大鼠心因性勃起功能障碍模型制作

目的:建立心因性勃起功能障碍(ED)动物模型。方法:获得性交配经验的36只SD雄性大鼠随机分为正常组(n=12)、模型组(n=12)及去势组(n=12)。模型组大鼠每日悬空倒吊在水面上,并不断激惹。2周后观测与雌性大鼠合笼后的性活动状况,包括雄鼠的骑乘潜伏期和骑乘次数,插入潜伏期和插入次数以及雄鼠的射精潜伏期,并计数发生性活动的大鼠数,同时取大鼠血液作血液流变学指标检测。结果:与正常组大鼠相比,模型组大鼠骑乘潜伏期[(152.5±24.6)svs(42.4±9.6)s]、插入潜伏期[(437.0±67.7)svs(130.8±39.1)s]明显延长(P<0.01),射精潜伏期[(385.3±80.0)svs(547.3±69.4)s]明显缩短(P<0.05),骑乘次数[(38.3±6.1)次vs(38.5±5.4)次]无明显差别,插入次数[(9.2±1.7)次vs(20.3±3.1)次]明显减少(P<0.01),性活动的发生率(骑乘发生率为58.3%,插入发生率为33.3%,射精发生率为16.7%)明显降低(P<0.01);但模型大鼠与去势大鼠间的性活动能力无明显差别。模型组大鼠血液粘度、红细胞比容以及红细胞聚集指数均明显高于正常组及去势组大鼠(P<0.05),而正常组与去势组大鼠间无明显差异。结论:重复悬吊加激惹方法可引起大鼠的性动机和性活动能力明显减弱,显示运用此方法可制作理想的心因性ED大鼠模型。     

心因性勃起功能障碍患者的心理治疗结果分析(附13例报告)

目的探讨心因性ED患者的心理特征和心理治疗。方法用Beck抑郁自评量表、艾森克个性问卷对13例ED患者进行测评。然后进行心理治疗,用IIEF-5问卷对患者治疗前后阴茎的勃起功能进行评估,了解心理治疗的效果。结果ED患者具有明显的抑郁情绪,个性特征表现为不稳定的内向性格。治疗前后对照,IIEF-5的5项症状指标中,Ⅰ、Ⅲ、Ⅳ、Ⅴ项指标P<0.05,有统计学意义。结论对于ED患者的治疗,心理治疗师的参与是积极有效的。     

青年男子心因性勃起功能障碍治疗初探

目的：探讨青年男子心因性勃起功能障碍的有效方法。方法：１９９６年２月－１９９７年６月，对３６例心因性勃起功能障碍（ＥＤ）的未婚成年男子心理咨询、性知识讲解和性咨询，配合阴茎海绵体局部注射小剂量血管活性药物及真空负压吸引装置（ＶＣＤ）对其进行治疗。结果：２２．２％在治疗至第２周时，已能正常完成性生活，５５．６％于第一疗程结束时可以完成性生活７例已经生育。８８．９％对这各联合治疗方式表示满意。结论：对     

心理性勃起功能障碍的行为疗法

本文 2 9例在确定为心理性勃起功能障碍后 ,向患者细致解释性生理和性心理 ,进行心理分析 ,使其明疾病的心理症结所在 ,了解疾病的可治性 ,增强其治疗兴趣和治愈信心 ,减轻心理压力 ,然后对夫妻进行性教育 ,使之树立性对人体心身健康有益的正确观念 ,从而夫妻双方能够互相理解 ,感情融洽 ,有正常的夫妻语言 ,拥抱和接吻等感情交流。性行为治疗 :在男方处于熟睡时 ,阴茎呈生理性勃起状态 ,女方在自己外阴涂以润滑剂 ,然后主动地将阴茎纳入阴道。若纳入后刺激致醒男方 ,可辅以抚摸 ,情话挑逗 ,拥抱接吻等 ,以提高性爱气氛及男方心身感受 ,唤…     

