海绵体神经损伤性勃起功能障碍治疗研究进展

Treatment of erectile dysfunction caused by cavernous nerve injury: An update

随着前列腺手术的广泛开展和骨盆骨折尿道损伤患者的不断增多,海绵体神经损伤性阴茎勃起功能障碍越来越受到关注。海绵体神经损伤后,阴茎平滑肌和内皮细胞凋亡,NOS阳性神经密度降低,进而出现海绵体平滑肌纤维化。损伤后的神经再生策略一直是ED研究的热点之一。本综述将围绕促进海绵体神经再生的治疗策略,讨论海绵体神经损伤性ED治疗的基础及临床研究现状,既涉及神经营养因子、RhoA/ROCK抑制剂、亲免素配体、促红细胞生成素、干细胞治疗、基因治疗等传统策略,也包含富血小板血浆和低强度体外冲击波治疗等易于临床转化的新的治疗方式。本综述旨在为相关领域学者提供参考,以期开展更多具有较高临床转化意义的研究。

With the development of prostate surgery and increasing number of patients with pelvic fracture urethral injury, ED caused by cavernous nerve injury(CNI) has attracted more and more medical attention. CNI induces the apoptosis of penile smooth muscle cells and endothelial cells, decreases the density of NOS-positive nerves, and results in the fibrosis of the cavernous smooth muscle. The strategies of nerve regeneration after CNI has been one of the hotspots in the studies of ED. This review focuses on the current treatment strategies to promote the cavernous nerve regeneration and status quo of basic and clinical researches on the treatment of CNI-induced ED. The treatment strategies discussed in this review involve neurotrophic factors, RhoA/ROCK inhibitors, immunophilic ligands, erythropoietin, stem cell therapy, gene therapy, platelet-rich plasma, and low-intensity extracorporeal shock wave therapy, which are all new and suitable for clinical transformation.