性治疗在男性阴茎折断伤术后心理性勃起功能障碍中的应用

Application of sexual therapy in psychological erectile dysfunction after operation of male penile fracture injury

目的分析性治疗在男性阴茎折断伤术后心理性勃起功能障碍中的应用。方法选取2013年7月至2021年7月在本院因阴茎折断伤行急诊手术的57例患者的临床资料,术前及术后3个月行国际勃起功能指数评分(IIEF-5)及抑郁自评量表(SDS)了解患者的勃起情况及心理状态。术后出现勃起功能障碍(ED)的患者行阴茎海绵体注射血管活性药物试验(ICI)联合彩色多普勒双功能超声(CDDU)及夜间阴茎涨大实验(NPTR)检查,判断ED产生的原因。根据患者意愿给予性治疗(性治疗组)或小剂量规律服用他达拉非治疗(小剂量规律服用他达拉非组),1个月后观察患者性功能恢复情况。结果57例患者术前均无ED及抑郁状态,术后3个月复诊时11例出现ED,皆为轻度(11分<IIEF-5≤21分),行ICI联合CDDU及NPTR检查提示为心理性ED,SDS提示46例术后恢复正常患者无抑郁症状,11例ED患者中有6例存在抑郁症状,差异有统计学意义(P<0.05)。11例患者有7例接受性治疗,4例接受小剂量规律服用他达拉非治疗。治疗1个月后,性治疗组患者均恢复正常,而小剂量规律服用他达拉非组患者中只有1例恢复正常,差异有统计学意义(P<0.05)。结论阴茎折断伤后部分患者会出现心理性ED,伴随着不良心理状态,性治疗对于此类患者有较好的治疗效果。

Objective To analyze the application of sex therapy in psychological erectile dysfunction after male penile fracture.Methods The clinical data of 57 patients who underwent emergency surgery due to penile fracture in our hospital from July 2013 to July 2021 were collected.The international index of erectile function(IIEF-5)and self-rating depression scale(SDS)were used to evaluate the erectile status and psychological state of the patients before and 3 months after surgery.Patients with postoperative erectile dysfunction(ED)were examined by corpus cavernosal injection vasoactive drug test(ICI)combined with color Doppler duplex ultrasound(CDDU)and nocturnal penile enlargement test(NPTR)to determine the cause of ED.According to the patients'wishes,they were given sexual therapy(sex therapy group)or low-dose regular tadalafil treatment(low-dose regular tadalafil group),and the recovery of sexual function was observed after 1 month.Results None of the 57 patients had ED or depression before surgery.At 3 months after surgery,11 patients had mild ED(11 scores<IIEF-5≤21 scores),which was diagnosed as psychogenic ED by ICI combined with CDDU and NPTR.Among the 11 ED patients,6 had depressive symptoms,and the difference was statistically significant(P<0.05).Of the 11 patients,7 were treated with active therapy,and 4 were treated with tadalafil at a low dose.After 1 month of treatment,all patients in the sex therapy group returned to normal,while only one patient in the low-dose regular tadalafil group returned to normal,and the difference was statistically significant(P<0.05).Conclusions After penile fracture,some patients will have psychological ED,accompanied by poor psychological state.Sexual therapy has a good therapeutic effect on these patients.