无创性动态阴茎海绵体测压初探

目的 :初步评价VISER软件进行无创性动态阴茎海绵体测压在ED诊断中的应用。　方法 :采用AquariusXLT型尿流动力学仪配置的VISER软件 ,辅助眼镜式影像仪听觉视觉性刺激 (AVSS)或阴茎海绵体内血管活性药物注射 (ICI)进行无创性动态海绵体测压 68例 ,其中ED病人 4 8例 ,正常对照 2 0例。　结果 :正常对照 2 0例均可通过AVSS诱发勃起 ;4 8例ED病人中 ,18例单纯通过AVSS可诱发勃起 ,占 3 7.5 % ;3 0例单纯AVSS无效者 ,给予罂粟碱 10mg海绵体内注射 ,其中 19例出现勃起 ,占 63 .3 %。VISER检查结果表明 ,除受ICI影响 ,ED罂粟碱组的勃起平均时间延长外 ,勃起数据和峰值数据中的其他多项指标ED各组均低于对照组 ,尤其表现为勃起和峰值总能量降低。　结论 :VISER具有精确的动态阴茎海绵体测压功能 ;辅助眼镜式影像仪有助于增强AVSS的效果和减少阴茎海绵体ICI剂量 ;由于VISER检查具有无创、准确、便捷等优点 ,有望成为今后ED诊断的首选方法。     

勃起功能障碍病人阴茎海绵体血浆中降钙素基因相关肽含量的研究

目的　了解阴茎勃起前后 ,阴茎海绵体内血浆中降钙素基因相关肽 (CGRP)含量。方法　对不同组受检者行海绵体内注射生理盐水、盐酸罂粟碱、盐酸罂粟碱和酚妥拉明混合液。每次注药间隔时间超过 3 0分钟 ,注药前后取海绵体内血液测定CGRP含量。结果　正常人及各类ED在海绵体内注射血管活性药物后阴茎均发生勃起。在阴茎勃起过程中海绵体内血浆CGRP含量升高 (P <0 .0 5 )。周围静脉注射罂粟碱和酚妥拉明混合液的受检者 ,注药后周围静脉血浆CGRP含量无变化 (P >0 .0 5 )。结论　CGRP是参与人类阴茎勃起的重要神经递质     

海绵体内注射亚甲蓝治疗阴茎异常勃起

20 0 1年 3月～ 2 0 0 2年 6月 ,我们采用海绵体内注射亚甲蓝治疗因注射罂粟碱等血管活性药物而导致的阴茎异常勃起病人 5例 ,疗效满意 ,报告如下。1　资料和方法1.1　临床资料　本组病人 5例 ,年龄 2 9～ 4 8岁 ,平均 4 2 .5岁 ,均因治疗勃起功能障碍 (erectiledisfunc tion ,ED)行阴茎海绵体注射罂粟碱 +酚妥拉明导致阴茎长时间勃起。发病至就诊时间 4～ 9h ,平均 6.4h。其中 2例就诊前于外院行阿拉明海绵体内注射、海绵体穿刺抽吸等无效后转来我院。1.2　治疗方法　先行海绵体穿刺抽吸 ,抽出瘀血30～ 5 0ml,然后将 1%亚甲蓝注射液 (江苏…     

中药振阳煎对动脉性勃起功能障碍患者阴茎血流动力学的影响

目的:通过中药振阳煎对动脉性勃起功能障碍(ED)患者阴茎血流动力学的临床观察,探索对动脉性ED 患者有效的治疗方法。　方法:47例(40～49岁)动脉性ED患者,用中药振阳煎口服治疗1个月,治疗前后均采 用罂粟碱30mg+酚妥拉明1mg进行阴茎海绵体内注射(ICI),并运用双功能彩色多普勒超声检查治疗前后阴茎 左右海绵体动脉收缩期最大血流流率(PSV)。　结果:47例患者经中药振阳煎治疗后,左右两侧海绵体动脉PSV 明显改善(P<0.05)。　结论:中药振阳煎能明显改善动脉性ED患者的阴茎海绵体动脉血流,有效促进阴茎勃起。     

