less than 10 mm increased with age: 2.7% in the 5th decade, 7.1% in the 6th decade, 16.7% in the 7th decade and 29.1% in the 8th decade. These findings indicate that the incidence of organic erectile dysfunction increased with age. 2) To evaluate the penile vascular status, measurement of penile blood pressure index (PBPI) and papaverine test were performed. The mean PBPI values were significantly decreased in the subjects over 70 years of age. The percentage of subjects having good response to papaverine injection obviously decreased with age: 66.7% between 50 to 59 years, 48.6% between 60 to 69 years, and 15.8% of over 70 years. All subjects in whom the NPT was less than 10 mm showed either a low PBPI level of less than 0.6 or an incomplete response to papaverine injection. These results suggest that penile vascular impairment plays a major role in the age-associated decline in erectile function. 3) We investigated the relationship between cigarette smoking and penile vascular impairment. Smokers showed not only lower PBPI values but higher incidence of the incomplete response to papaverine injection than nonsmokers. Therefore, it is considered that cigarette smoking is a significant risk factor in the erectile dysfunction that occurred in the aged.