血管性勃起功能障碍特殊检查的临床应用(附105例报告)

目的应用双功能超声、阴部内动脉造影和海绵体造影三项血管性勃起功能障碍（ED）主要特殊检查结合海绵体血管活性药物注射，对血管性ED动脉功能和静脉关闭机制进行评估。方法105例血管性ED，其中12例有骨盆骨折尿道断裂。本组病人先行阴茎双功能超声检查，判断动脉功能和静脉关闭机制异常情况。外伤动脉性ED病人进一步行阴部内动脉造影，静脉性ED进一步行海绵体造影。结果（1）阴茎双功能超声检查显示，动脉性ED 63例，静脉性ED 42例；（2）12例外伤性动脉性ED阴部内动脉造影显示，阴茎勃起供血动脉受损，包括阴茎动脉主干狭窄、断裂和阴部内动脉断裂；（3）42例静脉性ED阴茎海绵体造影显示静脉漏，包括背深静脉漏、脚静脉漏、海绵体间静脉漏和混合性静脉漏。结论（1）双功能超声检查提供了阴茎勃起血流动力学异常的客观数据，可鉴别动脉功能或静脉关闭机制异常，为血管性ED第一线检查方法；（2）动脉造影检查可对阴茎供血动脉病变损伤部位进行解剖定位；（3）海绵体造影检查提供了静脉漏病变的解剖部位，后二项造影检查可为手术方案制定提供客观依据。     

勃起功能障碍诊断方法探讨

目的:探讨ED的诊断方法。方法:对365例11个民族拟诊为血管性ED的患者分别采用阴茎海绵体注射试验、阴茎-肱动脉血压指数测定、阴茎彩色双功能超声、阴茎海绵体造影、阴茎数字减影血管造影及阴茎动、静脉血池显像等检查。结果:有365、204、168、228、142、136例患者分别接受了上述6种检查。诊断动脉性ED82例,静脉性ED132例,混合性ED57例,原因不明ED94例。不同民族间差异无统计学意义(P>0.05)。结论:ED是高度个性化疾病,针对ED患者不同情况采取相应的诊断方法有利于选择高效、经济、安全的治疗方法。     

如何诊断血管性勃起功能障碍

血管性勃起功能障碍(ED)，是器质性ED之一种。血管性ED分动脉性与静脉性两种，其具体诊断方法，都是通过判断阴茎血液动力学情况，以估计阴茎的动脉或静脉有否问题。目前，临床上常用的阴茎血液动力学检查方法有如下几种。     

彩色多普勒超声检查在血管性勃起功能障碍诊断中的应用

目的 :探讨多普勒超声检查在诊断血管性勃起功能障碍 (ED)的临床价值。　方法 :应用多普勒超声检查阴茎药物诱导勃起前后的血液动力学改变 ,将非血管性ED病人与明确诊断血管性ED病人的多普勒超声变化进行对比 ,寻找血管性ED的特征。　结果 :动脉性ED病人深动脉的最大血流速度 (PSV)明显小于正常组 (P <0 .0 1) ;静脉性ED病人在阴茎完全勃起后背深静脉血流 (VV)仍大于对照组 (P <0 .0 5 )。　结论 :配合药物诱导阴茎勃起 ,多普勒超声检查是临床上筛选血管性ED的有效手段     

声视觉性刺激联合多普勒超声在重度ED患者诊断中的价值

目的 采用自身前后对照探讨声视觉性刺激联合多普勒超声在重度勃起功能障碍(ED)患者诊断中的价值。方法 自2015年6月至2016年7月,在中南大学湘雅三医院泌尿外科门诊对以ED为主诉的患者进行筛选,采用国际勃起功能评分量表-5(IIEF-5)初筛,IIEF-5评分小于8分的重度ED患者纳入研究,共筛选出139例患者。采用自身对照方式,研究对象先后接受两次阴茎彩色多普勒超声检查。第一次检查仅阴茎海绵体注射前列腺素E1(A组),7 d后的第二次检查予以声视觉性刺激(AVSS)联合阴茎海绵体注射前列腺素E1(B组)。采集注射后第5、10、20 min的收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、血流阻力指数(RI)。结果 在第一期检测中(A组),共有117例患者被检测为血管性ED,包括54例动脉性ED、40例静脉性ED、23例混合性ED。在第二期检测中(B组),共有91例患者被检测为血管性ED,包括34例动脉性ED、30例静脉性ED、27例混合性ED。B组患者加入AVSS后需要的血管活性药物注射剂量与次数明显低于A组,同时发现AVSS联合ICI可以提高非血管性ED检出率,26例患者...     

