伴有下尿路症状的良性前列腺增生患者勃起功能状况及坦索罗辛的干预研究

目的:研究伴有下尿路症状(LUTS)的良性前列腺增生(BPH)对患者性功能的影响及坦索罗辛干预的效果。方法:192例典型的伴有LUTS的BPH患者治疗前进行国际前列腺症状评分(IPSS)、生活质量评分(QOL)、勃起功能障碍国际问卷5(IIEF-5)调查,同时检测最大尿流率(Qm ax)。然后随机分两组,治疗组(103例)给予坦索罗辛0.2 mg,对照组(89例)应用安慰剂,1次/d,疗程8周。分析治疗前不同因素对性功能的影响和治疗后LUTS及性功能改善情况。结果:192例患者治疗前IPSS评分3~32(20.20±6.81)分,QOL评分0~6(4.51±0.76)分,Qm ax 8~30(9.6±8.79)m l/s,IIEF-5评分1~24(9.80±8.62)分。勃起功能障碍(ED)发生率75%(144/192)。统计学显示:IPSS和IIEF-5有明显的相关性(r=-0.312,P<0.001)。年龄与IPSS和IIEF-5均有明显的相关性(r=0.203,P<0.005和r=-0.571,P<0.001)。对照组治疗后各项指标变化差异无显著性,治疗组治疗后各项指标较治疗前有明显改善(P<0.001),好于对照组(P<0.001)。结论:年龄和LUTS是性功能障碍的危险因素,LUTS的严重程度与性功能障碍的发展密切相关。坦索罗辛在改善LUTS的同时可明显改善患者的性功能状况。     

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。     

Sildenafil reduces bother associated with erectile dysfunction: pooled analysis of five randomized, double-blind trials

Improvement in bother associated with erectile dysfunction (ED) is an important aspect of successful treatment of ED. Changes in erectile function and the bother associated with ED were assessed in this analysis of pooled data from five 12-week, multicenter, randomized, double-blind, placebo-controlled, flexible-dose studies of sildenafil. Men who received sildenafil (n=578, vs placebo, n=550) had significantly greater (least squares mean+/-s.e.) improvement in erectile function (EF) domain scores of the international index of erectile function (IIEF) (10.0+/-0.3 vs 1.0+/-0.3, P<0.0001) and in erection distress scale (EDS) total transformed score (18.8+/-0.8 vs 4.8+/-0.9, P<0.0001). Scores on individual questions of the EDS were 24-65% higher after treatment with sildenafil (vs 8-12%, for placebo). The change in EF domain score correlated positively with the change in total transformed EDS score (0.43, P<0.0001). Successful treatment of ED with sildenafil may reduce the bother associated with ED.     

Addition of metformin to sildenafil treatment for erectile dysfunction in eugonadal nondiabetic men with insulin resistance. A prospective, randomized, double-blind pilot study

Erection depends largely on the release of nitric oxide (NO) by vascular endothelial cells. Insulin resistance (IR) is a metabolic abnormality that produces endothelial dysfunction characterized by decreased synthesis and release of NO. The aim of this paper is to evaluate the effect of treatment with metformin on the response to sildenafil in patients with erectile dysfunction (ED) and IR enrolled in a prospective, randomized, controlled, double-blind placebo study. We included 30 male patients with ED, IR, and poor response to sildenafil. Exclusion criteria included pharmacologic, anatomic, or endocrine ED; diabetes; prostatic surgery; or chronic illnesses. Erectile function was rated according to the International Index of Erectile Function 5 (IIEF-5); IR was measured by homeostasis model assessment (HOMA; IR = HOMA ≥ 3). Patients were randomized to receive metformin (n = 17) or placebo (n = 13). After treatment with metformin, patients with ED showed a significant increase in IIEF-5 score and a significant decrease in HOMA, both occurring at month 2 (IIEF-5: 17.0 ± 6.0 vs 14.3 ± 3.9, P = .01; HOMA: 3.9 ± 1.6 vs 5.5 ± 2.4, P = .01) to 4 of treatment (IIEF-5: 19.8 ± 3.8 vs 14.3 ± 3.9, P = .005; HOMA: 4.5 ± 1.9 vs 5.5 ± 2.4, P = .04), with no changes in these parameters in patients with ED receiving placebo. Patients treated with metformin had more adverse events than those who received placebo: 61.5% compared with 7.7%, P = .03, respectively. Adverse events were mild, mainly gastrointestinal, and did not cause discontinuation of treatment. Treatment with metformin in patients with ED and poor response to sildenafil reduced the IR and improved erectile function.     

