McMahon C G, Samali R, Johnson H
Australian Centre for Sexual Health, Sydney.
J Urol. 1999 Dec;162(6):1992-7; discussion 1997-8. doi: 10.1016/S0022-5347(05)68085-8.
We assess the efficacy of sildenafil as salvage therapy for intracorporeal injection therapy nonresponse.
The study group comprised 93 patients with a mean age of 53.6 years (range 24 to 77) with chronic erectile dysfunction. In all cases a home trial of intracavernosal injection of high dose alprostadil and triple agent intracavernosal injection therapy had failed. Patients were treated with sildenafil citrate alone or in combination with intracavernosal injection therapy.
The etiology of erectile dysfunction was arteriogenic in 29 cases, cavernosal venous leakage in 36, mixed vasculogenic in 24, psychogenic in 3 and post-priapism intracavernous fibrosis in 1. Of the 32 sildenafil responders (34% of the study group) 30 required 100 and 2 required 50 mg. The 29 sildenafil intracavernosal injection (combined therapy) responders (31% of the study group) required 100 mg. sildenafil. There were 32 nonresponders (34% of the study group). Mean International Index of Erectile Function questions 3 and 4 scores were 1.7 and 1.5 at baseline, 2.3 and 1.9 with intracavernosal injection, 4.6 and 42.2 with sildenafil, and 4.1 and 4.10 with combined therapy, respectively. Of the 93 patients 29 (31%) treated with intracavernosal injection reported adverse effects, including penile pain in 27, dizziness in 5 and headache in 2. Of the patients treated with sildenafil 34 (37%) reported side effects, including headache in 30, facial flushing in 25, dyspepsia in 12, nasal congestion in 9, dizziness in 5 and visual disturbances in 1. Of the 41 patients given combined therapy 20 (49%) reported adverse effects, including penile pain in 15, headache in 15, facial flushing in 12, dyspepsia in 7, nasal congestion in 3, dizziness in 12 and syncope in 1.
Sildenafil alone or sildenafil plus intracavernosal injection is effective salvage therapy for intracavernosal injection nonresponse. Sildenafil in combination with intracavernosal injection is associated with a 33% incidence of adverse effects, including a 20% incidence of dizziness.
我们评估西地那非作为海绵体内注射治疗无反应的挽救疗法的疗效。
研究组包括93例慢性勃起功能障碍患者，平均年龄53.6岁（范围24至77岁）。在所有病例中，高剂量前列地尔海绵体内注射的家庭试验以及三联药物海绵体内注射疗法均失败。患者接受单独西地那非治疗或联合海绵体内注射疗法。
勃起功能障碍的病因中，动脉源性29例，海绵体静脉漏36例，混合血管源性24例，心理性3例，阴茎异常勃起后海绵体内纤维化1例。在32例对西地那非有反应的患者（占研究组的34%）中，30例需要100毫克，2例需要50毫克。29例对西地那非联合海绵体内注射（联合疗法）有反应的患者（占研究组的31%）需要100毫克西地那非。有32例无反应者（占研究组的34%）。国际勃起功能指数问题3和4的平均得分在基线时分别为1.7和1.5，海绵体内注射时为2.3和1.9，西地那非治疗时为4.6和4.2，联合疗法时为4.1和4.10。在93例患者中，29例（31%）接受海绵体内注射治疗的患者报告有不良反应，包括27例阴茎疼痛、5例头晕和2例头痛。接受西地那非治疗的患者中有34例（37%）报告有副作用，包括30例头痛、25例面部潮红、12例消化不良、9例鼻塞、5例头晕和1例视觉障碍。在41例接受联合疗法的患者中，20例（49%）报告有不良反应，包括15例阴茎疼痛、15例头痛、12例面部潮红、7例消化不良、3例鼻塞、12例头晕和1例晕厥。
单独使用西地那非或西地那非加海绵体内注射是海绵体内注射无反应的有效挽救疗法。西地那非联合海绵体内注射的不良反应发生率为33%，其中头晕发生率为20%。