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.     

彩色多普勒超声在血管性阴茎勃起功能障碍诊断中的应用

目的评估阴茎海绵体注射后彩色多普勒超声对男性血管性阴茎勃起功能障碍（ED）患者诊断作用。方法47例ED患者经阴茎海绵体注射PGE1 30μg诱导勃起后行彩色超声多普勒检查左、右海绵体动脉血流指标,包括收缩期最大流速（PSV）,动脉舒张末期血流速度（EDV）,阻力指数（RI）。结果非血管性ED组41例（87.2%）,其中左、右海绵体动脉PSV分别〉25 cm/s者33例,左右海绵体动脉PSV相加〉50 cm/s者8例。动脉性ED组2例（4.25%）,左右海绵体动脉PSV均〈25 cm/s,背深静脉未见血流。静脉性ED组4例（8.51%）。结论阴茎海绵体注射血管活性药物后多普勒彩色超声对男性血管性ED检查是一种微创而准确的方法。     

阴茎勃起功能障碍诊断方法探讨

目的　探讨阴茎勃起功能障碍 (ED)的诊断方法。　方法　对 186例阴茎勃起功能障碍患者分别采取国际勃起功能评分 (IIEF 5 )、阴茎海绵体注射 (ICI)试验、血清性激素 (LH、T、PRL和E2 )测定、阴茎彩色双功能超声、阴茎海绵体造影及球海绵体肌反射潜伏时间等检查。　结果　有186、71、2 8、4 5、2 1和 17例患者分别接受了上述检查 ,诊断心理性ED 4 6例 ,动脉性ED 6例 ,静脉性ED 15例 ,内分泌性ED 3例 ,神经性ED 3例 ,混合性ED 10例 ,原因不明 10 3例。　结论　ED是高度个性化疾病 ,针对患者不同情况采取相应的诊断方法 ,有利于选择高效、经济、安全的治疗方法。     

VISER检查鉴别心理性与器质性勃起功能障碍(附320例报告)

目的应用VISER鉴别心理性与器质性ED并利用该方法对心理性ED严重性进行客观分级。方法320例ED患者接受了VISER检查。首先海绵体内注射罂粟硷10mg；未诱发勃起，药物剂量增至30mg。将药物试验阳性者定义为心理性ED，并根据海绵体压力、波幅形态以及药物剂量将心理性ED分为轻、中、重二度。两次检查均失败者，行阴茎彩色多普勒超声和海绵体造影检查。结果本组中，心理性ED占81．9％，其中轻度、中度和重度者分别占19．8％，60．7％和19．5％。在部分病例中，检查结果与Zung氏抑郁量表评分具有一定相关性。33例接受阴茎多普勒超声或海绵体造影检查提示，正常13例，动脉性ED5例，静脉性ED9例，动脉静脉混合性ED6例。结论VISER有助于签别心理性与器质性ED，依据其结果对心理性ED严重程度进行客观分级，便于对患者选择有针对性的治疗。     

IIEF-5在血管性勃起功能障碍诊断中的应用

目的:评价国际勃起功能简化量表(IIEF-5)对血管性勃起功能障碍(ED)病因区分的意义,以指导血管性ED诊断及治疗。方法:将103例ED患者分为4组,非血管性ED组37例(37/103,35.9%)、动脉性ED组18例(18/103,17.5%)、静脉性ED组35例(35/103,34.0%)、混合性ED组13例(13/103,12.6%),其IIEF-5得分与海绵体血管活性药物注射试验结果、多普勒超声检查结果及双核素检测结果进行比较,以非参数检验的多个独立样本检验(Kruskal-WallisTEST)比较各组之间IIEF-5得分差异的显著性。结果:上述4组之间的IIEF-5得分没有统计学差异(P=0.253)。结论:IIEF-5不能作为一种诊断工具用于鉴别血管性ED的病因以及判断血管病变严重程度。     

Is sildenafil citrate an alternative agent in the evaluation of penile vascular system with color Doppler ultrasound?

