Li Ke-Fan, Fu Qiang, Zhang Ke-Qin, Zhang Hui, Sun Ding-Qi, Liu Hui, Liu Xiao, Gao Shuang, Liu Shuai
Department of Urology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China.
Department of Urology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, Shandong 250021, China.
Zhonghua Nan Ke Xue. 2022 Dec;28(12):1096-1102.
To investigate the application value of RigiScan monitoring in assisting tadalafil medication.
This self-control study included 89 ED patients (IIEF-5 < 21) treated in our hospital from August 2019 to July 2020. The patients underwent audiovisual sexual stimulation (AVSS), nocturnal penile tumescence and rigidity (NPTR) test, scoring on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-Item Scale (GAD-7), blood routine test, blood biochemical analysis, and hormone secretion examination, which confirmed 21 cases of psychogenic, 28 cases of organic and 40 cases of mixed ED. We treated the patients with tadalafil at 5 mg/d for 30 days, followed by examination of their erectile function by IIEF-5 scoring and AVSS and comparison of their erectile function with the baseline. For some of the patients that responded poorly to tadalafil at 5 mg/d, we increased the dose to 20 mg and detected the efficacy by AVSS at 1 h after medication. For those with organic or mixed ED irreponsive to tadalafil at 20 mg, we performed screening for corpora cavernosal venous leakage (CCVL) by intracavernosal injectionof alprostadil and penile color Doppler duplex ultrasonography or used dynamic infusion cavernosometry and cavernosography (DICC) to confirm the diagnosis of CCVL.
The effectiveness rates of 5 mg/d tadalafil on mild, moderate and severe ED were 85.4%, 53.1% and 43.8%, respectively, significantly higher on mild than on moderate and severe ED (P = 0.002), and its effectiveness rates on psychogenic, organic and mixed ED were 90.5%, 60.7% and 57.5%, respectively, remarkably higher on psychogenic than on organic and mixed ED (P = 0.026). For those with organic or mixed ED irresponsive to 5 mg/d tadalafil, the increased dose of 20 mg achieved an effectiveness rate of 64.3%. (P = 0.033). The results of DICC did not encourage tadalafil medication for the cases of organic or mixed ED with CCVL irresponsive to both 5 mg and 20 mg tadalafil.
RigiScan monitoring plays a guiding role in tadalafil medication of ED and helps distinguish organic from psychogenic ED. Tadalafil at 5 mg/d produces a better effect on mild than on moderate and severe ED, and so does it on psychogenic than on organic and mixed ED. The dose of medication can be increased to 20 mg for organic and mixed ED irresponsive to 5 mg tadalafil, but tadalafil is not recommended for organic and mixed ED with CCVL irresponsive to both 5 mg and 20 mg tadalafil.
探讨RigiScan监测在辅助他达拉非用药中的应用价值。
本自身对照研究纳入了2019年8月至2020年7月在我院治疗的89例勃起功能障碍（ED）患者（国际勃起功能指数-5[IIEF-5]<21）。患者接受视听性刺激（AVSS）、夜间阴茎勃起硬度（NPTR）测试、患者健康问卷-9（PHQ-9）和广泛性焦虑障碍7项量表（GAD-7）评分、血常规检查、血液生化分析以及激素分泌检查，确诊为心因性ED 21例、器质性ED 28例、混合性ED 40例。我们给予患者5mg/d的他达拉非治疗30天，随后通过IIEF-5评分和AVSS检查其勃起功能，并将其勃起功能与基线进行比较。对于部分对5mg/d他达拉非反应不佳的患者，我们将剂量增加至20mg，并在用药后1小时通过AVSS检测疗效。对于20mg他达拉非治疗无效的器质性或混合性ED患者，我们通过海绵体内注射前列地尔和阴茎彩色多普勒超声进行海绵体静脉漏（CCVL）筛查，或采用动态灌注海绵体测压和海绵体造影（DICC）来确诊CCVL。
5mg/d他达拉非对轻度、中度和重度ED的有效率分别为85.4%、53.1%和43.8%，对轻度ED的有效率显著高于中度和重度ED（P = 0.002），对心因性、器质性和混合性ED的有效率分别为90.5%、60.7%和57.5%，对心因性ED的有效率显著高于器质性和混合性ED（P = 0.026）。对于5mg/d他达拉非治疗无效的器质性或混合性ED患者，剂量增加至20mg后的有效率为64.3%（P = 0.033）。DICC结果显示，对于5mg和20mg他达拉非均无效的伴有CCVL的器质性或混合性ED病例，不建议使用他达拉非治疗。
RigiScan监测在ED的他达拉非用药中起指导作用，有助于区分器质性ED和心因性ED。5mg/d的他达拉非对轻度ED的疗效优于中度和重度ED，对心因性ED的疗效优于器质性和混合性ED。对于5mg他达拉非治疗无效的器质性和混合性ED患者，可将药物剂量增加至20mg，但对于5mg和20mg他达拉非均无效的伴有CCVL的器质性和混合性ED患者，不建议使用他达拉非。