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.     

Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome.

OBJECTIVE: Randomized, double-blinded, placebo-controlled, clinical trial to determine the effectiveness of palatal implants for treatment of mild/moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). STUDY DESIGN AND SETTING: Sixty-two non-obese adults with history of snoring, daytime sleepiness, and mild/moderate OSAHS, were randomized to receive palatal implants (n = 31) or placebo procedure (n = 31). Complete follow-up including quality of life (QOL, SF-36), snoring visual analog scale (VAS), and Epworth Sleepiness Scale (ESS) data were obtained in 62 patients. Seven patients refused follow-up polysomnography for a total of 55 patients (29 implant and 26 placebo). RESULTS: The treatment group (change in score of -7.9 +/- 7.7) was significantly improved compared with the placebo group (change in score of 0.9 +/- 4.3) for apnea/hypopnea index (AHI) (P < 0.0001), QOL, SF-36 (P < 0.0001), snoring VAS (P < 0.0001), and ESS (P = 0.0002). CONCLUSIONS: Palatal implants improve AHI, QOL, snoring intensity, and daytime sleepiness for selected patients with mild/moderate OSAHS.     

养精胶囊治疗男性性功能障碍的临床观察

目的:观察养精胶囊治疗男性性功能障碍的临床疗效。方法:将210例性功能障碍患者随机分成治疗组(n=136)和对照组(n=74),分别予以养精胶囊和五子衍宗丸,连服60d,通过国际勃起功能指数问卷表(IIEF)积分评估性功能的改变。结果:ED患者治疗组在治疗前后IIEF5积分由(11.26±2.72)分上升到(16.84±3.12)分,两者相比差异有显著性(P<0.01);治疗后治疗组与对照组比较亦有显著性差异(P<0.01)。ED患者治疗组在治疗前后IIEF第11、12问题积分由(5.12±1.16)分上升到(8.50±1.02)分,两者相比差异有显著性(P<0.01);治疗后治疗组与对照组比较差异亦有显著性(P<0.01)。对早泄的治疗,两组间无统计学意义。结论:养精胶囊可显著改善男性的性欲和勃起功能。     

Erectile dysfunction after PlasmaKinetic vaporization of the prostate: incidence and risk factors

PURPOSE: To determine the incidence of erectile dysfunction (ED) after PlasmaKinetic vaporization of the prostate (PKVP) using objective and subjective parameters and risk factors. PATIENTS AND METHODS: A total of 153 men completed a questionnaire detailing perceived sexual dysfunction and underwent nocturnal penile-tumescence testing using the RigiScan for three consecutive nights 3 or 4 days preoperatively and 3 months postoperatively. The International Index of Erectile Function (IIEF)-5 scores were obtained preoperatively and postoperatively. Full details of each operation were recorded, including grams of tissue resected, operative time, any short-term complications, especially emphasizing capsular perforation, and concomitant diseases such as diabetes and hypertension. The association of risk factors with the development of ED after PKVP was assessed. Complete data were available for 103 men (67.3%). Their mean age was 62.1 years (range 48-83 years). RESULTS: Postoperatively, 11 patients (10.6%) were found to have ED. Patients who developed ED postoperatively had a lower IIEF-5 score and penile-tumescence parameters preoperatively (for all parameters, P < 0.0001). As risk factors, diabetes, capsular perforation, and an IIEF-5 score <21 were found to be significant. CONCLUSIONS: The incidence of ED after PKVP measured objectively was 10.6%. In the absence of the risk factors, PKVP is a safe therapeutic strategy with regard to sexual function.     

阴茎海绵体白膜破裂术后患者心理、勃起功能及排尿功能变化情况

目的:探究手术治疗阴茎海绵体白膜破裂对患者心理、勃起功能及排尿功能的影响. 方法:选择2010年6月至2015年12月急诊收治的50例阴茎海绵体白膜破裂术后患者作为研究对象,采用Zung焦虑(SAS)和抑郁自评量表(SDS)、IIEF-5和IPSS在术后1d、6个月和18个月评价患者的心理、勃起功能及排尿功能,并对术后...     