IINTRODUCION: The ideal diagnosis and therapeutic agent for erectile dysfunction (ED) would be an oral drug taken prior to color Doppler ultrasound (CDU) examination and sexual intercourse. In the present study we have investigated if the efficacy of oral sildenafil is optimal in the diagnosis of underlying pathology of ED. MATERIAL AND METHODS: The study group comprised of 41 patients with ED. Firstly, all patients underwent CDU examinations after the combined intracavernosal injection of 60 mg of papaverine and sexual stimulation (CIS). Secondly, these patients were examined after taking 50 mg of oral sildenafil citrate combined with self-manual and visual sexual stimulation. RERSULTS The differences of peak systolic velocity values were statistically significant between CIS and sildenafil (right: 40.7 +/- 2.9 vs. 28.7 +/- 3.3; left: 41.2 +/- 3.3 vs. 25.7 +/- 2.4; p < 0.001) in patients with normal penile vascular system. However, end-diastolic velocity and resistance index values were not significant between the same groups. In addition, there were not significant differences for peak systolic and end-diastolic blood flow velocities and resistances index with CIS and sildenafil in cases with vasculogenic ED. CONCLUSIONS: Sildenafil citrate plus visual sexual stimulation is not reliable as CIS to make accurate interpretation of penile vascular status using CDU. On the other hand, in some cases suspected of psychogenic ED after detailed sexual history, sildenafil might be tried as an initial step of the functional evaluation with CDU in order to prevent prolonged erection risk with intracavernosal injection of vasoactive agents.     

内皮损伤与勃起功能障碍研究进展

内皮在维护血管稳态、调节血管紧张度及血流、预防血管内血栓形成等方面起重要作用。血管内皮是阴茎勃起过程中的重要角色,ED多数情况下存在不同程度的内皮功能障碍,内皮损伤是ED的重要病理基础。不良生活方式、心血管疾病、氧自由基、炎症因子等均可导致内皮损伤。血管内皮具有自我修复机制,内皮损伤是损伤因素与修复因素失衡的结果。本文就内皮损伤机制、内皮损伤后的修复、内皮损伤与ED关系等方面的进展作一综述。     

无创性动态阴茎海绵体测压诊断阴茎勃起功能障碍

目的　探讨应用无创性动态阴茎海绵体测压 (VISER)在勃起功能障碍 (ED)诊断中的价值。　方法　对 5 3例ED患者的PGE1阴茎海绵体内注射试验、VISER及彩色双功能超声检查结果进行对比分析。　结果　PorstⅢ级者 4 3例 ,平均海绵体压力和压力指数分别为 14 4 .2 9mmHg(1mmHg=0 .133kPa)和 1.2 4。 4 2例血管功能正常 ,1例为静脉性ED ;PorstⅡ级者 10例 ,平均海绵体压力和压力指数为 87.76mmHg和 0 .81,两组间比较差别有显著性意义 (P <0 .0 5 ) ;PorstⅡ级者中动脉性ED2例 ,静脉性ED8例 ,两组间海绵体压力比较差别有显著性意义 (P <0 .0 5 )。　结论　VIS ER是一种有效的无创性诊断ED的方法 ,对动脉性及静脉性ED的鉴别亦有一定价值。     

A comparison of the International Index of Erectile Function and erectile dysfunction studies

OBJECTIVE: To evaluate the ability of the five-item version of the International Index of Erectile Function (IIEF-5) to diagnose the vascular aetiology and severity of erectile dysfunction (ED), and to compare it with pharmacological testing and duplex Doppler ultrasonography, as such questionnaires are widely used by the pharmaceutical industry to categorize the severity of ED and to assess the efficacy of drug therapy. PATIENTS AND METHODS: In all, 80 patients (mean age 45.2 years, sd 14.0; mean duration of ED 3.5 years) were reviewed by an examiner unaware of their IIEF scores during testing. Penile blood flow was assessed in each patient after an intracavernosal injection with prostaglandin-E1 (10 micro g), with self-stimulation in privacy. The peak systolic velocity, end diastolic velocity and resistive index were measured for the vascular diagnosis. Visual ratings of erectile responses were also used for analysis. RESULTS: Of the 80 patients, 30 had a normal vascular response, 38 arterial insufficiency and 12 were diagnosed with venous leakage. There was no significant difference in the IIEF scores among patients with a normal vascular response, arterial insufficiency or venous leakage. Analysis of visual ratings of erections showed no difference in IIEF scores among the different groups of patients. CONCLUSION: The IIEF was designed and developed specifically for assessing and evaluating sexual function in clinical trials. However, as shown here, the IIEF cannot and should not be used as a tool to diagnose or compare specific vascular causes of ED.     