40例心因性勃起功能障碍的治疗

勃起功能障碍（erectile dysfunction，ED）虽不危及患者生命，但对患者的生活质量以及人际、婚姻关系均可产生严重不良影响。2002年1月，2003年6月我们采用性功能康复治疗仪（武汉信恒科技有限公司，型号XH-B-02），配合心理咨询、性知识讲解和性咨询等综合治疗40例心因性ED患者，取得良好疗效，现总结如下。     

心因性勃起功能障碍的综合治疗

目的观察综合治疗对于心因性勃起功能障碍(ED)的疗效。方法40例心因性ED患者,使用性功能康复治疗仪进行治疗,每次30min,每天1次,5次为一疗程；配合性知识、性心理和性生理教育等综合治疗。治疗结束后3月评价其治疗效果并追踪观察6月。结果40例心因性勃起功能障碍患者治愈21例,占52．5%；好转14例,占35．0%；无效5例,占12．5%,总有效率达87．5%。治疗前后IIEF-5评分比较有统计学意义(P＜0．05)。35例治疗有效的患者中有31例获得半年随访,性生活正常。结论性功能康复治疗仪,配合性知识、性心理和性生理教育对病人恢复信心和诱发勃起完成性生活有重要作用。     

青年男子心因性勃起功能障碍治疗初探

目的：探讨青年男子心因性勃起功能障碍的有效治疗方法。方法：1996年2月～1997年6月，对36例心因性勃起功能障碍（ED）的未婚成年男子采用心理咨询、性知识讲解和性咨询，配合阴茎海绵体局部注射小剂量血管活性药物（盐酸罂粟碱3～6mg十前列腺素E_15～10μg混合液）及真空负压吸引装置（VCD）对其进行治疗。结果：22．2％（8／36）在治疗至第2周时，已能正常完成性生活，55．6％（20／36）于第一疗程结束时可以正常完成性生活，17例已经生育。88．9％（32／36）对这种联合治疗方式表示满意。结论：对于青年男子心因性ED应尽早并尽可能给予治疗；在性知识教育、性心理疏导的基础上，配合进行小剂量血管活性药物阴茎海绵体注射及阴茎真空负压吸引治疗，是一种较为有效、无创及经济的治疗方法。     

西地那非治疗心因性或混合性勃起功能障碍具有良好有效性和耐受性

万艾可上市多年来，已被广泛应用于治疗勃起功能障碍（ED），并显示出对各种病因的ED都有很好的疗效，Olsson AM等进行的一项关于枸橼酸西地那非片（万艾可）用于治疗心因性或混合性ED的研究很好地证明了上述观点。研究者将患精神性或混合性ED患者随机分组进行双盲、不同治疗剂量的研究。     

心理干预对勃起功能障碍病人焦虑的影响

随机选择30例勃起功能障碍（ED）病人进行焦虑情绪评定，并实施针对性心理干预。结果ED病人SAS评分较心理干预前明显降低，提示心理干预可有效减轻ED病人的焦虑情绪。     

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。     

Correlation between gut microbiota diversity and psychogenic erectile dysfunction

BackgroundTo analyze the distribution of gut microbiota in erectile dysfunction (ED) patients and explore the relationship between the diversity of gut microbiota and psychogenic ED.MethodsStool specimen were collected from 30 patients with ED and 30 healthy persons (healthy donors, HDs) and analyzed Paired end (PE) 300 sequencing on V3-V4 region sequences of bacterial 16S rRNA gene by using Illumina’s Miseq platform, whereby sequencing results were analyzed to assess differences in species composition and diversity. The analysis comprised five modules: sequencing data quality control, operational taxonomic units (OTU) species clustering and annotation, alpha diversity, beta diversity and the use of t-tests and analysis of linear discriminant analysis effect size (LEfSe) differences.ResultsThe International Index of Erectile Function (IIEF-5) score ranged between 8 and 21. The scores of ED patients were ≥11 and ≤20, and the mean value was 15.67±2.94. The flora diversity in the group of ED patients was significantly different from that of HDs (P<0.01), with the ED group having low bacterial diversity. There were no significant differences in the genus level between the ED and HD group, and abundant bacteria (TOP10) and core flora (90%). Comparison of total flora (the abundance >1%) display, Alloprevotella genera showed differences, whereby Alloprevotella was only be identified in the HD group. Erectile dysfunction and HD showed good separation and clustering respectively in principal component analysis, showing significant differences in two kinds of microflora. T-tests showed that six species were significantly different, and that in the ED group, streptococci and Subdoligranulum were significantly increasing, and Prevotella sp.9, Blautia, Lachnospiraceae NK4A136 groups and Roseburia were significantly lower. Analysis using LEfSe analysis revealed 24 species were significantly different between ED and HD groups.ConclusionsWhen gene sequencing was performed of ED and HD specimens, the microbial community structure and diversity showed significant differences, suggesting that ED specimen had lower gut microbiota diversity.     

