De Palma R G
Department of Surgery, University of Nevada School of Medicine, Reno 89520, USA.
West J Med. 1996 Jan;164(1):54-61.
New developments in the diagnosis and treatment of impotence or erectile dysfunction are increasingly based on better understanding of the erectile process. In 1978 it was thought that the failure of arterial inflow was the main cause of male erectile dysfunction. Emphasis was placed on methods of corpus cavernosal revascularization. In recent years, interest has shifted to abnormal cavernosal smooth muscle function. An understanding of the erectile process was greatly enhanced by intracavernosal administration of vasoactive agents in 1982 and, more recently, the use of prostaglandin E1. These agents promote erection by causing smooth muscle to relax. The intracavernosal administration of vasoactive agents is now used in diagnosis and in therapy. Standard approaches to diagnosis and therapy still vary, but more rational steps are evolving. Considerable progress has been made in quantifying penile blood flow. Increasingly effective therapies are available for an estimated 10 million American men suffering from erectile dysfunction. Therapies include the use of drugs, administering vasoactive agents intracavernosally, vacuum constrictor devices, and vascular interventions in highly selected cases of arterial or venous disease. These procedures are being carefully reevaluated. Critical analysis of recent results suggests that about 7% of men are amendable to vascular interventions, with success rates approximating 70% when supplemental therapy is used.
阳痿或勃起功能障碍诊断与治疗方面的新进展越来越多地基于对勃起过程的更深入理解。1978年，人们认为动脉血流不足是男性勃起功能障碍的主要原因，重点放在了海绵体血运重建方法上。近年来，关注点已转向海绵体平滑肌功能异常。1982年海绵体内注射血管活性药物以及最近使用前列腺素E1极大地增进了对勃起过程的理解。这些药物通过使平滑肌松弛来促进勃起。海绵体内注射血管活性药物目前用于诊断和治疗。诊断和治疗的标准方法仍然各不相同，但更合理的步骤正在形成。在量化阴茎血流量方面已经取得了相当大的进展。对于估计1000万患有勃起功能障碍的美国男性，越来越有效的治疗方法可供使用。治疗方法包括使用药物、海绵体内注射血管活性药物、真空收缩装置以及对高度选定的动脉或静脉疾病病例进行血管干预。这些程序正在被仔细重新评估。对近期结果的批判性分析表明，约7%的男性适合进行血管干预，使用辅助治疗时成功率约为70%。
