Department of Urology, Mayo Clinic, Jacksonville, Florida; Department of Health Sciences Research (BR, ZL), Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida.
Department of Urology, Mayo Clinic, Jacksonville, Florida; Department of Health Sciences Research (BR, ZL), Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida.
J Urol. 2016 Oct;196(4):1223-7. doi: 10.1016/j.juro.2016.04.089. Epub 2016 May 7.
The primary aim of our study was to determine whether an evidence-based rationale could categorize cavernous venous occlusive disease into mild, moderate and severe erectile dysfunction.
A total of 863 patients underwent color duplex Doppler ultrasound from January 2010 to June 2013 performed by a single urologist. We identified a cohort of 75 patients (8.7%) with a diagnosis of cavernous venous occlusive disease based on a unilateral resistive index less than 0.9, and right and left peak systolic velocity 35 cm per second or less after visual sexual stimulation. At a median followup of 13 months patients were evaluated for treatment efficacy.
A total of 75 patients with a median age of 60 years (range 19 to 83) and a mean body mass index of 26.3 kg/m(2) (range 19.0 to 39.3) satisfied the criteria of cavernous venous occlusive disease. When substratified into tertiles, resistive index cutoffs were obtained, including mild cavernous venous occlusive disease-81.6 to 94.0, moderate disease-72.6 to 81.5 and severe disease-59.5 to 72.5. Using these 3 groups the phosphodiesterase type 5-inhibitor failure rate (p = 0.017) and SHIM (Sexual Health Inventory for Men) score categories (1 to 10 vs 11 to 20, p = 0.030) were statistically significantly different for mild, moderate and severe cavernous venous occlusive disease. Treatment satisfaction was also statistically significantly different. Penile prosthetic placement was a more common outcome among patients with erectile dysfunction and more severe cavernous venous occlusive disease.
Our retrospective analysis supports a correlation between the phosphodiesterase type 5 inhibitor failure rate, SHIM score and the rate of surgical intervention using resistive index values. Our data further suggest that an evidence-based classification of cavernous venous occlusive disease by color Doppler ultrasound is possible and can triage patients to penile prosthetic placement.
我们研究的主要目的是确定基于循证的原理是否可以将海绵体静脉闭塞性疾病分为轻度、中度和重度勃起功能障碍。
2010 年 1 月至 2013 年 6 月，共有 863 名患者由一位泌尿科医生进行了彩色双功能多普勒超声检查。我们根据单侧阻力指数小于 0.9 和视觉性刺激后右侧和左侧收缩期峰值速度均小于 35cm/s，确定了 75 例（8.7%）海绵体静脉闭塞性疾病的患者队列。中位随访 13 个月后，对患者进行治疗效果评估。
共 75 例患者，中位年龄 60 岁（范围 19 至 83 岁），平均体重指数 26.3kg/m²（范围 19.0 至 39.3），符合海绵体静脉闭塞性疾病的标准。当分为三分位数时，获得了阻力指数的截断值，包括轻度海绵体静脉闭塞性疾病-81.6 至 94.0、中度疾病-72.6 至 81.5 和重度疾病-59.5 至 72.5。使用这 3 组，磷酸二酯酶 5 抑制剂失败率（p=0.017）和男性性健康量表（SHIM）评分类别（1 至 10 与 11 至 20，p=0.030）在轻度、中度和重度海绵体静脉闭塞性疾病之间具有统计学显著差异。治疗满意度也存在统计学显著差异。在勃起功能障碍和更严重的海绵体静脉闭塞性疾病患者中，阴茎假体植入更为常见。
我们的回顾性分析支持磷酸二酯酶 5 抑制剂失败率、SHIM 评分和使用阻力指数值进行手术干预之间的相关性。我们的数据进一步表明，通过彩色多普勒超声对海绵体静脉闭塞性疾病进行基于循证的分类是可能的，并可以对患者进行分诊以进行阴茎假体植入。