每日小剂量他达拉非治疗骨盆骨折尿道断裂后勃起功能障碍的疗效观察

目的:评价每日小剂量他达拉非治疗骨盆骨折尿道断裂(PFUD)后勃起功能障碍(ED)的疗效。方法:2008年1月至2011年12月共有46例骨盆骨折尿道断裂后ED患者纳入观察。患者年龄25～51(33.9±7.2)岁,受伤时间3～72(19.6±12.7)个月。所有患者自诉受伤前的性功能正常。患者在未服用5型磷酸二酯酶抑制剂的情况下进行夜间勃起周径和硬度测量(NPTR)。根据NPTR检测结果将患者分为有夜间勃起异常组和无夜间勃起组。对所有患者给予每晚他达拉非10 mg治疗3个月,采用IIEF-5评分、性生活日记问题2和问题3评价治疗效果。结果:38例(82.6%)患者完成检查和治疗,8例失访。NPTR检测证实夜间勃起异常26例(68.4%),无夜间勃起12例(31.6%)。他达拉非治疗3个月后,夜间勃起异常组患者IIEF-5改善明显高于无夜间勃起组(P<0.05),夜间勃起异常组患者对SEP2和SEP3回答"是"的比例明显高于无夜间勃起组(76.9%vs41.7%,65.4%vs 25.0%,P<0.05)。结论:每日小剂量他达拉非可有效改善PFUD后ED患者的勃起功能,有夜间勃起的患者治疗效果更明显。     

老年男性腔隙性脑梗死患者性功能问卷调查

目的:探讨老年男性腔隙性脑梗死患者性功能改变的特点,以利患者全面康复。方法:38例老年(60~70岁)患者,分为腔隙性脑梗死组20例,非脑梗死组18例,排除明显运动障碍、卒中后抑郁、帕金森病、严重系统性疾病等。于出院时及出院后6个月分别行国际勃起功能评分5(IIEF-5)问卷调查,比较各组之间以及随访前后IIEF-5评分的变化。结果:腔隙性脑梗死组19例(95.0%)发生勃起功能障碍(ED),较非梗死组(15例,83.3%)明显增高,且重度ED的发生率较高(60.0%vs44.4%,P<0.05),两组中合并糖尿病患者的ED程度较重。随访康复治疗6个月后脑梗死患者的IIEF-5评分较出院明显增加(11.2±3.2vs15.6±2.2,P<0.05)。结论:老年男性腔隙性脑梗死后ED的发病明显增加,程度更严重。合并糖尿病的患者ED更严重。卒中后康复治疗有助于患者勃起功能的恢复。     

The synergism of penile venous surgery and oral sildenafil in treating patients with erectile dysfunction

A possible synergistic effect between penile venous surgery and oral sildenafil was inadvertently found in treating patients with erectile dysfunction in our clinic. We therefore sought to elucidate the possible synergic effect between venous surgery and sildenafil through studying patients who were non-responders preoperatively. From July 1998 to July 2003, 128 patients were diagnosed with veno-occlusive dysfunction. Subsequently, 65 of them underwent penile venous surgery and were assigned to the surgical treatment group. The remaining 63 men were assigned to the control group, and were subject to a simple re-exposure of oral sildenafil. All patients were evaluated with the international index of erectile function (IIEF-5) scoring. Sildenafil (12.5-100 mg) was prescribed postoperatively to all surgical patients as venous surgery alone was unsatisfactory and similarly, 100 mg preparation was prescribed for patients in the control group. The IIEF-5 scoring in the control group changed from a preoperative mean IIEF-5 score of 9.4 +/- 3.9 to 10.7 +/- 3.5 postoperatively. In surgical patients, however, the mean preoperative IIEF-5 score of 9.2 +/- 5.0, which increased to 15.1 +/- 5.0 (p < 0.001) postoperatively, further increased to 20.1 +/- 5.4 (p < 0.0001) after the addition of sildenafil. Although there was no significant difference between the two groups characteristics, there was a statistically significant difference between treatment results (p < 0.001). Overall, 61 men (93.8%) reported a positive response to sildenafil after venous stripping surgery. In contrast, only eight patients (12.7%) felt a beneficial response in the control group (p < 0.001). Forty-one of 65 patients had scores of > or =22, and 19 of these had a score of 25. No response was found in three (4.6%), and a decrease of 7 was seen in one (1.5%). In summary, patients in whom sildenafil was not effective preoperatively can become excellent responders after careful penile venous surgery. It appears that together, oral sildenafil and penile venous surgery may provide an encouraging solution to impotent patients with veno-occlusive dysfunction who are non-responders to sildenafil.     

