Kaplan S A, Reis R B, Kohn I J, Shabsigh R, Te A E
Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Urology. 1998 Nov;52(5):739-43. doi: 10.1016/s0090-4295(98)00388-4.
Intracavernosal injection with a combination of agents (ie, phentolamine plus papaverine or alprostadil) has been used in an effort to increase efficacy and reduce side effects compared with single agents. The purpose of this pilot study was to determine the potential role of oral alpha-blockers in combination with intracavernosal therapy in men with erectile dysfunction, for whom intracavernosal therapy alone failed.
Thirty-eight consecutive men with moderate to severe erectile dysfunction on the basis of history and examination and with minimal or no therapeutic response to intracavernosal alprostadil injection therapy were evaluated. All patients received daily doxazosin titrated to 4 mg over 3 weeks in combination with intracavernosal therapy as needed for 12 weeks. Efficacy was assessed at 4, 8, and 12 weeks after doxazosin titration using the 1 5-item, self-administered International Index of Erectile Function (IIEF) and a global efficacy question (GEQ: Did treatment improve your erections?).
For the group, the mean baseline IIEF score before therapy was 29.7+/-9.8. After intracavernosal therapy (mean dose 34.7+/-7.3 microg), IIEF improved to 36.1+/-1 1.4 (17.7%). After addition of doxazosin, IIEF improved to 48.6+/-13.4, 46.4+/-10.9, and 51.5+/-14.3 at 4, 8, and 12 weeks, respectively (P < 0.01). The GEQ response improved from 25.7% at baseline to 81.4% at 12 weeks. Overall 22 (57.9%) of 38 patients with the combined regimen had a significant (more than 60% improvement in IIEF) therapeutic response.
The addition of an oral alpha-blocker may have a beneficial effect in patients with erectile dysfunction for whom intracavernosal therapy alone fails. The synergistic effects of vascular dilation and blockade of sympathetic inhibition may explain this response. The potential role of alpha-blockade in synergy with other agents designed to treat erectile dysfunction remains to be determined.
与单一药物相比，联合使用多种药物（如酚妥拉明加罂粟碱或前列地尔）进行海绵体内注射，旨在提高疗效并减少副作用。本初步研究的目的是确定口服α受体阻滞剂与海绵体内治疗联合应用于单独使用海绵体内治疗无效的勃起功能障碍男性患者中的潜在作用。
对38例根据病史和检查诊断为中度至重度勃起功能障碍且对海绵体内注射前列地尔治疗反应极小或无反应的男性患者进行评估。所有患者在3周内每日服用多沙唑嗪，滴定至4mg，并根据需要联合海绵体内治疗12周。在多沙唑嗪滴定后4周、8周和12周，使用15项自我管理的国际勃起功能指数（IIEF）和一个总体疗效问题（GEQ：治疗是否改善了你的勃起功能？）评估疗效。
该组患者治疗前IIEF平均基线评分为29.7±9.8。海绵体内治疗后（平均剂量34.7±7.3μg），IIEF改善至36.1±11.4（改善17.7%）。加用多沙唑嗪后，IIEF在4周、8周和12周时分别改善至48.6±13.4、46.4±10.9和51.5±14.3（P<0.01）。GEQ反应从基线时的25.7%改善至12周时的81.4%。联合治疗方案的38例患者中，总体有22例（57.9%）有显著（IIEF改善超过60%）的治疗反应。
对于单独使用海绵体内治疗无效的勃起功能障碍患者，加用口服α受体阻滞剂可能具有有益作用。血管扩张和交感神经抑制阻断的协同作用可能解释了这种反应。α受体阻断与其他旨在治疗勃起功能障碍的药物协同作用的潜在作用仍有待确定。