夜间生物电阻抗容积测定对勃起功能障碍的诊断

目的:探讨夜间生物电阻抗容积测定(NEVA)在诊断勃起功能障碍(ED)中的应用价值。方法:对临床怀疑ED的100例患者进行NEVA测定。其中58例怀疑血管性ED,将该测定与阴茎海绵体造影联合彩超检查进行比较。结果:10例糖尿病性ED中有2例夜间阴茎勃起(NPT)正常,2例为动脉供血不足,6例无NPT。4例内分泌性ED患者中,2例NPT正常,2例无NPT。20例心理性ED的患者中,16例NPT正常,1例为动脉供血不足,3例无NPT。58例怀疑血管性ED的患者中确诊者有30例,其中18例为动脉性,12例为静脉性,非血管性ED28例。而应用NEVA发现在30例血管性ED中6例NPT正常,28例非血管性ED中4例NPT异常。8例外伤性ED中,2例腰椎骨折患者的NPT表现为轻度动脉供血不足;3例骨盆骨折患者中2例NPT正常,1例无NPT;3例骨盆骨折并发-后尿道断裂的患者,2例NPT正常,1例NPT提示动脉供血不足。结论:NE-VA对临床上怀疑心理性ED和血管性ED的诊断有较好的参考价值。     

Doppler evaluation of erectile dysfunction - part 2

Doppler evaluation in erectile dysfunction (ED) has a significant role in determining the cause of ED. The advantages of penile Doppler and pharmacologic duplex ultrasonography include objective, minimally invasive evaluation of penile hemodynamics at a relatively low cost. Arteriogenic ED may be secondary to peripheral vascular disease and diabetes, or may be seen in association with coronary artery disease. Various parameters, such as diameter of the cavernosal artery, peak systolic flow velocity, degree of arterial dilatation and acceleration time, have been suggested for the diagnosis of arteriogenic ED, but peak systolic flow velocity is the most accurate indicator of arterial disease. This second part of the review article describes the various causes of ED and the interpretation and evaluation of color flow Doppler examination in ED.     

Retinal vascular findings and penile cavernosal artery blood flow

OBJECTIVE: To assess the correlation between retinal vascular findings and penile cavernosal arterial blood flow, as it is probable that systemic atherosclerotic vascular disease is important in male erectile dysfunction (ED), and being systemic, it might be possible to evaluate the extent of atherosclerosis from retinal vascular findings. PATIENTS AND METHODS: The study included 75 patients with ED; any with a history of pelvic injury, pelvic surgery, or diabetes mellitus were excluded. All patients gave fully informed consent. Ocular fundus photographs were taken with an automatic-focus fundus camera under amydriatic conditions. Three ophthalmologists, unaware of the patients' detailed data, evaluated the photographs using Hyman's classification to evaluate retinal vascular findings. Blood flow in the penile cavernosal artery was measured with colour Doppler ultrasonography, and the peak systolic velocity used as a haemodynamic variable. Correlations among the peak systolic velocity, retinal vascular findings and vascular risk factors (including hypertension, age, cigarette smoking, and hyperlipidaemia) were investigated using multivariate analysis. RESULTS: Of the 75 patients, 72 (96%) had both right and left retinal vascular images of sufficient quality for evaluation; 37 were classified as normal and 35 as Grade I, while no patient was Grade II. From a logistic regression multivariate analysis, the peak systolic velocity was the only significant factor correlating with retinal vascular findings, with an odds ratio of 3.34. In contrast, hypertension, age, cigarette smoking and hyperlipidaemia did not correlate significantly with the retinal vascular findings. Similarly, the retinal vascular finding was the only significant factor correlating with the peak systolic velocity of cavernosal blood flow (odds ratio 3.28) and again hypertension, age, cigarette smoking and hyperlipidaemia were not significant factors. CONCLUSIONS: These findings support the assumption that penile erectile function is one of the diseases of atherosclerosis, and emerges nearly simultaneously with retinal vascular disease. It is possible to predict penile arterial conditions in patients with ED from their retinal vascular findings. Thus, amydriatic fundoscopy, a simple practical examination, may be helpful for primary physicians in diagnosing and treating ED.     

