Department of Neurophysiology, Hospital Universitario Central de Asturias, Oviedo, Spain.
BJU Int. 2011 Dec;108(11):1855-9. doi: 10.1111/j.1464-410X.2011.10126.x. Epub 2011 May 18.
• To assess the prevalence of peripheral neuropathy in patients with erectile dysfunction (ED). • To evaluate the reliability of clinical tests such as the five-item version of the International Index of Erectile Function (IIEF-5) and the Neuropathy Symptom Score (NSS) classification system in predicting the concurrence of peripheral neuropathy.
• We studied 90 patients who were consecutively recruited from the Department of Andrology of the Central Hospital of Asturias. • Anamnesis included questions about risk factors related to ED. • The severity of ED was classified according to IIEF-5 scores and symptoms of peripheral neuropathy were assessed using the NSS. • Neurophysiological tests included electromyography, nerve conduction studies, evoked potentials from pudendal and tibial nerves as well as bulbocavernosus reflex. • Small fibre function was assessed using quantitative sensory tests and sympathetic skin response. Statistical analysis was performed using the SPSS-11 program.
• Patients with more severe symptoms of peripheral neuropathy showed lower (worse) IIEF-5 scores (P= 0.015) and required more aggressive therapies (P < 0.001). • Neurophysiological exploration confirmed neurological pathology in 68.9% of patients, of whom 7.8% had myelopathy and 61.1% peripheral neuropathy. • Polyneuropathy was found in 37.8% of the patients, of whom 8.9% had pure small fibre polyneuropathy, and pudendal neuropathy was diagnosed in 14.4%. • No association between neurophysiological diagnosis and IIEF-5 score was detected, but a statistical association was found between neuropathy and NSS scores.
• Up to now, the impact of peripheral neuropathy in the pathogenesis of ED has been underestimated. The combination of anamnesis and an ad hoc neurophysiological protocol showed its high prevalence and provided a more accurate prognosis. • In future, clinical practice should optimize the assessment of pelvic small fibre function.
评估勃起功能障碍（ED）患者周围神经病变的患病率。
评估临床测试（如国际勃起功能指数（IIEF-5）的五分量表和神经病变症状评分（NSS）分类系统）在预测周围神经病变同时发生的可靠性。
我们研究了 90 名连续从阿斯图里亚斯中央医院男科招募的患者。
病史包括与 ED 相关的危险因素问题。
根据 IIEF-5 评分对 ED 的严重程度进行分类，并使用 NSS 评估周围神经病变的症状。
神经生理学测试包括肌电图、神经传导研究、阴部和胫后神经的诱发电位以及球海绵体反射。
使用定量感觉测试和交感皮肤反应评估小纤维功能。统计分析使用 SPSS-11 程序进行。
周围神经病变症状更严重的患者 IIEF-5 评分较低（更差）（P=0.015），需要更积极的治疗（P <0.001）。
神经生理学探索证实了 68.9%的患者存在神经病理学，其中 7.8%有脊髓病，61.1%有周围神经病。
37.8%的患者患有多发性神经病，其中 8.9%有单纯小纤维多发性神经病，14.4%诊断为阴部神经病。
未发现神经生理学诊断与 IIEF-5 评分之间存在关联，但发现神经病与 NSS 评分之间存在统计学关联。
到目前为止，周围神经病变在 ED 发病机制中的影响被低估了。病史和专门的神经生理学方案的结合显示了其高患病率，并提供了更准确的预后。
在未来，临床实践应优化对骨盆小纤维功能的评估。
