Hatzimouratidis Konstantinos, Hatzichristou Dimitrios G
Center for Sexual and Reproductive Health, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Drugs. 2005;65(12):1621-50. doi: 10.2165/00003495-200565120-00003.
The field of erectile dysfunction (ED) has been revolutionised over the last two decades. Several treatment options are available today, most of which are associated with high efficacy rates and favourable safety profiles. A MEDLINE search was undertaken in order to evaluate all currently available data on treatment modalities for ED. Phosphodiesterase type 5 (PDE5) inhibitors (sildenafil, tadalafil, vardenafil) are currently the first-choice of most physicians and patients for the treatment of ED. PDE5 inhibitors have differences in their pharmacological profiles, the most obvious being the long duration of action of tadalafil, but there are no data supporting superiority for any one of them in terms of efficacy or safety. Sublingual apomorphine has limited efficacy compared with the PDE5 inhibitors, and its use is limited to patients with mild ED. Treatment failures with oral drugs may be due to medication, clinician and patient issues. The physician needs to address all of these issues in order to identify true treatment failures. Patients who are truly unresponsive to oral drugs may be offered other treatment options.Intracavernous injections of alprostadil alone, or in combination with other vasoactive agents (papaverine and phentolamine), remain an excellent treatment option, with proven efficacy and safety over time. Topical pharmacotherapy is appealing in nature, but currently available formulations have limited efficacy. Vacuum constriction devices may be offered mainly to elderly patients with occasional intercourse attempts, as younger patients show limited preference because of the unnatural erection that is associated with this treatment modality. Penile prostheses are generally the last treatment option offered, because of invasiveness, cost and non-reversibility; however, they are associated with high satisfaction rates in properly selected patients. All treatment options are associated with particular strengths and weaknesses. A patient-centred approach based on patient needs and expectations is necessary for the management of ED. The clinician must educate the patient and provide a supportive environment for shared decision making. The management strategy must be supplemented by careful follow-up in order to identify changes in patient health and relationship/emotional status that may necessitate treatment optimisation.
在过去二十年中，勃起功能障碍（ED）领域发生了变革。如今有多种治疗选择，其中大多数具有高有效率和良好的安全性。进行了一项医学文献数据库（MEDLINE）检索，以评估目前所有关于ED治疗方式的可用数据。5型磷酸二酯酶（PDE5）抑制剂（西地那非、他达拉非、伐地那非）目前是大多数医生和患者治疗ED的首选。PDE5抑制剂在药理特性上存在差异，最明显的是他达拉非作用时间长，但在疗效或安全性方面，没有数据支持其中任何一种具有优越性。与PDE5抑制剂相比，舌下含服阿扑吗啡疗效有限，其使用仅限于轻度ED患者。口服药物治疗失败可能归因于药物、临床医生和患者等方面的问题。医生需要解决所有这些问题，以识别真正的治疗失败情况。对于对口服药物确实无反应的患者，可以提供其他治疗选择。单独海绵体内注射前列地尔，或与其他血管活性药物（罂粟碱和酚妥拉明）联合注射，仍然是一种出色的治疗选择，长期以来已证实其疗效和安全性。局部药物治疗本质上很有吸引力，但目前可用的制剂疗效有限。真空缩窄装置主要可提供给偶尔尝试性交的老年患者，因为年轻患者因这种治疗方式所带来的不自然勃起而表现出有限的偏好。阴茎假体通常是最后的治疗选择，因为具有侵入性、成本高且不可逆转；然而，在适当选择的患者中，它们具有很高的满意度。所有治疗选择都有其特定的优缺点。对于ED的管理，基于患者需求和期望的以患者为中心的方法是必要的。临床医生必须对患者进行教育，并为共同决策提供支持性环境。管理策略必须辅以仔细的随访，以识别患者健康状况以及关系/情感状态的变化，这些变化可能需要优化治疗。
