Morgado Afonso, Moura Maria Leonor, Dinis Paulo, Silva Carlos Martins
Serviço de Urologia, Centro Hospitalar São João, Porto, Portugal; Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Sex Med. 2019 Jun;7(2):177-183. doi: 10.1016/j.esxm.2019.01.004. Epub 2019 Mar 14.
The importance of erectile dysfunction (ED) diagnosis and treatment has been highlighted since the early 2000s. However, nearly 20 years after the first phosphodiesterase 5 inhibitor (PDE5i) was marketed, underdiagnosis and undertreatment of ED in the primary health care setting may still be present.
To assess the relative frequency of patients who are medically treated for ED before referral to specialized urology care. The secondary objectives were to evaluate possible reasons for non-treatment prior to referral and other signs of undertreatment, namely cardiovascular risk assessment and antihypertensive treatment.
200 male patients referred for ED to specialist urology care by general practitioners were screened after consent between January 2016-December 2018. A full standardized medical and sexual history were taken. Previous medical treatment of ED, namely pharmacologic name and dosages, and cardiovascular risk factors were noted.
Of the 115 included patients, only 33.9% of patients had already taken PDE5i before referral, and none had taken alprostadil by intracavernous route.
The mean patient age was 58.68 ± 10.01 years old. Only 45.2% had been prescribed the highest dose of PD5i. From the remaining untreated patients, only 19.7% had ≥3 cardiovascular risk factors, including 5.6% of patients who also presented moderate-to-severe stable or unstable angina requiring a stress test or cardiology assessment before treatment. Regarding the 54 patients with medical history of arterial hypertension, 43.4% and 30.2% were treated for hypertension with a diuretic and a beta blocker, respectively.
More focus on the primary healthcare continuous medical education regarding sexual dysfunction, namely ED, is needed because major undertreatment of ED is still present because low prescription of PD5i before referral is noted. Morgado A, Moura ML, Dinis P, et al. Misdiagnosis And Undertreatment Of Erectile Dysfunction In The Portuguese Primary Health Care. Sex Med 2019;7:177-183.
自21世纪初以来，勃起功能障碍（ED）诊断和治疗的重要性就已得到强调。然而，在首个磷酸二酯酶5抑制剂（PDE5i）上市近20年后，初级卫生保健机构中ED的诊断不足和治疗不足情况可能仍然存在。
评估在转诊至专业泌尿外科治疗之前接受药物治疗的ED患者的相对频率。次要目标是评估转诊前未治疗的可能原因以及其他治疗不足的迹象，即心血管风险评估和抗高血压治疗。
2016年1月至2018年12月期间，在获得同意后，对200名由全科医生转诊至专业泌尿外科治疗ED的男性患者进行了筛查。采集了完整的标准化病史和性病史。记录了既往ED的药物治疗情况，即药物名称和剂量，以及心血管危险因素。
在纳入的115名患者中，只有33.9%的患者在转诊前已经服用过PDE5i，且无人通过海绵体内注射途径使用过前列地尔。
患者的平均年龄为58.68±10.01岁。只有45.2%的患者被开具了最高剂量的PDE5i。在其余未治疗的患者中，只有19.7%有≥3种心血管危险因素，其中5.6%的患者还患有中度至重度稳定或不稳定型心绞痛，在治疗前需要进行负荷试验或心脏科评估。在有动脉高血压病史的54名患者中，分别有43.4%和30.2%的患者使用利尿剂和β受体阻滞剂进行高血压治疗。
需要更加关注初级卫生保健中关于性功能障碍（即ED）的继续医学教育，因为ED的主要治疗不足仍然存在，原因是转诊前PDE5i的处方量较低。莫尔加多A、莫拉ML、迪尼斯P等。葡萄牙初级卫生保健中勃起功能障碍的误诊和治疗不足。性医学2019；7：177 - 183。