不同途径前列腺切除术后发生性功能障碍的比较

目的:探讨耻骨上经膀胱前列腺切除术(SPP)、经尿道前列腺电切术(TURP)、经尿道前列腺电气化联合电切术(TUVP加TURP)治疗BPH对患者性功能的影响。方法:采用国际勃起功能问卷简化表(IIEF5)通过调查问卷方式,对104例接受上述手术的BPH患者术前、术后6个月勃起功能及逆行射精情况进行问卷评分。结果:SPP、TURP、TUVP加TURP三组患者术前IIEF5评分分别为17.4、17.9、18.1分,术后6个月IIEF5评分分别为11.7、13.2、10.2分,手术前后比较差别有统计学意义(P<0.05)。三组之间IIEF5评分降低程度比较TUVP加TURP>SPP>TURP,差别有统计学意义(P<0.05)。三组术后逆行射精的发生率分别为23.1%、32.5%、25.0%。结论:三组手术均可导致患者勃起功能障碍的发生,其中以TUVP加TURP发生率最高,逆行射精发生率以TURP最高。提高手术操作技巧,避免包膜损伤,作好解释工作,可减少术后患者勃起功能障碍的发生。     

药物性阴茎双功能超声在勃起功能障碍诊断中的应用

对１２４例勃起功能障碍（ＥＤ）者应用药物性阴茎双功能超声（ＰＰＤＵ）检查评估阴茎海绵体动脉功能和静脉关闭机制。结果显示：非血管性ＥＤ者８５例（６８５４％），动脉性ＥＤ者４例（３２３％），静脉性ＥＤ者３５例（２８２３％）。认为ＥＤ患者应常规行ＰＰＤＵ检查。     

西地那非治疗勃起功能障碍的安全性和疗效的临床应用研究

目的：观察枸椽酸西地那非上市后实际临床应用中的安全性和有效性。方法：采用多中心、开放、非对照的方法，在全国36家医院对2101例因勃起功能障碍口服西地那非治疗的患者进行了观察随访。平均观察期65d(6-310d)。260例患者（12.4％）观察达6个月以上。结果；所观察到的各系统不良事件的特点和类型与说明书中所列及中国II期临床试验结果一致。未发现新的不良事件，不良事件发生率并不因服药期延长而升高。所有不良事件均为轻度至中度（以轻度为主），多数不需处理即可缓解，多于服药当天缓解。西地那非治疗勃起功能障碍的总有效率为82.3％。结论：西地那非治疗勃起功能障碍安全、有效、耐受性好。     

Multicentral clinical evaluation of the aetiology of erectile dysfunction: A survey report

Patients with erectile dysfunction, who admitted to 4 different urological centres in Turkey were evaluated in terms of aetiological factors to establish the aetiology of erectile dysfunction in our population and compare it with the data derived from Western communities. After the history, physical examination, psychological evaluation and laboratory testing, a clinical diagnosis was established as primarily psychogenic, organic, or mixed aetiology. Mean patient age was 43.5 years (range 17 to 69), and 9 of the patients were unmarried. Of the patients 53 had vascular risk factors, and 10 reported a history of alcohol abuse. Eleven patients were using drugs that might interfere with the disorder. In this multicentral study of 115 impotent men, an organic cause was found in 43%, psychogenic in 47%, and mixed in 19%. Mean age of the overall patients was 43.48. When the ages of the patients with organic erectile dysfunction and those with psychogenic erectile dysfunction were compared, it was clearly seen that those with organic erectile dysfunction were much older (52.73 versus 33.02). This revised version was published online in June 2006 with corrections to the Cover Date.     

