Lue T F
Department of Urology, University of California, San Francisco 94143-0738, USA.
J Formos Med Assoc. 1999 Apr;98(4):233-41.
Innovative research in the past 2 decades has shown that the hemodynamics of penile erection involve arterial dilation, sinusoidal expansion, and venous compression. Relaxation of the intracorporeal smooth muscles (trabecular and arteriolar) seems to be the final common pathway that leads to the above events. Neuropharmacologic studies have also established nitric oxide as the principal neurotransmitter for penile erection and confirmed the importance of cyclic adenosine monophosphate and cyclic guanosine monophosphate systems in penile smooth muscle relaxation. Recent years have also witnessed dramatic changes in the therapy of erectile dysfunction. The penile prosthesis, a gold standard of therapy of the 1970s, was replaced in the 1980s by the intracavernous injection and the vacuum constriction device. In the 1990s, two revolutionary concepts in erectile dysfunction therapy were added: transurethral alprostadil and oral sildenafil. However, the tremendous publicity surrounding the recent introduction of sildenafil has also created socioeconomic and ethical dilemmas, especially with regard to insurance coverage and government regulation. Medically, many problems also surfaced when large numbers of erectile dysfunction patients overwhelmed primary care physicians who were unfamiliar with the diagnosis and treatment of erectile dysfunction. This article reviews the advances in penile physiology and the clinical usefulness of topical and oral agents. In addition, a patients' goal-directed approach to the diagnosis and treatment of erectile dysfunction is presented.
过去20年的创新性研究表明，阴茎勃起的血流动力学涉及动脉扩张、海绵体窦扩张和静脉受压。体内平滑肌（小梁肌和小动脉）的松弛似乎是导致上述事件的最终共同途径。神经药理学研究也已确定一氧化氮是阴茎勃起的主要神经递质，并证实了环磷酸腺苷和环磷酸鸟苷系统在阴茎平滑肌松弛中的重要性。近年来，勃起功能障碍的治疗也发生了巨大变化。阴茎假体曾是20世纪70年代治疗的金标准，在20世纪80年代被海绵体内注射和真空紧缩装置所取代。在20世纪90年代，勃起功能障碍治疗中又增加了两个革命性概念：经尿道前列地尔和口服西地那非。然而，最近西地那非上市后的大量宣传也引发了社会经济和伦理困境，尤其是在保险覆盖范围和政府监管方面。在医学上，当大量勃起功能障碍患者让不熟悉勃起功能障碍诊断和治疗的初级保健医生应接不暇时，许多问题也浮出水面。本文综述了阴茎生理学的进展以及局部用药和口服药物的临床应用。此外，还介绍了一种以患者为导向的勃起功能障碍诊断和治疗方法。
