Lehmann K, Schöpke W, Hauri D
Urologic Clinic, University Hospital Zurich, Switzerland.
Eur Urol. 1995;27(4):306-10. doi: 10.1159/000475186.
A substantial number of young men with erectile dysfunction have neither systemic disease nor a trauma in their history. We are familiar with impotence after major trauma but it is an unanswered question whether subclinical trauma may also induce arterial degeneration with subsequent erectile dysfunction. In a period of 36 months 129 patients underwent penile arteriography. After excluding those with major surgery, trauma or psychogenic impotence 91 angiograms were reevaluated. Special attention was paid to atherosclerotic and to focal occlusive arterial disease (> 50% stenosis) in the hypogastric-cavernous branch. 12 angiograms showed normal arteries, 59 typical atherosclerotic and 20 focal occlusive arterial disease. The mean age of patients with atherosclerosis was 53 +/- 8 years versus 35 +/- 14 years of those with focal lesions (p < 0.0001). 30% with focal arterial lesions were subject to subclinical trauma. 68% with atherosclerotic disease had clinical relevant atherosclerotic risk factors. Latency between onset of erectile dysfunction and presentation at the impotence clinic was 51 months in patients with focal lesions and 39 months in those with atherosclerotic disease (nonsignificant). We conclude that subclinical trauma of the hypogatric-cavernous arteries can induce focal arterial lesions with significant impairment of perfusion. This pathology may contribute to erectile dysfunction. These patients are significantly younger and they suffer from clinically evident impotence approximately 18 years earlier than patients whose impotence is clearly of atherosclerotic origin. Focal arterial lesions due to subclinical trauma are described for the first time as an etiology of erectile dysfunction. Further studies are needed to confirm these results.
相当数量患有勃起功能障碍的年轻男性既没有全身性疾病，病史中也没有创伤经历。我们都熟知重大创伤后会出现阳痿，但亚临床创伤是否也会引发动脉退变并继而导致勃起功能障碍，这仍是一个未解之谜。在36个月的时间里，129例患者接受了阴茎动脉造影。排除那些经历过重大手术、创伤或患有心因性阳痿的患者后，对91份血管造影进行了重新评估。特别关注了腹下-海绵体分支中的动脉粥样硬化和局灶性闭塞性动脉疾病（狭窄>50%）。12份血管造影显示动脉正常，59份为典型的动脉粥样硬化，20份为局灶性闭塞性动脉疾病。动脉粥样硬化患者的平均年龄为53±8岁，而局灶性病变患者的平均年龄为35±14岁（p<0.0001）。30%有局灶性动脉病变的患者曾遭受亚临床创伤。68%患有动脉粥样硬化疾病的患者有临床相关的动脉粥样硬化危险因素。局灶性病变患者从勃起功能障碍发作到在阳痿诊所就诊的间隔时间为51个月，动脉粥样硬化疾病患者为39个月（无显著差异）。我们得出结论，腹下-海绵体动脉的亚临床创伤可诱发局灶性动脉病变，导致灌注显著受损。这种病理情况可能导致勃起功能障碍。这些患者明显更年轻，与阳痿明显源于动脉粥样硬化的患者相比，他们出现临床明显阳痿的时间要早约18年。首次描述了亚临床创伤导致的局灶性动脉病变是勃起功能障碍的一种病因。需要进一步研究来证实这些结果。
