Giuliano F, Droupy S
Neuro-uro-andrologie, service de médecine physique et réadaptation, université de Versailles Saint-Quentin en Yvelines, hôpital Raymond-Poincaré, Garches, AP-HP, 104, boulevard R.-Poincaré, 92380 Garches, France.
Prog Urol. 2013 Jul;23(9):629-37. doi: 10.1016/j.purol.2013.01.010. Epub 2013 Mar 1.
Erectile dysfunction (ED) is the most commonly studied sexual disorder. ED is defined by a consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual activity.
Medical literature was reviewed and combined with expert opinion of the authors.
A review of ED prevalence is less than 10% in men aged below 50, superior to 20% for men over 60. Age, cardiovascular diseases, diabetes, hypercholesterolemia, smoking, depression and psychiatric illness, psychological disorders, unfavorable socio-economic conditions are all risk factors for erectile dysfunction. Drug sexual side-effects must also be envisaged. Erectile dysfunction can be psychogenic, organic or a mix of both. The pathophysiological mechanisms are diverse and can implicate deterioration of the central or peripheral neural pathways, from the arterial supply to the penis, endothelial dysfunction, smooth muscle tone impairment, structural damage of the sinusoidal spaces of the erectile tissue, or even hormonal disorders. Psychological and sexological management can help some patients suffering from psychogenic erectile dysfunction, usually associated with pharmacological treatment. Phosphodiesterase type 5 inhibitors (PDE5i) on demand or daily are an efficient symptomatic treatment in two thirds of patients with all forms of erectile dysfunction. Diabetic patients, after radical prostatectomy and/or with severe cardiovascular diseases respond poorly to PDE5i. Intracavernous injections of PGE1 or vacuum pump provide second line treatment for most patients. Penile implants are third line treatment and when the indication is carefully established give excellent results.
ED work-up and treatment are highly standardized. Therapeutic success rates are high.
勃起功能障碍（ED）是研究最为广泛的性功能障碍。勃起功能障碍的定义为持续或反复无法达到和/或维持足以进行性活动的阴茎勃起。
对医学文献进行综述并结合作者的专家意见。
勃起功能障碍患病率在50岁以下男性中低于10%，在60岁以上男性中高于20%。年龄、心血管疾病、糖尿病、高胆固醇血症、吸烟、抑郁和精神疾病、心理障碍、不利的社会经济状况均为勃起功能障碍的危险因素。还必须考虑药物的性副作用。勃起功能障碍可由心理因素、器质性因素或两者共同引起。其病理生理机制多种多样，可能涉及从阴茎的动脉供应到中枢或外周神经通路的退化、内皮功能障碍、平滑肌张力受损、勃起组织海绵体间隙的结构损伤，甚至激素紊乱。心理和性学管理对一些患有心理性勃起功能障碍的患者有帮助，通常与药物治疗相结合。按需或每日服用5型磷酸二酯酶抑制剂（PDE5i）对三分之二的各种形式勃起功能障碍患者是一种有效的对症治疗。糖尿病患者、根治性前列腺切除术后和/或患有严重心血管疾病的患者对PDE5i反应较差。海绵体内注射前列地尔（PGE1）或使用真空泵为大多数患者提供二线治疗。阴茎假体植入是三线治疗方法，在严格掌握适应症时效果良好。
勃起功能障碍的检查和治疗高度标准化。治疗成功率很高。
