Erectile dysfunction
Erectile dysfunction
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DOI：
10.1016/j.purol.2013.01.010
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发表时间：
2013-07-01
影响因子：
1.1
通讯作者：
Droupy, S.
中科院分区：
文献类型：
--
作者：
Giuliano, F.;Droupy, S.
导论. - 勃起功能障碍（艾德）是最常被研究的性功能障碍。艾德的定义是持续或反复的不能达到和/或维持足以进行性活动的阴茎勃起。- 复习相关医学文献并结合作者的专家意见。- 对艾德患病率的回顾显示，50岁以下男性的患病率低于10%，60岁以上男性的患病率上级20%。年龄，心血管疾病，糖尿病，高胆固醇血症，吸烟，抑郁症和精神疾病，心理障碍，不利的社会经济条件都是勃起功能障碍的危险因素。药物的性副作用也必须考虑到。勃起功能障碍可以是心因性的，器质性的或两者的混合。病理生理学机制是多种多样的，并且可能涉及从动脉供应到阴茎的中枢或外周神经通路的恶化、内皮功能障碍、平滑肌张力受损、勃起组织的窦腔的结构损伤、或甚至激素紊乱。心理和性学管理可以帮助一些患有心因性勃起功能障碍的患者，通常与药物治疗有关。磷酸二酯酶5型抑制剂（PDE 5i）按需或每日使用是三分之二所有形式勃起功能障碍患者的有效对症治疗。糖尿病患者，根治性椎间盘切除术后和/或严重的心血管疾病对PDE 5i反应较差。海绵体内注射PGE 1或真空泵为大多数患者提供二线治疗。阴茎植入物是第三线治疗，当适应症被仔细确定时，效果会很好。- 艾德检查和治疗高度标准化。治疗成功率很高。(C)2013年Elsevier Masson SAS。All rights reserved.
Introduction. - Erectile dysfunction (ED) is the most commonly studied sexual disorder. ED is defined by a consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual activity.Methods. - Medical literature was reviewed and combined with expert opinion of the authors.Results. - A review of ED prevalence is less than 10% in men aged below 50, superior to 20% for men over 60. Age, cardiovascular diseases, diabetes, hypercholesterolemia, smoking, depression and psychiatric illness, psychological disorders, unfavorable socio-economic conditions are all risk factors for erectile dysfunction. Drug sexual side-effects must also be envisaged. Erectile dysfunction can be psychogenic, organic or a mix of both. The pathophysiological mechanisms are diverse and can implicate deterioration of the central or peripheral neural pathways, from the arterial supply to the penis, endothelial dysfunction, smooth muscle tone impairment, structural damage of the sinusoidal spaces of the erectile tissue, or even hormonal disorders. Psychological and sexological management can help some patients suffering from psychogenic erectile dysfunction, usually associated with pharmacological treatment. Phosphodiesterase type 5 inhibitors (PDE5i) on demand or daily are an efficient symptomatic treatment in two thirds of patients with all forms of erectile dysfunction. Diabetic patients, after radical prostatectomy and/or with severe cardiovascular diseases respond poorly to PDE5i. Intracavernous injections of PGE1 or vacuum pump provide second line treatment for most patients. Penile implants are third line treatment and when the indication is carefully established give excellent results.Discussion. - ED work-up and treatment are highly standardized. Therapeutic success rates are high. (C) 2013 Elsevier Masson SAS. All rights reserved.