可充胀阴茎假体治疗勃起功能障碍的体会

目的：探讨三件套可充胀阴茎假体治疗勃起功能障碍（ED）的疗效。方法：选择5例ED患者，其中50岁以上4例，并发糖尿病3例，高血压动脉粥样硬化1例，另1例为骨盆骨折、尿道断裂伤引起神经性ED。5例均采用三件套可充胀阴茎假体植入术。结果：4例术后伤口如期愈合，能够达到满意的性生活，另1例因阴茎过短，假体植入后，伤口长期不愈合，出现组织排异现象，导致尿道海绵体坏死、穿孔。漏尿而最后不得不取出假体。结论：ED患者植入三件套可充胀阴茎假体，手术切口小，愈合后不易察觉，治疗效果好，患者乐于接受。     

Testosterone deficiency and risk factors in the metabolic syndrome: implications for erectile dysfunction

The most common cause of erectile dysfunction (ED) is penile vascular insufficiency. This is usually part of a generalized endothelial dysfunction and is related to several conditions, including type 2 diabetes mellitus, hypertension, hyperlipidemia, and obesity. These conditions underlie the pathophysiology of metabolic syndrome (MetS). Hypogonadism, or testosterone deficiency (TD), is an integral component of the pathology underlying endothelial dysfunction and MetS, with insulin resistance (IR) at its core. Testosterone replacement therapy for TD has been shown to ameliorate some of the components of the MetS, improve IR, and may serve as treatment for decreasing cardiovascular and ED risk.     

Stress management and erectile dysfunction: a pilot comparative study

Erectile dysfunction (ED) is a complex disorder with various biopsychosocial implications leading the individual into a state of chronic stress that further worsens ED symptoms. The aim of this study is to investigate the effects of a 8‐week stress management programme on erectile dysfunction (ED). A convenience sample of 31 newly diagnosed men with ED, aged between 20 and 55 years, was recruited during a period of 5 months to receive either tadalafil (12 patients) or tadalafil and the 8‐week stress management programme. Both groups showed statistical significant improvement of both perceived stress and erectile function scores. Men practising stress management showed a statistical significant reduction in perceived stress score compared with men receiving tadalafil alone. No other statistical significant differences were noted between the two groups, although the stress management group showed a lower daily exposure to cortisol compared with the control group after 8 weeks. Finally, perceived stress and cortisol showed some interesting correlations with sexual function measurements. These findings provide important insight into the role of stress management, as part of the recommended biopsychosocial approach, in ED. Future studies should focus on randomised, controlled trials with larger samples and longer follow‐up time.     

Pathogenetic aspects of erectile dysfunction in patients with the metabolic syndrome

BackgroundAlthough it is well known that the metabolic syndrome is a common cause of erectile dysfunction (ED) the pathogenesis of the latter in this group of patients is poorly understood. The present study aimed to improve our knowledge in this area.MethodsThe study included 385 men with ED (control group) who underwent a full evaluation, including laboratory and ultrasound assessment of endothelial function.ResultsThe full complex evaluation showed that arteriogenic impairment in the cavernosal circulation was the primary pathogenic factor for ED in patients with the metabolic syndrome. The ultrasound-assisted measurement of postocclusive changes in the diameter of the cavernosal arteries, which reflects the local endothelial function, was the most valuable method in the diagnosis of this form of ED. In addition, a considerable number of patients with the metabolic syndrome demonstrated both hormonal and neurological disorders which also contribute to the pathogenesis of ED in this cohort of men.ConclusionThe pathogenesis of ED in patients with the metabolic syndrome is multifactorial in nature: ED is primarily caused by arteriogenic disorders which are combined with neuropathic disorders in almost every second patient and with hormonal factors in every third one. In addition, psychomotor status has an impact on the development of ED in patients with metabolic syndrome.