Suzuki N, Kumamoto Y
Department of Urology, School of Medicine, Sapporo Medical University.
Nihon Hinyokika Gakkai Zasshi. 1995 Jun;86(6):1098-107. doi: 10.5980/jpnjurol1989.86.1098.
Erectile dysfunction is a well documented complication among male hemodialysis patients. The cause has been reported to be related to multiple factors, including neurological, endocrinological and vasculogenic elements. The purpose of this study was to identify the factors which most greatly determine erectile dysfunction in hemodialysis patients. Male hemodialysis patients without diabetes mellitus and severe anemia (Hb value < 8.0 g/dl) were entered into the study. We measured nocturnal penile tumescence (NPT) values in these patients and carried out neurological studies (measurement of the penile dorsal nerve conduction velocity and the bulbocavernosus reflex (BCR) latency). a vasculogenic study (measurement of the penile blood pressure index (PBPI) and endocrinological studies (measurement of serum free testosterone levels and serum prolactin levels before hemodialysis). NPT values (maximum penile circumference changes) in hemodialysis patients decreased compared with those in healthy males. In both hemodialysis patients and healthy males, NPT values decreased with age. NPT values in hemodialysis patients were significantly lower than those in healthy males in the fifties and sixties. 32.2% of hemodialysis patients had severe penile neurological disorder. 55.6% of them showed abnormal NPT. PBPI was low in only 10.0% of hemodialysis patients. However, there was a significant correlation between PBPI and the NPT value (r = 0.387). Serum free testosterone levels in hemodialysis patients were significantly lower than those in healthy males. There was a significant correlation between the serum free testosterone level and the NPT value (r = 0.328). However, there was no correlation between the serum prolactin level and the NPT value. To identify the factors which most greatly determine erectile dysfunction in hemodialysis patients, we carried out multivariate analysis. The criterion variables in this analysis were NPT values. The coefficient of determination was highest for a neurological disorder (30.7%), followed by an endocrinological disorder (a reduction in the serum free testosterone level) (11.6%) and a vasculogenic disorder (a reduction in PBPI) (4.2%).
勃起功能障碍是男性血液透析患者中一种有充分文献记载的并发症。据报道，其病因与多种因素有关，包括神经、内分泌和血管生成因素。本研究的目的是确定在血液透析患者中最能决定勃起功能障碍的因素。无糖尿病和严重贫血（血红蛋白值<8.0 g/dl）的男性血液透析患者被纳入研究。我们测量了这些患者的夜间阴茎勃起（NPT）值，并进行了神经学研究（测量阴茎背神经传导速度和球海绵体反射（BCR）潜伏期）、血管生成研究（测量阴茎血压指数（PBPI））以及内分泌学研究（在血液透析前测量血清游离睾酮水平和血清催乳素水平）。与健康男性相比，血液透析患者的NPT值（最大阴茎周长变化）降低。在血液透析患者和健康男性中，NPT值均随年龄增长而降低。五十多岁和六十多岁的血液透析患者的NPT值显著低于健康男性。32.2%的血液透析患者存在严重的阴茎神经功能障碍。其中55.6%表现出异常的NPT。仅10.0%的血液透析患者PBPI较低。然而，PBPI与NPT值之间存在显著相关性（r = 0.387）。血液透析患者的血清游离睾酮水平显著低于健康男性。血清游离睾酮水平与NPT值之间存在显著相关性（r = 0.328）。然而，血清催乳素水平与NPT值之间无相关性。为了确定在血液透析患者中最能决定勃起功能障碍的因素，我们进行了多变量分析。该分析中的标准变量为NPT值。神经功能障碍的决定系数最高（30.7%），其次是内分泌功能障碍（血清游离睾酮水平降低）（11.6%）和血管生成功能障碍（PBPI降低）（4.2%）。