海绵体内法射血管活性药物治疗勃起障碍渐进性方案的三年经验

为了探讨 4种不同方案 (罂粟碱 +酚妥拉明 ;前列腺素Ｅ1;罂粟碱 ,酚妥拉明和前列腺素Ｅ1;硫酸阿托品 +罂粟碱 +酚妥拉明 +前列腺素Ｅ1)进行阴茎海绵体注射的近期和远期疗效 ,作者对 62 5例年龄2 6～ 85岁之间的勃起功能障碍患者进行了渐进性治疗。所有患者首先接受方案 1的治疗 ,药物剂量为罂粟碱 6～ 2 5ｍｇ ,酚妥拉明 0 .0 5到 2 0ｍｇ ,时间间隔为 4～ 6天 ,阴茎与身体呈 80°～ 90°角 ,注射后 5～ 2 0分钟能成功插入阴道为治疗后的阳性反应 ,即阴茎大于 80 %最大硬度 ,否则为治疗失败。对于治疗失败者用方案 2进行治疗 ,当ＰＧＥ1达 2…     

无创性动态阴茎海绵体测压的临床应用

目的　初步评价应用VISER软件行无创性动态阴茎海绵体测压在阳萎 (ED)诊断中的作用。　方法　采用AquariusXLT型尿动力学仪配置的VISER软件 ,辅助眼镜式影像仪听觉视觉性刺激 (AVSS)或阴茎海绵体内血管活性药物注射 (ICI)进行无创性动态海绵体测压 39例 ,其中ED患者 32例 ,正常对照 7例。　结果　正常对照 7例均可通过AVSS诱发勃起 ;32例ED患者中 ,13例单纯AVSS可诱发勃起 ,占 4 0 % ;19例单纯AVSS无效者 ,给予罂粟碱 10mg海绵体内注射 ,其中 13例出现勃起 ,占 6 8%。结果除ED罂粟碱组勃起平均时间延长外 ,勃起数据和峰值数据中的其他多项指标ED各组均低于对照组 ,尤以勃起和峰值总能量降低明显。　结论　VISER具有精确的动态阴茎海绵体测压功能 ;辅助眼镜式影像仪有助于增强AVSS效果和减少阴茎海绵体血管活性药物注射剂量 ;VISER检查具有无创、准确、便捷等优点 ,有望成为ED诊断的首选方法     

阴茎深动脉彩色多普勒超声检测时血管活性药物的剂量选择

彩色多普勒超声(color Doppler ultrasono-graphy,CDU)目前已广泛应用于血管性勃起功能障碍(ED)的诊断,检查前用作阴茎海绵体内注射(In-tracavernosal injection ICI)的血管活性药物大多为罂粟碱和酚妥拉明,但不同剂量血管活性药物对阴茎深动脉CDU检测的结果是否有影响,目前报道尚少,本文分4组用不同的剂量分别进行CDU检测,以探讨ED患者CDU初次检测所需的最佳血管活性药物剂量,现报告如下:     

NO供体作用阴茎海绵体前后血液生化研究

目的 :通过阴茎海绵体血生化指标的检测 ,探索NO在阴茎海绵体平滑肌中的作用。　方法 :选取 42例勃起功能障碍病人 ,采用NO供体硝普钠进行阴茎海绵体内注射 (ICI) ,注射前后血气分析及血NO含量测定 ,所有病例均采用罂粟碱 /酚妥拉明ICI进行对比。　结果 :(1)阴茎海绵体血液NO含量ICI前后有明显变化 ,而硝普钠作用效果优于罂粟碱 /酚妥拉明。 (2 )血气分析方面 :两类药物ICI前后对比 ,PO2 及O2 Sat均存在显著性差异 ;硝普钠注射前后pH值无显著差异 ,而罂粟碱 /酚妥拉明ICI前后有显著性差异 ,而这两种制剂效果之间相比 ,pH ,PO2 值之间存在显著性差异 ,O2 Sat值之间无显著性差异。　结论 :硝普钠系一良好的NO供体 ,而NO可导致阴茎海绵体平滑肌舒张 ,血流增加 ,且其模拟内源性血管扩张较其他药物介质更符合人体自身生理机制。     

