A definitionErectile dysfunction (Erectile Dysfunction, ED) refers to a lack of sustained erection of the penis for satisfactory sexual acti
Erectile dysfunction (Erectile Dysfunction, ED) refers to a lack of sustained erection of the penis for satisfactory sexual activity.
Use ED to replace "impotent" because "impotent" reflect is serious, complete ED, and mild ED uses "impotent" it is not exact, and "impotent" the meaning of sexual impotence (impotence), it is derogatory meaning.
Organic or abnormal vessels, nerve, endocrine and cavernous structure of lesions.
Psychological: the inhibition of mental and psychological factors.
Mixing: organic and psychological factors exist simultaneously.
Results of the Massachusetts Male Aging Study (MMAS): ED affects more than half of 40 - to 70 year old men, of whom 1/3 is moderate to complete ED.
Schematic diagram of penile erection
Four, erection mechanism
1 hemodynamic regulation
The penis contains three column like structures, respectively is two and a penis cavernous body of urethra. Each honeycomb structure is within the cavernous trabecular separation, composed of smooth muscle cells, fibroblasts, composed of collagen and elastin, the cavity covered with vascular endothelial layer similar to the sponge, the blood vessels in the body is divided into a plurality of supply sponge. When the sex of Xing, the excitement of the parasympathetic nerve leads to smooth muscle relaxation, arterial blood flow and expansion of sinus cavity directly increases, and the small vein compression, blocked, the reflux disorder only in the penis, and urethral sponge is not affected. Ischiocavernous muscle synergies, erectile rigidity, further limiting the venous return.
2 nerve regulation
(1) central regulation of the brain
Sensory stimuli such as vision, hearing, smell, touch, etc.
Fear, grief, tension, altitude flight, interference, brain, sexual inhibition
(2) central modulation of spinal cord
The sympathetic nerve (psychological erectile central):T11L2 accept psychological stimulation caused by impulse
Sympathetic nerve (reflex erection Center):S2 - S4 to accept the glans penis or urethral stimulation caused by impulse
(3) partial nerve regulation of penis
The central neural connections of ilioinguinal nerve and perineal nerve, pudendal nerve, dorsal penile nerve and spinal cord and brain to control erectile or flaccid.
(4) neural mediators: there are two kinds of neural mediators related to erection:
A: nitric oxide (NO)
B: apomorphine: relax neurotransmitter cavernous smooth muscle, can promote erectile function
3 hormone regulation
The FSH (LH) produced by the hypothalamic gonadotropin releasing hormone (GnRH) regulates the production of testosterone and spermatogenic function (PRL), and the level of testosterone can be regulated by regulating the secretion of PRL.
Five, common ED related risk factors: 70-90% of ED was related with some common diseases, drugs and lifestyle
(a) chronic disease
Systemic diseases: hypertension, arteriosclerosis, I, type II diabetes, cardiovascular disease, depression, renal failure, liver failure, etc..
Nervous system diseases: Alzheimer's disease, multiple sclerosis, etc..
Penile diseases: painful nodules.
Mental illness: tension, anxiety, etc.
Endocrine disorders: hyperthyroidism, hypothyroidism, sexual dysfunction, high Rusu in cui.
(two) surgery and trauma
Nervous system damage: spinal cord injury.
Pelvic injury: injury, surgery, pelvic radiotherapy, etc..
Urinary system injury: radical prostatectomy, transurethral resection of the prostate (TURP), etc..
(three) drugs and other factors that may change.
Some drugs: antihypertensive drugs, heart disease, central nervous system drugs, tricyclic antidepressants, non steroidal anti-inflammatory drugs, etc..
Smoking, drinking, etc..
Six. Diagnosis and evaluation of erectile dysfunction
(a) the diagnosis should include a detailed history and physical examination
1 of the 2 history; 3 life history; physical examination; 4 laboratory examination; 5 if the laboratory abnormalities, suggestions for further examination and consultation; the necessary or the patient wants to further examinations to determine the causes and willing to accept a check, can be used for further examination. Recommended in this case to find expert advice.
(two) ED diagnosis based on patient treatment goals
Because of the particularity of the treatment of erectile dysfunction, the majority of patients prefer non-invasive or minimally invasive treatment, rather than choose a large trauma treatment. But in the past ten years, with the continuous progress of the erection mechanism, a new noninvasive or invasive treatment of small launch, which the patient's wish fulfilled, so the diagnosis of ED should also be the least invasive, start detection method of cost.
1 medical history: including a history of sexual life, past history of surgical disease, history of surgery and trauma, medication and bad habits, etc..
2 physical examination: signs of vascular, endocrine, and neurological disorders associated with ED.
3 laboratory tests: fasting blood glucose, blood routine.
The above three items are the most basic diagnostic procedure, and the following items should be recommended if necessary, based on the positive findings in the diagnosis and the treatment options to be selected.
1 oral medicine, vacuum constriction device (VCD) or MUSE: unless the patient asked to know the exact cause of ED, otherwise there is no need to do further costly and painful examination.