The prevalence of erectile dysfunction and its relation to chronic prostatitis in Chinese men

This study was performed to evaluate the prevalence of erectile dysfunction (ED) and to explore its correlation to chronic prostatitis in China. A cross-sectional investigation from a large cohort study of Chinese men was used in this survey. A questionnaire consisting of general information regarding socio-demographics, chronic disease history, sexual function, the National Institutes of Health-Chronic Prostatitis Symptom Index, and the International Index of Erectile Function-5 (IIEF-5) was administered to 15 000 Chinese men aged from 15 to 60. The prevalence of ED was determined from the patient's self-evaluation and IIEF-5 score. The eligible individual both was married and had intercourse experience. In total, there were 12 743 respondents, giving a response rate of 84.95%. Among 7372 eligible men, ED prevalence as assessed by self-report and IIEF-5 score was 12.0% and 17.1%, respectively. Among 771 men with prostatitis-like symptoms, ED prevalence as assessed by self-report and IIEF-5 score was 39.3% and 30.1%, respectively. Among 370 men suffering from chronic prostatitis, ED prevalence as assessed by self-report and IIEF-5 score was 40.5% and 35.1%, respectively. The prevalence of self-reported and IIEF-5 score-assessed ED had high correlation with increasing age among all eligible men, men with prostatitis-like symptoms, and men with chronic prostatitis (P(t) < .05, P(s) < .05, P(cp) < .05). ED prevalence as assessed by both self-report and IIEF-5 score was higher in men with prostatitis-like symptoms and with chronic prostatitis than in the general group (P(s) < .05, P(cp) < .05). The prevalence of ED was higher in the prostatitis population than in the general population with either self-reported or IIEF-5 score assessment. The prevalence was higher with self-reported than with IIEF-5 assessment in men with prostatitis. Estimates of ED prevalence among men with prostatitis should not rely on self-reporting alone in that this is likely to overestimate the true prevalence.     

症状性良性前列腺增生患者的性功能调查

目的:调查伴有下尿路症状(LUTS)的良性前列腺增生(BPH)患者治疗前性功能障碍的程度,并分析性功能障碍与LUTS、年龄的相关性。方法:88例具有典型LUTS的BPH患者,年龄49~86(67.90±7.59)岁。所有患者均进行了国际前列腺症状评分(IPSS)、勃起功能障碍国际问卷-5(IIEF-5)、简明性功能问卷(BSFI)调查,并同时检测尿流率、前列腺总体积和血清睾酮。应用多元逐步回归分析方法和一元相关回归分析评价各检测变量间的相关性。结果:本组患者IPSS评分2~33(18.4±7.79)分。IIEF-5评分1~25(8.50±8.98)分,其中勃起功能障碍(ED)患者76例(86.36%)。BSFI中性欲部分评分0~8(1.92±2.21)分,其中性欲低下患者65例(72.86%);勃起功能部分评分0~16(4.18±4.96)分,其中ED患者70例(79.55%);射精部分评分0~8(2.55±3.57)分,其中射精障碍患者60例(68.18%);问题部分评分0~12(10.44±3.57)分;满意度部分评分0~4(1.90±1.37)分。统计学分析表明:年龄只与BSFI中勃起功能有显著的相关性(γ=-0.552,P=0.000),同样IIEF-5与年龄有显著的相关性(γ=-0.567,P=0.000),IPSS评分与年龄有显著的相关性(γ=0.213,P=0.047)。IPSS评分与BSFI中勃起功能和满意度有显著的相关性(γ=-0.332,P=0.002;γ=-0.302,P=0.005)。IIEF-5与BSFI中性欲、勃起功能和射精部分评分具有一致的相关性(P<0.05)。血清睾酮与年龄、IIEF-5和BSFI评分间无明显相关性(P>0.05),同样最大尿流率和前列腺总体积与IPSS、IIEF-5和BSFI评分间无明显相关性(P>0.05)。结论:年龄和LUTS是性功能障碍的危险因素,LUTS的严重程度与性功能障碍的发展密切相关。     