Efficacy of sildenafil in erectile dysfunction after radical prostatectomy

Radical retropubic prostatectomy (RRP) is an important cause of iatrogenic erectile dysfunction (ED). While sildenafil has been widely used since its introduction as a new treatment option for ED, its efficacy in post-RRP patients has not been extensively studied. We retrospectively compared the efficacy of sildenafil in post-RRP and non-surgical patients with ED (NSED) using a subset of questions from the International Index of Erectile Function (IIEF) and correlated results with their specific etiology of ED based on penile blood flow study (PBFS). A brief questionnaire regarding satisfaction with sildenafil was administered to 72 consecutive post-RRP patients (nerve sparing status unknown) and 32 consecutive NSED patients who had previously undergone PBFS with pharmacotesting as part of their evaluation for ED. PBFS diagnoses were arterial insufficiency (AI) for peak systolic velocity (PSV) < 25 cm/sec; venogenic (CVOD) for PSV > or = 35 cm/sec, mixed vascular for PV > 25 but < 35 cm/sec and resistive index (RI) < 0.9; a vascular normal diagnosis (neurogenic impotence) required excellent rigidity sustained for 20 min. Differences in the IIEF subscores for the different groups of patients were assessed. Success with sildenafil was defined as moderate or excellent improvement (3/4 or 4/4) with ability for penetration. No differences were found among the different subgroups of RRP patients with respect to IIEF scores or success rates with sildenafil. NSED patients had both significantly higher post-treatment IIEF scores (3.6/3.4 vs 2.5/2.2; t=4.50, P<0.0001) and success rates (63% vs 31%; t=3.11, P < 0.01) with sildenafil treatment than RRP patients. We found that sildenafil is significantly less effective in impotent RRP patients than in age-matched patients with ED (31% vs 63%). We had postulated that sildenafil would be least effective among RRP patients with excellent sustained rigidity to PGE1, as this subgroup is likely to have neurogenic impotence. We found that sildenafil response rates among subgroups of RRP patients were statistically similar regardless of PBFS diagnosis. IIEF scores for the RRP subgroups were similar but statistically lower than in men with ED and no history of RRP. While individuals with normal vascular responses to PGE1 have an increased likelihood of having neurogenic impotence, in RRP patients, we were unable to demonstrate any difference in efficacy of sildenafil, regardless of the PBFS diagnosis.     

超声多普勒在体表血管畸形诊治中的应用

探讨超声多普勒在体表血管畸形诊治中的作用。采用多普勒血流仪ＤＵＦ（Ｄｏｐｐｌｅｒｕｌｔｒａｓｏｎｉｃｆｌｏｗｍｅｔｅｒ）并结合彩色多普勒血流成像ＣＤＦＩ（Ｃｏｌｏｒｄｏｐｐｌｅｒｆｌｏｗｉｍａｇｉｎｇ）、血管造影ＳＡ（Ｓｅｌｅｃｔｉｖｅａｎｇｉｏｇｒａｐｈ）、术后组织学检查作自身对照２８例、３７个瘤体及ＤＵＦ术中应用１２例。ＤＵＦ对体表部位的高或低流量性病损的定性诊断与上述三种检查基本相符,其还能指导选择性结扎瘤体内的血管及术中避免损伤体表知名动脉,但不能提示病损结构和范围;ＣＤＦＩ除能提供病损区动、静脉血流信号外,尚可提示深部（肌层）病损情况,但不能显示病损的完整结构;ＳＡ既能提示病损的血流情况,也能显示病损大小和范围。总之,ＤＵＦ结合临床可初步明确体表血管畸形的高或低流量性病损,该方面诊断ＣＤＦＩ更为精确,ＣＤＦＩ与ＳＡ结合对血管异常的诊断和治疗是必要的。