2 psychological treatment: if necessary with NPT or intracavemous injection plus stimulation combined test (CIS).
3 in vivo injection (ICI) therapy: CIS, or Doppler ultrasound.
4 penile prosthesis implantation: NPT, CIS
5 penile venous surgery: NPT, CIS, Doppler ultrasound, angiography and cavernosal pressure.
6 penile artery surgery: NPT, CIS, Doppler ultrasound, penile angiography
Seven, the treatment of ED
Under the principle of evidence-based medicine (Evidence Based Medicine) under the guidance of Urology, andrology experts will be divided into first-line ED treatment, second-line and three line treatment.
First line therapy - noninvasive therapy, first choice therapy
Cause of disease treatment: is the most basic and most important treatment, try to find out the cause of ED to be removed.
(two) psychotherapy: targeted psychotherapy. Focus on knowledge education and psychological counseling to eliminate anxiety. Sexy focused training: behavioral therapy combined with behavioral and sexual education initiated by Masters and Johnson in 60s.
(three) drug treatment:
Hormonal drugs: available for both primary and secondary hypogonadism. Testosterone preparation, HCG, etc..
Non hormonal drugs:
Henbin is a reversible alpha 2- adrenoceptor antagonist, which began to be used in 60s, which is 46% effective in psychological ED, and is not effective for organic ED.
The phentolamine: non selective alpha adrenergic receptor antagonists, 1988 began treatment with oral ED, efficiency of 3050%.
The apomorphine: dopamine agonist, can stimulate CNS and the dopamine receptor, also can be applied to the corpus cavernosum smooth, on the psychological ED efficiency of 32-60%, but more side effects limit its use.
The sildenafil (Sildennafil): is a specific phosphodiesterase type 5 inhibitor, can inhibit the degradation of cGMP, increase the concentration of cGMP, promote the cavernous smooth muscle was effective for relaxation, mental, organic and mixed ED, the total efficiency of 60 - 70%.
Topical creams, ointments;
The nitroglycerin (2% ointment): only can increase the penis filling, rarely erect completely, side effects include dizziness, headache, hypotension, less.
The three one: cream containing 3% aminophylline, 0.25% two isosorbide sugar ester, 0.05%Codergocrine, about 60% can improve erectile.
The prostaglandin E1:0.01% gel preparation, can increase the cavernosal artery diameter and blood flow.
The traditional Chinese medicine: aphrodisiac, such as three treasure etc..
(four) vacuum suction device (Vacuum Constriction Device, VED)
The principle of VCD is to use the principle of vacuum suction to make the penis hyperemia swelling to achieve the hardness of the sexual intercourse, the ring will be pushed to the root of the penis, to prevent blood backflow, after the removal of the vacuum tube to maintain the hardness of sexual intercourse. 92% can produce 72% erection, can finish sexual intercourse, applicable to various types of ED, but to the cavernous fibrosis and Peyronie's disease (Peyronie disease) effect.
(a) Urethral (Medicated System for Erection, MUSE) was approved by the FDA in 1982
The use of methods for medication before micturition time, then the MUSE device is inserted into the urethra 3cm, push the device to make PGE1 pills in mid urethral, remove the MUSE device with side Qingrou penis while standing and walking 10 to 15 minutes, 60 minutes, 30 sustained erection, dose from 125ug to 1000ug is suitable for all kinds of It differs from man to man.. ED, the total effective rate was 66%; the main side effects were urethral pain (30%); growth period husband using MUSE should wear a condom, because of residual PGE1 in semen, offspring of.
(two) (Infracorporal Injection Therapy intracavernous injection therapy, ICI)
80s began to apply to a variety of ED. Commonly used drugs and methods
1 (PAP) + papaverine phentolamine (PHEN): PAP 30-60mg, PHEN 0.5-1mg, proximal side injection from the penis with a OT needle.
The PGE1 has fast metabolism and no systemic reaction, no cavernous fibrosis and scar formation, priapism rate low dose 10-20ug, priapism time 0.5-4 hours.
The PAPPHENPGE1:PAP 50mgPHEN 0.4mgPGE1 mixture 20, each 0.5ml intracavernous injection of 45% to fully erect.
Three wire treatment (surgery, penile prosthesis implantation)
(a) penile prosthesis implantation: suitable for first, second line treatment invalid ED patients
1 semi rigid (flexible) prosthesis. 2 expandable prosthesis: (one piece, two pieces, three pieces)
(two) penile revascularization: vascular ED, pioneered by Michal in 1973.
1 arterial reconstruction:
The abdominal wall A penis kiss and operation; the inferior epigastric A dorsal penile A anastomosis
The abdominal wall under the A dorsal A, V anastomosis; the deep dorsal artery of V
The abdominal wall A A anastomosis of penis.
The recent efficiency 4080%, long-term effect.
2 venous fistula surgery:
The deep penile vein ligation; the penis foot ligation
The penis vein ligation; the internal iliac vein ligation
The short-term effective rate of 60-70%, the long-term effect is poor.