Bondil P, Blachère P
Service d'Urologie-Andrologie, CHG Chambéry, France.
Prog Urol. 1998 Feb;8(1):17-31.
Despite considerable progress, the treatment of erectile insufficiency is often difficult due to its usually multifactorial aetiology and to the fact that the 3 components of a satisfying sex life are: 1) Sufficient penile rigidity with no other associated sexual dysfunction, 2) an adapted mental state, 3) a loving relationship with the partner. All of these parameters must be taken into account to ensure a lasting success, hence the need for a global approach rather than an approach localized to the organ. Consequently, there is not one, but several treatments which must be adapted to each case. The rarity of easily curable aetiologies explains the very widespread use of symptomatic treatments and the primordial place of clinical assessment. A consensus has currently been reached concerning: a) give the patient objective information, an essential prerequisite for the choice and success of treatment, b) start by proposing minimally invasive medical treatments, c) emphasize the value of a multidisciplinary approach in the case of failure, d) recognize the fact that achievement of a rigid penis is not necessarily synonymous with cure. In practice, two situations can be distinguished: 1) in the presence of predominantly psychogenic disorders, sex therapy and/or sexual advice can be used in all patients, either alone or in combination with drug treatments and/or a vacuum device (especially in the case of failure of either of these treatments), 2) in the presence of predominantly organic abnormalities which are not easily curable drug treatments and/or vacuum must be proposed first, but sexological management is always useful in these so-called "organic" patients. Prosthetic surgery, the only approach with demonstrated efficacy, is only indicated following failure of medical treatment, after rigorous selection. The release onto the market, in the near future, of promising new oral or intraurethral drugs used "on request" will certainly modify the treatment hierarchy. Due to their acceptability and efficacy, they will certainly be prescribed as first-line treatment, regardless of the origin of the erectile insufficiency. However, the therapeutic approach in the case of failure will remain unchanged. Erectile insufficiency can effectively be treated provided a rigorous assessment is performed.
尽管取得了显著进展，但勃起功能不全的治疗往往很困难，这是因为其病因通常是多因素的，而且令人满意的性生活包含三个要素：1）阴茎有足够的硬度且无其他相关性功能障碍；2）合适的心理状态；3）与伴侣的亲密关系。为确保持久成功，所有这些参数都必须考虑在内，因此需要采用整体治疗方法，而不是局限于器官的局部治疗方法。因此，治疗方法并非单一，而是有多种，必须根据具体情况进行调整。易于治愈的病因罕见，这就解释了对症治疗为何广泛应用以及临床评估为何至关重要。目前已就以下几点达成共识：a）向患者提供客观信息，这是治疗选择和成功的必要前提；b）首先推荐微创药物治疗；c）强调在治疗失败时多学科方法的价值；d）认识到阴茎勃起并不一定意味着治愈。在实践中，可以区分两种情况：1）主要存在心理性障碍时，性治疗和/或性咨询可用于所有患者，可单独使用或与药物治疗和/或真空装置联合使用（特别是在其中任何一种治疗失败的情况下）；2）主要存在不易治愈的器质性异常时，必须首先推荐药物治疗和/或真空装置，但性学管理对这些所谓的“器质性”患者始终有用。假体手术是唯一已证实有效的方法，只有在严格筛选后，药物治疗失败时才会考虑。在不久的将来，有望上市的按需使用的新型口服或尿道内药物肯定会改变治疗顺序。由于其可接受性和有效性，无论勃起功能不全的病因如何，它们肯定会被作为一线治疗药物处方。然而，治疗失败时的治疗方法将保持不变。只要进行严格评估，勃起功能不全是可以有效治疗的。
