Department of Medical Pathophysiology, Sapienza University of Rome, Rome, Italy.
Int J Urol. 2010 Jan;17(1):38-47. doi: 10.1111/j.1442-2042.2009.02426.x. Epub 2009 Nov 25.
Penile erection is a vascular event that requires an intact endothelium to occur. A dysfunctional endothelium is an early marker for the development of atherosclerotic changes and can also contribute to the occurrence of acute cardiovascular events. The pathogenesis of both endothelial and erectile dysfunction (ED) is intimately linked through decreased expression and activation of endothelial nitric oxide (NO) synthase, and the subsequent blunted physiological actions of NO naturally occurring with aging. It is now well-understood that ED is a symptom of underlying disease rather than a disease itself; for this reason in the near future both general practitioners, internal medicine practitioners and many specialists will have to interplay with sexual medicine. Aging in the man is also associated with several changes in arterial structure and function, part of them related to the decline of circulating levels of steroids, that is, testosterone and estradiol. These changes may be responsible, in part, for the lack of efficacy of ED treatments. The recent discovery that chronic administration of phosphodiesterase type 5 inhibitors may improve erectile and endothelial responsiveness of men previously non-responsive to on-demand regimes, and the knowledge that testosterone is one of the main modulators of the expression of penile phosphodiesterase type 5 isoenzyme, opens a new scenario in the treatment of men with ED and co-morbidities. The aim of this review is to discuss the pathophysiology of endothelial dysfunction and its relationship with ED in the aging male, and to suggest possible strategies to improve arterial function with regard to sexual dysfunctions.
阴茎勃起是一种血管事件，需要完整的内皮才能发生。功能失调的内皮是动脉粥样硬化变化发展的早期标志物，也可能导致急性心血管事件的发生。内皮和勃起功能障碍（ED）的发病机制通过内皮型一氧化氮合酶（eNOS）的表达和激活减少密切相关，随着年龄的增长，NO 的生理作用自然减弱。现在人们已经清楚地认识到，ED 是潜在疾病的症状，而不是一种疾病本身；因此，在不久的将来，全科医生、内科医生和许多专家都将不得不与性医学相互配合。男性的衰老也与动脉结构和功能的几个变化有关，其中一部分与循环类固醇水平（即睾酮和雌二醇）的下降有关。这些变化可能部分解释了 ED 治疗效果不佳的原因。最近的发现表明，慢性服用磷酸二酯酶 5 抑制剂可能改善以前对按需治疗方案无反应的男性的勃起和内皮反应性，而且睾酮是调节阴茎磷酸二酯酶 5 同工酶表达的主要调节剂之一，为 ED 和合并症男性的治疗开辟了新的前景。本综述的目的是讨论衰老男性内皮功能障碍及其与 ED 的病理生理学关系，并提出改善与性功能障碍相关的动脉功能的可能策略。
