Wespes E, Schulman C C
Department of Urology, CHU de Charleroi, Hôpital Erasme, Brussels, Belgium.
Arch Esp Urol. 2010 Oct;63(8):649-54.
Erection is a vascular phenomenon under a psychologic control in a hormonal environment. Erectile dysfunction is defined as the inability to obtain and to maintain sufficient erection for satisfactory intercourse. Organic erectile dysfunction results mainly from vascular problems due to atherosclerosis, a process that begins during childhood, and becomes clinically evident from middle age. Endothelial dysfunction is the first step of atherosclerosis. As the endothelial cells recover the sinusoid spaces in the cavernous tissue and because common risk factors for atherosclerosis have been frequently found in patients with erectile dysfunction, it is logical that vascular impotence presents the same pathophysiology of the other vascular diseases. They share a similar pathogenic involvement of nitric oxide pathway leading to impairment of endothelium dependent vasodilatation and structural vascular abnormalities. Circulating markers of endothelial cell damage have been reported in patients with erectile dysfunction while they have not yet presented any other vascular pathology. Endothelial progenitor cells of bone marrow origin that play a role in promoting endothelial repair are also reduced in vascular abnormalities.As penile arteries have the smallest diameter in the vascular network and because atherosclerosis is a systemic disease, erectile dysfunction could be a sentinel symptom of a more generalized vascular pathology. Modifications of reversible causes or risk factors at the base of the pathogenesis of atherosclerosis remain the first approach toward improving endothelial function and associated with chronic exposure to PDE5-I, they could improve or even cure ED and could avoid fatal cardiovascular attacks in the future.
勃起是在激素环境下受心理控制的一种血管现象。勃起功能障碍被定义为无法获得并维持足够的勃起以进行满意的性交。器质性勃起功能障碍主要由动脉粥样硬化导致的血管问题引起，动脉粥样硬化这一过程始于儿童期，从中年开始在临床上显现。内皮功能障碍是动脉粥样硬化的第一步。由于内皮细胞恢复海绵体组织中的窦状隙空间，并且由于勃起功能障碍患者中经常发现动脉粥样硬化的常见危险因素，因此血管性阳痿呈现出与其他血管疾病相同的病理生理学是合乎逻辑的。它们在一氧化氮途径中有着相似的致病参与情况，导致内皮依赖性血管舒张受损和血管结构异常。在勃起功能障碍患者中已报告有循环内皮细胞损伤标志物，而此时他们尚未出现任何其他血管病变。骨髓来源的内皮祖细胞在促进内皮修复中起作用，在血管异常中也会减少。由于阴茎动脉在血管网络中直径最小，且动脉粥样硬化是一种全身性疾病，勃起功能障碍可能是更广泛血管病变的一个警示症状。改变动脉粥样硬化发病机制基础上的可逆病因或危险因素仍然是改善内皮功能的首要方法，并且与长期暴露于5型磷酸二酯酶抑制剂相关，它们可以改善甚至治愈勃起功能障碍，并可避免未来致命的心血管发作。
