St Georges NHS Trust, Tooting, London, UK.
BJU Int. 2011 Jan;107(2):268-71. doi: 10.1111/j.1464-410X.2010.09463.x.
To report on the largest series to date of ulceration of the external genitalia, related to treatment with nicorandil - a vasodilator for the prevention and long-term treatment of angina - and to review the literature on the subject, focusing on the clinical features and the pathogenesis of this rare, yet marked, side-effect.
Three patients (aged 71-83 years) were referred for severe ulceration of the penis. A complete work-up was performed to exclude potential underlying causes, including malignancy and sexually transmitted diseases. After a careful review of the patients' medical history, a potentially causal relationship was noted; all patients had been taking nicorandil for at least 2 years before the development of penile ulceration.
Penile ulcers associated with nicorandil are characteristically large, deep, painful and have punched-out edges. They usually involve the prepuce or the penile shaft skin. Higher doses of nicorandil (at least 40 mg daily) and surgical procedures seem to increase the risk for nicorandil-related ulceration. Response to topical steroids is poor, but complete healing is achieved by discontinuation of nicorandil, while surgical treatment should be discouraged.
The growing body of literature showing the link between treatment with nicorandil and ulceration at multiple sites has led to the recognition of this side-effect by the World Health Organization. Nicorandil-related ulcers rarely involve the penile skin and constitute a diagnostic and therapeutic challenge. The pathogenesis of this rare side-effect is largely unknown, but mechanisms such as the 'vascular steal phenomenon' and the direct toxic effect of the drug or its metabolites have been implicated.
报告迄今为止最大系列的生殖器外部溃疡病例，这些病例与尼可地尔（一种血管扩张剂，用于预防和长期治疗心绞痛）治疗有关，并回顾该主题的文献，重点关注这种罕见但明显的副作用的临床特征和发病机制。
3 名患者（年龄 71-83 岁）因阴茎严重溃疡而就诊。进行了全面的检查以排除潜在的潜在病因，包括恶性肿瘤和性传播疾病。在仔细审查患者的病史后，注意到潜在的因果关系；所有患者在出现阴茎溃疡之前至少已经服用尼可地尔 2 年。
与尼可地尔相关的阴茎溃疡具有特征性的大、深、疼痛和穿孔边缘。它们通常涉及包皮或阴茎干皮肤。较高剂量的尼可地尔（至少每天 40 毫克）和手术似乎会增加与尼可地尔相关的溃疡风险。局部类固醇反应不佳，但通过停用尼可地尔可实现完全愈合，而应避免手术治疗。
越来越多的文献表明尼可地尔治疗与多处溃疡之间存在关联，世界卫生组织已经认识到这种副作用。尼可地尔相关的溃疡很少累及阴茎皮肤，构成诊断和治疗挑战。这种罕见副作用的发病机制在很大程度上尚不清楚，但已涉及到“血管窃血现象”和药物或其代谢物的直接毒性等机制。
