Int J Impot Res. 1999 Apr;11(2):59-70; discussion 70-4. doi: 10.1038/sj.ijir.3900411.
This paper addresses pertinent issues concerning the role of physicians in the assessment and treatment of men with complaints of erectile dysfunction. With the availability of safe and effective oral drug therapy, the field of erectile dysfunction has expanded rapidly to encompass multiple disciplines and specialties. Recognizing the need for evidence-based standards and guidelines in the management of this common disorder, a multidisciplinary panel of experts was convened to examine existing literature and practice standards. This panel employed a modified Delphi methodology to develop consensus on definition and classification, rational utilization of diagnostic and therapeutic options, and clinical guidelines for the management of erectile dysfunction in a primary care setting. A 'Process of Care Model for Erectile Dysfunction' was thus developed, incorporating a step-wise decision making approach, defined in terms of relevant processes, actions and outcomes. According to this method, initial assessment should include a careful clinical history, focused physical examination and selected laboratory tests. Subsequent management should be goal-oriented, taking into account patient and partner needs and preferences. The step-wise treatment algorithm is based on the selection criteria of ease of administration, reversibility, relative invasiveness and cost. In addition, common referral indications for specialized diagnostic testing and treatment are provided. By assisting the primary physician in selecting appropriate assessment tools and treatment interventions, the proposed guidelines are intended to optimize care of the patient with erectile dysfunction. The panel strongly recommends further research into the causes and associated risk factors for erectile dysfunction, prevention and the role of lifestyle modification, and the critical issue of partner-related sexual dysfunction. Considering the strong relationship between sexual dysfunction and overall quality of life, it is incumbent upon physicians to address the sexual needs of their patients in a sensitive and informed manner.
本文探讨了医生在评估和治疗主诉勃起功能障碍男性患者时的相关问题。随着安全有效的口服药物疗法的出现，勃起功能障碍领域迅速扩展，涵盖了多个学科和专业。认识到在管理这种常见疾病时需要基于证据的标准和指南，于是召集了一个多学科专家小组来审查现有文献和实践标准。该小组采用改良的德尔菲方法，就勃起功能障碍在初级保健环境中的定义和分类、诊断和治疗选择的合理利用以及临床指南达成共识。由此制定了一个“勃起功能障碍护理流程模型”，其中纳入了一种逐步决策方法，该方法根据相关流程、行动和结果来定义。根据这种方法，初始评估应包括详细的临床病史、针对性的体格检查和选定的实验室检查。后续管理应以目标为导向，同时考虑患者及其伴侣的需求和偏好。逐步治疗算法基于给药便利性、可逆性、相对侵入性和成本等选择标准。此外，还提供了进行专门诊断测试和治疗的常见转诊指征。通过协助初级医生选择合适的评估工具和治疗干预措施，拟议的指南旨在优化勃起功能障碍患者的护理。该小组强烈建议进一步研究勃起功能障碍的病因和相关危险因素、预防以及生活方式改变的作用，以及与伴侣相关的性功能障碍这一关键问题。考虑到性功能障碍与整体生活质量之间的密切关系，医生有责任以敏感且明智的方式满足患者的性需求。
