Department of Urology, Rush University Medical Center, Chicago, IL, USA.
BJU Int. 2019 Jan;123(1):173-179. doi: 10.1111/bju.14458. Epub 2018 Aug 28.
To assess baseline characteristics of a cohort of young men with erectile dysfunction (ED) but no identifiable organic cause and to evaluate the efficacy of our treatment algorithm.
We retrospectively reviewed the charts of men aged <40 years referred to our tertiary care centre for evaluation and treatment of their ED between March 2010 and August 2016. Of 185 men reviewed, we included 73 men who were identified as having no identifiable organic cause for their ED and had successfully completed a detailed questionnaire regarding their medical and sexual history at the initial consultation. The questionnaire was used to obtain baseline patient characteristics and identify comorbid conditions which may predispose to ED. For these men, our standard treatment comprised a daily low-dose phosphodiesterase type 5-inhibitor along with a referral for psychosexual therapy, with the option of more invasive treatment if this initial approach failed. After a minimum of 6 months of treatment, patients were asked to complete a follow-up questionnaire via phone or e-mail. Thirty-three men successfully completed the follow-up questionnaire. Pre- and post-treatment questionnaires were compared to determine treatment adherence and efficacy.
The mean (range) age of the study cohort was 31.9 (22-39) years. At the initial consultation, 85% of men (n = 62) reported problems obtaining an erection. After a minimum of 6 months of treatment, only 42% reported the same problem (n = 14), with 58% (n = 19) satisfied with their erectile function. Post-treatment International Index of Erectile Function (IIEF) scores showed a significant improvement in erectile function (18.8 vs 13.3; P < 0.01), orgasmic function (7.7 vs 6.2; P = 0.01) and overall satisfaction (6.1 vs 4.5; P < 0.01). No statistically significant improvement was noted in sexual desire or intercourse satisfaction.
Our proposed treatment approach for men with ED aged < 40 years without an identifiable organic aetiology appears to be a reasonable and effective first-line approach, as demonstrated by significantly improved post-treatment IIEF scores and patient-reported outcomes. This algorithm can provide urologists with a useful framework for managing these potentially challenging patients.
评估一组无明确器质性病因的年轻男性勃起功能障碍（ED）患者的基线特征，并评估我们的治疗方案的疗效。
我们回顾性分析了 2010 年 3 月至 2016 年 8 月期间因 ED 就诊于我们的三级保健中心接受评估和治疗的年龄<40 岁男性的病历。在 185 名男性中，我们纳入了 73 名被确定为 ED 无明确器质性病因且在初次就诊时成功完成了关于其医疗和性生活史的详细问卷的男性。该问卷用于获取患者的基线特征，并确定可能导致 ED 的合并症。对于这些男性，我们的标准治疗包括每日低剂量磷酸二酯酶 5 型抑制剂和性心理治疗转诊，如果初始治疗失败，则选择更具侵袭性的治疗方法。经过至少 6 个月的治疗后，通过电话或电子邮件要求患者完成随访问卷。33 名男性成功完成了随访问卷。比较治疗前后的问卷以确定治疗的依从性和疗效。
研究队列的平均（范围）年龄为 31.9（22-39）岁。在初次就诊时，85%（n=62）的男性报告勃起困难。经过至少 6 个月的治疗后，只有 42%（n=14）的男性报告存在同样的问题，58%（n=19）对勃起功能满意。治疗后国际勃起功能指数（IIEF）评分显示勃起功能（18.8 对 13.3；P<0.01）、性高潮功能（7.7 对 6.2；P=0.01）和整体满意度（6.1 对 4.5；P<0.01）显著改善。性欲望或性交满意度无统计学意义的改善。
对于年龄<40 岁且无明确器质性病因的 ED 患者，我们提出的治疗方法似乎是一种合理有效的一线治疗方法，因为治疗后 IIEF 评分和患者报告的结果明显改善。该算法可为泌尿科医生管理这些具有潜在挑战性的患者提供有用的框架。