西多芬单用或与三种药物海绵体注射联合应用治疗海绵体注射无效的阳萎

为评价西多芬 (Ｖｉａｇｒａ)对海绵体注射治疗无效的阳萎患者的治疗作用 ,作者于 1998年 4月～ 10月间对 93例 2 4～ 77岁 (平均 5 3 6岁 )海绵体注射治疗无效的慢性勃起功能障碍患者进行了临床研究。患者勃起障碍的原因分别为动脉性 2 9例 ,海绵体静脉漏 36例 ,混合性血管原因 2 4例 ,心理性 3例 ,顽固性勃起后海绵体硬结 1例。 93例均为用大剂量前列腺素Ｅ或与罂粟碱、酚妥拉明三种药联合海绵体注射治疗失败的患者。 32例 (34 % )单纯用西多芬治疗有效 ,其中 30例需 10 0ｍｇ ,2例需 5 0ｍｇ。2 9例 (31% )西多芬与海绵体注射联合治疗有…     

615例阴茎海绵体自体注射血管活性药物治疗阳萎

作者1982-1987年治疗615例阳萎患者,年龄19～75岁。精神性阳萎27.47%。器质性阳萎25.2%,混合性阳萎47.3%。治疗前根据性交次数,插入阴道口控制射精能力,确定性活动指数(SAI)0～10分钟。据此将病人分成四组,取罂粟碱8毫克或ceritine(罂粟碱与5种血管活性药组成)8单位阴茎海绵体注射,视觉性刺激试验,注药前,勃起10分钟内及视觉性刺激终止3分钟内,连续测定阴茎海绵体硬度和体积,视觉性刺激一半以上时间呈完全性勃起(硬度75或>PR),视觉性刺激停止后维持勃起1分钟者,均作自体注射,余行阴茎海绵体流量测定。维持勃起流量<50毫升/分者,仍可行自体注射。用药前由医生对病人作自体注射训练,每次注射ceritine剂量不大于1毫升,嘱咐患者根据阴茎勃起持续时间和     

Intracavernous injection of vasoactive drugs for treating erectile impotence

Intracavernous injection of various vasoactive drugs was performed in six erectile failure patients. The effects of each drug were evaluated in four grades: complete functional erection, incomplete functional erection, nonfunctional expansion and no effect. When papaverine hydrochloride (40 mg/ml) was administered, 4 of the 6 patients had nonfunctional expansion. By administering a mixture of 80 mg/ml papaverine hydrochloride with 1.0 mg/ml phentolamine mesylate, nonfunctional expansion was seen in four patients and incomplete functional erection in two patients. As for the effects of prostaglandin E1, incomplete functional erections were seen in all patients, while complete functional erection was seen in two patients. These findings indicated that the patients reacted differently to the same vasoactive drug, and that the papaverine and phentolamine mixture had a stronger effect than papaverine alone, while prostaglandin E1 had the strongest effect on erection. Intracavernous injection of the these drugs is useful for the treatment and differential diagnosis of impotence.     

Studies on intracavernosal VIP levels during pharmacologically induced penile erections

Intracavernosal and peripheral venous vasoactive intestinal polypeptide (VIP) levels were measured in men with predominantly organic or predominantly psychogenic impotence. The measurements were taken at intervals up to 30 min following intracavernosal injections of saline, papaverine hydrochloride and papaverine hydrochloride and phentolamine. Levels were also measured after tactile and visual sexual stimulation and following an intravenous injection of papaverine and phentolamine. A penile erection occurred in all men receiving intracavernosal vasoactive compounds. The mean VIP concentration did not alter significantly in either cavernosal or peripheral venous blood during the erection. Mean VIP concentrations were significantly greater in the neurogenic (all diabetic) group than in the other groups studied. Mean cavernosal and peripheral VIP concentrations did not alter following tactile or visual sexual stimulation and no significant alteration in mean peripheral venous VIP concentration occurred following injection of papaverine and phentolamine. The putative role of VIP in the induction of penile erection has not been elucidated in these studies.     

