Truss M C, Becker A J, Schultheiss D, Jonas U
Department of Urology, Medizinische Hochschule Hannover, Germany.
World J Urol. 1997;15(1):71-7. doi: 10.1007/BF01275160.
Intracavernous application of vasoactive substances not only has enhanced our understanding of penile hemodynamics, the physiology of penile erection, and the pathophysiology of erectile dysfunction but also has revolutionized the diagnosis and treatment of erectile dysfunction in the last 15 years. Virag was the first to report on the erectile effect of papaverine in humans, and Brindley later reported the effect of intracavernous application of alpha-receptor-blocking agents on cavernous tissue. These reports led to numerous basic and clinical investigations and ultimately established a new treatment alternative for patients with erectile dysfunction that is now considered to be the treatment of choice for most patients. Changes in penile hemodynamics include the relaxation of cavernous smooth musculature and arteries, which leads to an increase in arterial blood flow and a restriction of venous outflow through a compression of subtunical veins. These hemodynamic changes are the prerequisite for the induction and maintenance of penile erection. With the intracavernous application of vasoactive substances it was possible to influence penile hemodynamics at a local level and to induce an erection despite alterations in the nervous system, penile arterial blood flow, cavernous musculature, or neurotransmitter status. In addition, the local application of pharmacologically active substances directly to the end organ enabled the achievement of high local drug concentrations without severe systemic side effects. The commonly used substances are papaverine the combination of papaverine and phentolamine, and prostaglandin E1 (alprostadil). In addition to these established substances, several other regimens, such as linsidomine (SIN-1), calcitonin gene-related peptide (CGRP), moxisylyte, and various triple- or quadruple-drug mixtures have been described. In addition, several other compounds as well as different routes of administration are on the horizon and may prove to be effective in the future diagnosis and treatment of erectile dysfunction.
海绵体内应用血管活性物质不仅加深了我们对阴茎血流动力学、阴茎勃起生理学以及勃起功能障碍病理生理学的理解，而且在过去15年里彻底改变了勃起功能障碍的诊断和治疗方式。维拉格首先报道了罂粟碱对人体的勃起作用，布林德利随后报道了海绵体内应用α受体阻滞剂对海绵体组织的作用。这些报道引发了大量基础和临床研究，并最终确立了一种针对勃起功能障碍患者的新治疗方法，如今该方法被认为是大多数患者的首选治疗方案。阴茎血流动力学的变化包括海绵体平滑肌组织和动脉的松弛，这会导致动脉血流量增加，并通过压迫白膜下静脉来限制静脉流出。这些血流动力学变化是诱导和维持阴茎勃起的前提条件。通过海绵体内应用血管活性物质，可以在局部水平影响阴茎血流动力学，并在神经系统、阴茎动脉血流、海绵体肌肉组织或神经递质状态发生改变的情况下诱导勃起。此外，将药理活性物质直接局部应用于终末器官能够在不产生严重全身副作用的情况下实现高局部药物浓度。常用的物质有罂粟碱、罂粟碱与酚妥拉明的组合以及前列腺素E1（前列地尔）。除了这些已确立的物质外，还描述了其他几种方案，如亚硝基铁氰化钠（SIN-1）、降钙素基因相关肽（CGRP）、莫西赛利以及各种三联或四联药物混合物。此外，还有其他几种化合物以及不同的给药途径正在出现，可能在未来勃起功能障碍的诊断和治疗中被证明是有效的。
