重度原发性勃起功能障碍患者的临床特点

The Clinical Features of Patients with Severe Primary Erectile Dysfunction

目的:研究重度原发性勃起功能障碍(severe primary erectile dysfunction,S-PED)的临床特点,探讨理想的治疗方法。方法:本研究所选对象为从初次性生活至今-直主诉勃起功能障碍(ED)的患者。了解患者的性生活史和婚姻状况,应用勃起功能国际问卷(IIEF-5)评估勃起功能。对PDE5抑制剂无反应的患者施以性激素、CDDU、阴茎海绵体造影和神经肌电图检查。并对因S-PED而行阴茎起勃器植入手术的效果进行随访。结果:从220例原发性ED患者中筛选出对PDE5抑制剂无反应的S-PED患者共72例(32.7%),年龄(31.5±4.5)岁。其中68例(94.5%)有器质性疾病,包括动脉性13例、静脉性35例、内分泌性6例、神经性9例、以及海绵体纤维化5例。67例(93.5%)并发精索静脉曲张。95.8%的患者生活质量受到明显影响,93.1%的配偶双方对性生活不满意,甚至有22.2%的患者因此而离异。25例(34.7%)行阴茎起勃器植入手术,术后平均随访时间5.6年,患者IIEF-5和生活质量较术前明显改善(P<0.01),患者和配偶满意率分别为93.4%和92.3%,无严重并发症。结论:S-PED严重影响年轻夫妇的生活质量,其主要病理学异常为静脉性因素。阴茎起勃器植入手术治疗S-PED安全有效。

Objective： To investigate the clinical features of patients with severe primary erectile dystunction （S-PED） and discuss an ideal treatment option. Methods：Patients who have complained erectile dysfunction （ED） since initial sexual intercourse were involved in our study. Sexual history and marriage condition were evaluated and erectile function was evaluated by IIEF5 scores as well. A multidisciplinary diagnostic approach including sexual hormone analysis, color duplex Doppler ultrasound, neuro-electromyogram and cavernosography was carried out for those PDE5 inhibitor non-responders. The efficacy of penile prosthesis implantation for patients with S- PED was followed up. Results：Seventy two cases （32.7 %） were suffered from P SED with PDESi non-responders among of 220 cases primary ED. The mean age was （31.5±4.5） years, 68 cases （94.5%） were organic disorder include arteriogenic 13 cases, venogenic 35 cases, endocrine factor 6 cases, neurologie 9 cases, fibrosis of cavern ous 5 cases. Sixty-seven cases （93.5%） were co existed with varicocele. Among of them, 95 . 8% of patients were significant effect on the quality of life, 93 . 1% of the spouses are not satisfied with sexual life, even 22.2% of patients had been divorced. Twenty five cases（34.7% ） had been treated by penile prosthesis implantation, and in the results of 5.6 years＇ post-operation follow-up, erectile function （IIEF5） and life quality （QOL） were improved significantly compared to preoperation（P〈0.01）, and the satisfaction ratio of patient and partner was 93.4% and 92.3% respectively, and without severe complications. Conclusions： SPED seriously impact young couple＇s life quality and relationship. The main pathological abnormal of S-PED was venogenie factor, and penile prosthesis implantation is a safe and effective treatment for S-PED.