Intracavernous self-injection with phentolamine and papaverine for the treatment of impotence

To evaluate the efficacy and safety of intracavernous self-injection of phentolamine and papaverine for the treatment of impotence, 30 patients were enrolled in a prospective, randomized, double-blind, placebo-controlled cross-over study of papaverine and phentolamine versus normal saline. A total of 29 patients completed the study. The phentolamine plus papaverine combination resulted in erection in 24 patients (82.8 per cent) and no erection occurred after injection of saline. Of the patients 12 (41.4 per cent) experienced technical difficulties with the injection. Ecchymosis of the penis at the site of injection was common and 1 patient experienced priapism that resolved spontaneously. No other side effects occurred. Intracavernous self-injection with phentolamine and papaverine appears to be a safe and effective treatment of impotence but long-term effects must be determined.     

Intracavernous injection of prostaglandin E1 in combination with papaverine: enhanced effectiveness in comparison with papaverine plus phentolamine and prostaglandin E1 alone

We compared the erectile response to intracavernous injection of a combination of papaverine and prostaglandin E1 with that of a combination of papaverine and phentolamine (49 patients), and prostaglandin E1 alone (38). The degree of erection achieved was significantly better with papaverine plus prostaglandin E1 than with papaverine plus phentolamine and the duration of erection was less, although the incidence of prolonged erections (greater than 5 hours) was similar with both combinations. Papaverine with prostaglandin E1 likewise resulted in a significantly better degree of erection than prostaglandin E1 alone (prolonged erections occurred only after the drug combination). All erections subsided spontaneously and none required medical intervention throughout the study. Pain was noted only after injection of prostaglandin E1. The incidence was clearly lower (7 of 38 versus 13 of 38) after the injection of only 5 micrograms. prostaglandin E1 in combination with papaverine (although the difference is not statistically significant). Subjectively, the side effects caused by the drug combination were described as much less dramatic by the patients than after prostaglandin E1 alone. The combination of papaverine and prostaglandin E1 shows a clearly synergistic effect and might suitably replace papaverine plus phentolamine or prostaglandin E1 alone in patients who do not respond well or suffer side effects after high single doses.     

硝普钠阴茎海绵体内注射治疗阳萎的临床研究

本研究选择４２例阳萎患者，采用硝普钠进行阴茎海绵体注射（ＩＣＩ），并选择罂粟碱／酚妥拉明进行对照，结果表明，硝普钠ＩＣＩ后：（１）阴茎外形性状（长度、周径等）明显改变。（２）Ｖｉｒａｇ硬度计点表明硝普钠与罂粟碱／酚妥拉明效果之间无明显差别。（３）所有测试患者无一例出现低血压或局部不适等副反应，与罂粟碱／酚妥拉明相比各有优劣，但总体差异不大，这充分表明，硝普钠作为一种ＮＯ供体可导致阴茎平滑肌松弛，血窦充盈阴茎勃起，其副反应较小，有其临床应用之价值。     

Efficiency and side effects of prostaglandin E1 in the treatment of erectile dysfunction