Association between ED and LUTS in Japanese motorcyclists

Recently, the association between motorcycling and erectile dysfunction (ED) has been reported. Also, lower urinary tract symptoms (LUTS) were reported to be associated with ED. The aim of this study is to evaluate the association of ED with LUTS in motorcyclists. We investigated the prevalence and the status of ED using a 5-item version of the International Index of Erectile Function (IIEF-5) in 150 motorcyclists. ED was diagnosed when the IIEF-5 score was less than 17. The International Prostate Symptom Score (IPSS) was also applied, and the relationship between IIEF-5 and IPSS was evaluated. Of the 150 motorcyclists, 37 (25%) had ED, and 31 (21%) had moderate or severe symptoms of LUTS (IPSS >or=8). The IIEF-5 was significantly associated with the severity of IPSS (P=0.002) and age (P<0.0001). The IIEF-5 was also significantly associated with the scores of both voiding (P<0.0001) and storage symptoms (P=0.001). On stepwise logistic regression analysis, age and storage symptoms are independent risk factors for ED in motorcyclists. LUTS seemed to be associated with ED in motorcyclists.     

On-demand use of erectile aids in men with preoperative erectile dysfunction treated by whole gland prostate cryoablation

Prostate cryoablation is an established minimally invasive treatment for localized prostate cancer (PCa). However, the impairment of erectile function (EF) is considered a serious complication of the procedure. To investigate the efficacy of erectile aids following cryotherapy, 93 patients who underwent whole gland prostate cryoablation with required complete medical records were analyzed. The changes in postoperative EF were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. Additionally, independent factors that could have a correlation to the postoperative IIEF-5 score or postoperative Expanded Prostate Cancer Index Composite (EPIC) score were assessed. In the entire cohort, the mean preoperative IIEF-5 score was 7.0 ± 6.2. A total of 72 (77.4%) patients had moderate-to-severe preoperative erectile dysfunction. In longitudinal investigation, the patients using erectile aids showed the ability to recover to baseline after 24 months from cryoablation compared with the patients not using erectile aids. There were significant differences of IIEF-5 scores between these groups at 24 months (7.5 vs 3.0; P = 0.025) and 36 months (8.5 vs 3.5; P = 0.010). In multivariate analysis, the use of erectile aids correlated with restoration of IIEF-5 scores (odds ratio, 5.11; confidence interval (CI), 1.87-13.96; P < 0.001) and lower EPIC sexual bother (coef, 19.61; CI, 0.32-38.89; P = 0.046). Our data indicate that on-demand use of erectile aids could help restore EF and reduce sexual bother after whole gland prostate cryoablation. Although, erectile aids could not play a role as an adequate treatment for ED after whole gland prostate cryoablation, these results may aid in the decision-making process for PCa patients with preoperative and postoperative ED who have concern about sexual health-related quality of life.     

Bacille Calmette‐Guérin intravesical instillation and erectile function: is there a concern?

The aim of our study was to evaluate the effect of bacille Calmette-Guérin (BCG) therapy on erectile function in a cohort of male patients affected by non-muscle invasive bladder cancer. Thirty male patients undergoing BCG treatment for non-muscle invasive bladder cancer were enrolled in the study. Their mean age was 60.4 years. None of the patients had risk factors for erectile dysfunction (ED). All subjects underwent a BCG standard schedule therapy (once weekly instillation for 6 weeks). International Index of Erectile Function (IIEF-5) and International Prostate Symptom score (I-PSS) were addressed to the patients during the treatment schedule (at fourth or fifth instillation) and 1 month after the last instillation. The mean IIEF-5 score was 17.6 +/- 6.7 during therapy and 21.7 +/- 2.92 a month after the last instillation (P=0.008). Baseline ED and the association with lower urinary tract symptoms are variables significantly connected with post-treatment results (P=0.016 and 0.00 respectively) whereas the age seems not to be related to ED (P=0.256). No major side effects were recorded. It is concluded that BCG treatment is effective for prophylaxis of non-muscle invasive bladder cancer; however, it may induce a high incidence of ED. Although this effect is transient and reversible, erectile failure is another source of psychological distress that adversely affects the quality of life of men undergoing BCG treatment.     

