[早泄治疗建议]

[Recommendations for the treatment of premature ejaculation].

作者信息

Huyghe E, Cuzin B, Grellet L, Faix A, Almont T, Burte C

机构信息

Médecine de la reproduction, CHU de Toulouse, site de Paule-de-Viguier, Toulouse, France; Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, hôpital Rangueil, Toulouse, France; UMR DEFE Inserm 1203, université de Toulouse III, université de Montpellier, Montpellier, France.

Service d'urologie, chirurgie de la transplantation, CHU de Lyon, hôpital Édouard-Herriot, Lyon, France; Service de médecine de la reproduction, hôpital Femme-Mère-Enfant, HCL, Bron, France.

出版信息

Prog Urol. 2023 Apr;33(5):237-246. doi: 10.1016/j.purol.2023.02.003. Epub 2023 Mar 1.

DOI:10.1016/j.purol.2023.02.003

PMID:36868935

Abstract

OBJECTIVES

The Post-University Interdisciplinary Association of Sexology (AIUS) has brought together a panel of experts to develop French recommendations for the management of premature ejaculation.

METHODS

Systematic review of the literature between 01/1995 and 02/2022. Use of the clinical practice guidelines (CPR) method.

RESULTS

We recommend giving all patients with PE psychosexological counseling, and whenever possible combining pharmacotherapies and sexually-focused cognitive-behavioral therapies, involving the partner in the treatment process. Other sexological approaches could be useful. We recommend the use of dapoxetine as first-line, on-demand oral therapy for primary and acquired PE. We recommend the use of lidocaine 150mg/mL/prilocaine 50mg/mL spray as local treatment for primary PE. We suggest the combination of dapoxetine and lidocaine/prilocaine in patients insufficiently improved by monotherapy. In patients who have not responded to treatments with marketing authorisation, we suggest using an off-label SSRI, preferably paroxetine, in the absence of a contraindication. We recommend treating ED before PE in patients with both symptoms. We do not recommend using α-1 blockers or tramadol in patients with PE. We do not recommend routine posthectomy or penile frenulum surgery for PE.

CONCLUSION

These recommendations should contribute to improving the management of PE.

摘要

目的

大学后性学跨学科协会（AIUS）召集了一组专家，制定早泄管理的法国建议。

方法

对1995年1月至2022年2月间的文献进行系统综述。采用临床实践指南（CPR）方法。

结果

我们建议为所有早泄患者提供心理性咨询，并尽可能将药物治疗与针对性行为的认知行为疗法相结合，让伴侣参与治疗过程。其他性学方法可能有用。我们建议将达泊西汀作为原发性和获得性早泄的一线按需口服治疗药物。我们建议使用150mg/mL利多卡因/50mg/mL丙胺卡因喷雾剂作为原发性早泄的局部治疗药物。对于单药治疗改善不足的患者，我们建议联合使用达泊西汀和利多卡因/丙胺卡因。对于对已获上市许可的治疗无反应的患者，我们建议在无禁忌证的情况下使用未获批准的5-羟色胺再摄取抑制剂（SSRI），最好是帕罗西汀。我们建议对同时有早泄和勃起功能障碍（ED）症状的患者，先治疗ED。我们不建议早泄患者使用α-1阻滞剂或曲马多。我们不建议对早泄患者常规进行包皮环切术或阴茎系带手术。