The efficiency and side effects of a single dose of intracorporeally applied prostaglandin E1 (20 mcg.) in inducing penile erection were examined. In addition, the effect of this dose of prostaglandin E1 was compared to the effect of 7.5 mg. papaverine plus 0.25 mg. phentolamine in a double-blind, crossover designed study. We tested twice 12 men 52.9 +/- 7.6 years old (mean +/- standard deviation) with erectile dysfunction. On 1 occasion the subjects received 20 mcg. prostaglandin E1 and on the other they received 7.5 mg. papaverine and 0.25 mg. phentolamine. At this dosage prostaglandin E1 was most effective in inducing artificial penile erection (11 of 12 patients). However, 75 per cent of the subjects reported burning sensations during the entire period of erection and in 1 prostaglandin E1 treatment resulted in a sustained erection. At the doses used, prostaglandin E1 was more effective in inducing penile erection than papaverine plus phentolamine (11 versus 6 patients). Intracavernous injection of prostaglandin E1 is a potent tool for artificial penile erection and warrants precise examination for its potential clinical use.     

Comparison of Alprostadil (Caverject) and a combination of vasoactive drugs as local injections for the treatment of erectile dysfunction

The efficiency and side effects of a single dose of 20 mcg of intracorporeally applied Alprostadil (Caverject, Upjohn), a prostaglandin E1, in inducing penile erection were examined in 30 patients. In addition, the effect of this dose of prostaglandin E1 was compared to that of 30 mg of papaverine plus 0.5 mg of regitine (phentolamine). All patients received a first injection of the combination of the vasoactive drugs and a second injection of the prescribed dose of Caverject. The degree of erection, time interval between injections and achievement of full erection as well as side effects during and after injection were compared. All patients had a burning sensation during the inejction of Caverject. Two patients given the vasoactive combination got priapism and were evacuated; this complication was not reported for Caverject. In the doses used Caverject was superior to papaverine plus phentolamine in inducing penile erection and in achieving a higher grade of erection.     

Pharmacologically induced erections among geriatric men

Intracavernous injection of vasoactive drugs for the treatment of erectile impotence has become a standard therapeutic technique. Previous reports detailing experience with this treatment are based on patient populations significantly younger than most patients who suffer from impotence. The geriatric population, which comprises the majority of patients with importance, is unique due to the physical, psychological and social changes associated with the aging process. To characterize better elderly men with impotence, and determine whether intracavernous injection therapy is safe and effective in this age group, a retrospective analysis was performed upon patients attending the male sexual dysfunction clinic at our university medical center who received a standard papaverine and phentolamine mixture (30 mg. papaverine and 1.0 mg. phentolamine per ml.). The etiology of impotence, degree of patient satisfaction and complication rate of 65 patients 65 years or older (mean age 70 years) undergoing papaverine plus phentolamine self-injection therapy were compared to a similar size group of impotent men approximately 20 years younger (mean age 47 years). Significant differences in etiology of impotence were evident between the 2 groups. Treatment response rates were equal for the 2 age groups although elderly patients required a higher dose of papaverine and phentolamine to obtain an erection, and used the medication less frequently. Complications were few, of minimal consequence and occurred with equal frequency between the 2 age groups.     

Penile function following intracavernosal injection of vasoactive agents or saline

Few studies on the pharmacological assessment or treatment of impotence have included controls. In a double-blind crossover study, 18 impotent men received either a 2 ml injection of a solution containing 30 mg papaverine and 1 mg phentolamine or a similar volume of normal saline into the corpus cavernosum. The immediate and delayed effects (4 weeks later) were assessed independently and the alternative injection then given. All injections with papaverine and phentolamine were followed by an immediate increase in penile length and rigidity, and 70% of these patients were able to have sexual intercourse for periods of 1 to 4 weeks. No change in penile length or rigidity occurred following the saline injection and only one patient showed some improvement in erection over the next 4 weeks. In the crossover study, no patient developed any increase in length or rigidity of the penis following injection of saline, and improvement in spontaneous erection occurred in only two cases. In contrast, all patients who received papaverine and phentolamine had an increase in penile length and rigidity, and 50% were able to have normal sexual intercourse over the next 4 weeks. This study confirms the value of a combination of vasoactive agents in the management of impotence, irrespective of its aetiology, and suggests that any placebo effect is minimal in this group of patients with considerable psychological overlay.