Copel Laurian, Katz Ran, Blachar Arye, Sosna Jacob, Sheiman Robert G
Department of Radiology, Assaf-Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin, Israel 70300.
Radiology. 2005 Dec;237(3):986-91. doi: 10.1148/radiol.2373041529. Epub 2005 Oct 19.
To prospectively evaluate the clinical response and hemodynamic changes in cavernosal arteries after oral administration of sildenafil without and with audiovisual sexual stimulation and to compare those responses with responses from intracavernosal injections of vasoactive agents.
Institutional review board approval and written informed consent were obtained. Thirteen consecutive patients (age range, 22-77 years; mean, 60.4 years) with erectile dysfunction were evaluated with clinical assessment and cavernosal duplex ultrasonography (US). The patients were examined at two sessions 3 weeks apart. First, each patient received 100 mg of sildenafil citrate orally and was examined 60 minutes later without any sexual stimulation. Each patient then underwent repeat clinical and duplex US assessment after audiovisual sexual stimulation. Three weeks later, the patients underwent identical clinical evaluation and duplex US after intracavernosal injection of a commercially available combination of papaverine, prostaglandin E1, and phentolamine. Clinical and duplex US data (ie, peak systolic velocity [PSV]) were examined by using the Wilcoxon signed rank test for matched pairs.
At rest, the overall mean cavernosal artery PSV was 1.08 cm/sec and remained unchanged after intake of sildenafil without any audiovisual stimulation, with no clinical evidence of erection. With the addition of audiovisual sexual stimulation, eight (62%) of 13 patients had penile congestion or erection, and six (46%) had a PSV greater than 25 cm/sec. With intracavernosal injection of the combination of three drugs, all 13 patients achieved congestion or erection, and 10 (77%) had a PSV greater than 25 cm/sec. Both clinical and duplex US responses to intracavernosal injection were significantly greater than they were to sildenafil with audiovisual sexual stimulation (P = .04 and .003, respectively).
Oral sildenafil with audiovisual sexual stimulation led to a significant clinical response and increment in blood flow in the cavernosal arteries. However, more patients responded to intracavernosal injection of the combination of three drugs than to sildenafil, and the clinical response was significantly better.
前瞻性评估口服西地那非在有无视听性刺激情况下海绵体动脉的临床反应和血流动力学变化，并将这些反应与海绵体内注射血管活性药物的反应进行比较。
获得机构审查委员会批准和书面知情同意。对13例连续的勃起功能障碍患者（年龄范围22 - 77岁；平均60.4岁）进行临床评估和海绵体双功超声检查（US）。患者在相隔3周的两个时间段接受检查。首先，每位患者口服100mg枸橼酸西地那非，60分钟后在无任何性刺激的情况下接受检查。然后，每位患者在视听性刺激后接受重复的临床和双功超声评估。3周后，患者在海绵体内注射市售的罂粟碱、前列腺素E1和酚妥拉明组合后接受相同的临床评估和双功超声检查。使用配对的Wilcoxon符号秩检验检查临床和双功超声数据（即收缩期峰值流速[PSV]）。
静息状态下，海绵体动脉的总体平均PSV为1.08cm/秒，在无任何视听刺激的情况下服用西地那非后保持不变，无勃起的临床证据。加入视听性刺激后，13例患者中有8例（62%）出现阴茎充血或勃起，6例（46%）的PSV大于25cm/秒。在海绵体内注射三种药物的组合后，所有13例患者均出现充血或勃起，10例（77%）的PSV大于25cm/秒。海绵体内注射的临床和双功超声反应均显著大于视听性刺激下西地那非的反应（分别为P = .04和.003）。
口服西地那非并给予视听性刺激可导致显著的临床反应和海绵体动脉血流增加。然而，与西地那非相比，更多患者对海绵体内注射三种药物的组合有反应，且临床反应明显更好。
