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勃起功能障碍的植入物、机械装置和血管外科手术。

Implants, mechanical devices, and vascular surgery for erectile dysfunction.

机构信息

Tulane University School of Medicine, Department of Urology, New Orleans, LA 70112, USA.

出版信息

J Sex Med. 2010 Jan;7(1 Pt 2):501-23. doi: 10.1111/j.1743-6109.2009.01626.x.

Abstract

INTRODUCTION

The field of erectile dysfunction (ED) is evolving and there is a need for state-of-the-art information in the area of treatment. Aim. To develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery.

METHODS

To provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period.

MAIN OUTCOME MEASURE

Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.

RESULTS

The inflatable penile prosthesis (IPP) is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis. Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma. Currently, surgery to limit venous leakage is not recommended.

CONCLUSIONS

It is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient's medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery.

摘要

简介

勃起功能障碍(ED)领域正在不断发展,因此需要掌握该领域的最新治疗信息。目的:制定关于勃起功能障碍植入物、机械装置和血管手术治疗的循证、最新共识报告。

方法

为了提供关于植入物、机械装置和血管手术治疗勃起功能障碍的最新知识,代表来自 5 个国家的 7 位专家在 2 年的共识过程中提出意见。

主要观察指标

专家意见基于循证医学文献的分级、广泛的内部委员会讨论、公开陈述和辩论。

结果

可膨胀阴茎假体(IPP)适用于对其他治疗选择失败或拒绝的器质性勃起功能障碍的治疗。IPP 与其他形式的 ED 治疗方法的比较通常显示,选择假体的 ED 男性的满意度更高。勃起功能障碍对真空勃起装置(VED)治疗反应良好,尤其是对腔内药物治疗反应不佳的男性。根治性前列腺切除术后,VED 联合磷酸二酯酶 5 治疗可提高对单独使用 VED 不满意的患者的性满意度。阴茎血管重建术在没有静脉漏且会阴或骨盆创伤后仅存在内阴部动脉狭窄的年轻男性中似乎最成功。目前,不建议进行限制静脉漏的手术。

结论

为了患者的未来,让他们了解勃起功能障碍的所有治疗选择非常重要,以便做出明智的决定。治疗医生应了解患者的医疗和性史,以帮助指导决策。血管重建手术,特别是静脉流出手术领域需要更多的研究。

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