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

Daily low-dose tadalafil for erectile dysfunction induced by pelvic fracture urethral disruption

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。

Objective ： To evaluate the effect of daily low-dose tadalafil on erectile dysfunction （ED） induced by pelvic fracture urethral disruption （PFUD）. Methods： This study included 46 cases of PFUD-induced ED treated from Jan 2008 to Dec 2011. The patients were aged 33.9 ± 7.2 years （ range 25 - 51 yr）, and the interval between injury and treatment was 19.6 ± 12.7 months （ range 3 -72 mo）, all with normal erectile function before PFUD. Based on the nocturnal penile tumescence and rigidity （NPTR） recorded by erectometry without medication of phosphodiesterase type 5 inhibitor （PDE-5I）, the patients were divided into an abnormal nocturnal erection group and a non-nocturnal erection group, and treated with tadalafil 10 mg once daily for 3 months. The therapeutic effect was evaluated by IIEF-5 scores and the rate of yes responses to questions 2 and 3 of the Sexual Encounter Profile （SEP）. Results： Totally 38 （ 82.6% ） of the patients accomplished the treatment and follow-up, 26 （68.4%） in the abnormal nocturnal erection group and 12 （31.6%） in the non-nocturnal erection group. After 3 months of daily tadalafil treatment at 10 mg, the IIEF-5 scores were significantly improved in the abnormal nocturnal erection group than in the non-nocturnal erection group （ P 〈 0.05）, and the rate of yes responses to SEP2 and SEP3 was remarkably higher in the former than in the latter （76.9% vs 41.7% and 65.4% vs 25.0%, P 〈 0. 05 ）. Conclusions ： Daily low-dose tadalafil can effectively improve the erectile function of PFUD-induced ED patients, particularly in those with nocturnal erection.