男性下尿路症状和勃起功能障碍的相关性分析

目的:了解社区年龄≥50岁男性人群中有下尿路症状(LUTS)者ED的患病情况,评估LUTS(梗阻症状、刺激症状)和ED之间的相关性。方法:2006年10～11月对社区年龄≥50岁、有固定性伴侣的男性进行IPSS、IIEF-5调查,调查对象均签署知情同意书,完成规定问诊及相关检查,应用统计学方法对IPSS评分、梗阻症状评分以及刺激症状评分与勃起功能之间的相关性进行分析。结果:共调查245例,171例有LUTS患者中ED患病率为81.9%(140/171),无LUTS患者74例作为对照组,ED患病率为29.7%(22/74)。LUTS组中各年龄组ED的患病率分别为:50～59岁73.1%(38/52)、60～69岁82.1%(46/56)、≥70岁88.9%(56/63),各年龄组之间IPSS、IIEF-5比较差异有显著性(P<0.01),各年龄组之间轻、中、重度ED所占比例比较差异有显著性(P<0.01)。LUTS组中IPSS评分程度分布:轻度80例(46.8%)、中度67例(39.2%)、重度24例(14.0%),不同程度LUTS中ED者所占比例分别为:轻度LUTS71.3%(57/80)、中度LUTS89.6%(60/67)、重度LUTS95.8%(23/24),LUTS程度和ED患病率之间有显著相差性(r=0.52,P<0.01)。171例平均梗阻症状评分(3.1±3.6)分,梗阻症状与IIEF-5评分相关系数r=-0.41(P<0.01),平均刺激症状评分(6.8±4.9)分,刺激症状与IIEF-5评分相关系数r=-0.59(P<0.01)。结论:社区LUTS人群中ED有较高的患病率,LUTS程度和ED患病率显著性正相关,与梗阻症状相比刺激症状对中老年男性性生活的影响更大。在治疗LUTS的同时应该考虑ED问题,以求更有效改善患者生活质量。     

Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms： results from a center with over 500 patients

Aim:To identify possible risk factors for erectile dysfunction(ED)after transurethral resection of prostate(TURP)for benign prostatic hyperplasia(BPH).Methods:Between March 1999 and March 2004,629 patients underwentTURP in our department for the treatment of symptomatic BPH.All patients underwent transrectal ultrasoundexamination.In addition,the flow rate,urine residue,International Prostate Symptom Score(IPSS)and quality of life(QOL)were recorded for those who presented without a catheter.Finally,the erectile function of the patient wasevaluated according to the International Index of Erectile Function Instrument(IIEF-5)questionnaire.It was deter-mined that ED existed where there was a total score of less than 21.The flow rate,IPSS and QOL assessment wereperformed at 3 and 6 months post-treatment.The IIEF-5 assessment was repeated at a 6-month follow-up.A logisticregression analysis was used to identify potential risk factors for ED.Results:At baseline,522(83%)patientsanswered the IIEF-5 questionnaire.The mean patient age was(63.7±9.7)years.The ED rate was 65%.After 6months,459(88%)out of the 522 patients returned the IIEF questionnaire.The rest of the group was excluded fromthe statistical analysis.Six months after TURP,the rate of patients reporting ED increased to 77%.Statisticalanalysis revealed that the only important factors associated with newly reported ED after TURP were diabetes mellitus(P=0.003,r=3.67)and observed intraoperative capsular perforation(P=0.02,r=1.12).Conclusion:Theincidence of postoperative,newly reported ED after TURP was 12%.Risk factors for its occurrence were diabetesmellitus and intraoperative capsular perforation.(Asian J Androl 2006 Jan;8:69-74)     

'Multimodal' approach to management of prostate biopsy pain and effects on sexual function: efficacy of levobupivacaine adjuvant to diclofenac sodium – a prospective randomized trial

We assessed the analgesic efficacy of levobupivacaine when administered as an adjuvant to diclofenac sodium in prostate biopsy pain management and effects of prostate biopsy on sexual function. Ninety patients underwent transrectal ultrasound (TRUS)-guided biopsy of the prostate and were randomly assigned to three groups: group D received diclofenac sodium suppository; Group L received periprostatic injection of levobupivacaine; group DL received diclofenac suppository and levobupivacaine in addition. Patients were asked to use a visual analogue scale score (VAS) questionnaire about pain after 10 core prostate biopsy. Sixty-two patients reported to be prostate cancer-free underwent further evaluation with the International Index of Erectile Function-5 (IIEF-5) questionnaire at 1 and 3 months after biopsy. Mean pain scores during prostate biopsy were significantly lower in group DL and were superior to the group L and group D ( P  < 0.001). Mean IIEF-5 score prior to biopsies was significantly higher when compared with the mean IIEF-5 score 1 month after biopsy ( P  < 0.0001). Mean IIEF-5 scores 1 month after biopsy were significantly lower when compared with the mean IIEF-5 scores 3 months after biopsy ( P  = 0.002). TRUS-guided prostate biopsies have a statistically significant impact on short-term erectile function, but this difference is not clinically significant; however, medium-term erectile function is not affected both statistically and clinically.