Aversa A, Rocchietti-March M, Caprio M, Giannini D, Isidori A, Fabbri A
Department of Medical Pathophysiology, University of Rome La Sapienza, Italy.
Int J Androl. 1996 Oct;19(5):307-13. doi: 10.1111/j.1365-2605.1996.tb00481.x.
Intracavernous injection (ICI) of prostaglandin-E1 (PGE1) is used widely as the first diagnostic test in the study of erectile dysfunction. However, a lack of full erection after a maximal dose is frequent. As well as vascular incompetence, this may be due to stress-induced changes, related to the ICI procedure. The aim of this study was to investigate the influence of emotional disturbances on erectile response to ICI in impotent patients. Initially, 24 young men with non-organic impotence (age 34.6 +/- 1.5 years; mean +/- SEM) were selected and randomized single-blind to pharmacoerection with PGE1 alone (20 micrograms/mL) or a mixture (cocktail) containing 20 micrograms PGE1 plus an alpha-adrenergic receptor blocker, phentolamine (Phe, 0.5 mg/mL). Additional studies were also performed double-blind on 10 men with non-organic impotence (age 37.6 +/- 1.2 years) utilizing higher PGE1 dosages for ICI (25 micrograms/mL alone or in combination with Phe, 0.5 mg/mL). After a 7-day interval, all subjects were crossed-over to receive the alternative treatment. The presence of emotional disturbances was assessed in all patients by the administration of rapid tests (Stai-X1 and Stai-X1r for state-anxiety before and after ICI, respectively; Stai-X2 for trait-anxiety; Zung-test for depression) at the first and at the remaining (Stai-X1 and Stai-X1r) ICI sessions. ICI with 20 and 25 micrograms/mL PGE1 led to a comparable percentage of patients who reported a valid-for-intromission (VFI) erection (63 and 60%, respectively). In contrast, use of the cocktails significantly increased the percentage of subjects with a VFI (87 and 90% of the total number of patients tested, respectively; p < 0.05). Moreover, a strong inverse correlation between state-anxiety scores (Stai-X1) and the erectile response to ICI with 20 and 25 micrograms PGE1 was found (r = -0.69, p < 0.001); such a correlation was not present in patients who underwent ICI with the cocktails. Two cases of prolonged erection occurred (one after 20 micrograms PGE1 and the other after 20 micrograms PGE1 plus Phe) which were reversed promptly by the intracavernous injection of metharaminol. It is concluded that the lack of a full erectile response after ICI with PGE1 can be related to the presence of a high 'state-anxiety' in the patients. In such patients, a VFI erectile response can be induced by the administration of a cocktail test-dose.
前列腺素E1（PGE1）海绵体内注射（ICI）作为勃起功能障碍研究中的首个诊断测试被广泛应用。然而，注射最大剂量后仍缺乏完全勃起的情况很常见。除血管功能不全外，这可能是由于与ICI操作相关的应激诱导变化所致。本研究的目的是调查情绪障碍对阳痿患者ICI勃起反应的影响。最初，选择了24名患有非器质性阳痿的年轻男性（年龄34.6±1.5岁；平均值±标准误），并将其随机单盲分为单独使用PGE1（20微克/毫升）进行药物勃起或使用含有20微克PGE1加α-肾上腺素能受体阻滞剂酚妥拉明（Phe，0.5毫克/毫升）的混合物（鸡尾酒疗法）。还对10名患有非器质性阳痿的男性（年龄37.6±1.2岁）进行了双盲研究，使用更高剂量的PGE1进行ICI（单独使用25微克/毫升或与0.5毫克/毫升的Phe联合使用）。间隔7天后，所有受试者交叉接受另一种治疗。在首次及随后的ICI疗程中，通过快速测试（分别在ICI前后使用状态焦虑量表Stai-X1和Stai-X1r；特质焦虑量表Stai-X2；抑郁自评量表Zung测试）对所有患者的情绪障碍情况进行评估。使用20微克/毫升和25微克/毫升PGE1进行ICI后，报告有可进行性交插入（VFI）勃起的患者百分比相当（分别为63%和60%）。相比之下，使用鸡尾酒疗法显著提高了有VFI勃起的受试者百分比（分别占测试患者总数的87%和90%；p<0.05）。此外，发现状态焦虑评分（Stai-X1）与使用20微克和25微克PGE1进行ICI的勃起反应之间存在强烈的负相关（r=-0.69，p<0.001）；而接受鸡尾酒疗法进行ICI的患者中不存在这种相关性。发生了2例持续性勃起（1例在注射20微克PGE1后，另1例在注射20微克PGE1加Phe后），通过海绵体内注射间羟胺迅速得到缓解。得出的结论是，使用PGE1进行ICI后缺乏完全勃起反应可能与患者存在高度 “状态焦虑” 有关。在这类患者中，给予鸡尾酒测试剂量可诱导出VFI勃起反应。
