Betts C D, Jones S J, Fowler C G, Fowler C J
Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
Brain. 1994 Dec;117 ( Pt 6):1303-10. doi: 10.1093/brain/117.6.1303.
Forty-eight men with multiple sclerosis and erectile dysfunction were evaluated. Emphasis was placed on the neurological features and the relationship between impotence and the bladder dysfunction in multiple sclerosis. Erectile failure was invariably associated with pyramidal signs in the lower limbs and with urinary symptoms. All of the men with impotence and marked pyramidal dysfunction in their legs were found by cystometric studies to have bladder hyperreflexia. The severity of the urinary symptoms was related to the degree of pyramidal impairment in the lower limbs. The posterior tibial and the pudendal cortical evoked potentials were abnormal in most of the men with multiple sclerosis and erectile failure. However, recording the pudendal cortical responses in patients with multiple sclerosis and impotence provided no more information than the tibial cortical evoked potentials. The neurological examination findings together with the results of the neurophysiological and cystometric tests suggest that erectile dysfunction in multiple sclerosis is due to spinal lesions situated proximal to the sacral cord. The feasability of papaverine intracorporeal injection therapy for men with multiple sclerosis and impotence was assessed. Papaverine intracorporeal injections produced satisfactory erections in the majority of the impotent men. Erectile failure in patients with multiple sclerosis was successfully managed for up to 2 years, by intracorporeal self-injection therapy.
对48名患有多发性硬化症和勃起功能障碍的男性进行了评估。重点关注了神经学特征以及多发性硬化症中阳痿与膀胱功能障碍之间的关系。勃起功能障碍总是与下肢锥体束征和泌尿系统症状相关。通过膀胱测压研究发现，所有腿部存在阳痿且有明显锥体束功能障碍的男性均有膀胱反射亢进。泌尿系统症状的严重程度与下肢锥体束损伤程度相关。大多数患有多发性硬化症和勃起功能障碍的男性胫后皮质诱发电位和阴部皮质诱发电位均异常。然而，对于患有多发性硬化症和阳痿的患者，记录阴部皮质反应所提供的信息并不比胫后皮质诱发电位更多。神经学检查结果以及神经生理学和膀胱测压测试结果表明，多发性硬化症中的勃起功能障碍是由于骶髓近端的脊髓病变所致。评估了罂粟碱海绵体内注射疗法对患有多发性硬化症和阳痿男性的可行性。罂粟碱海绵体内注射在大多数阳痿男性中产生了满意的勃起效果。通过海绵体内自我注射疗法，成功治疗患有多发性硬化症患者的勃起功能障碍长达2年。
