Clinical necessity-treatment and management of erectile dysfunction

The etiology and pathogenesis of ED are complex, not only related to local lesions of the penis, but also closely related to a variety of chronic diseases. The ultimate goal of ED therapy is to improve penile erectile function, improve sexual life satisfaction and quality of life of both partners, and delay the progress of ED and prevention and treatment of concomitant diseases.

ED therapy focuses onControl etiology and reduce risk factorsAndSymptomatic treatmentAt the same time, we should also followOverall health management, implementChronic disease management、Simultaneous treatment of body and mindAndCo-governance of men and womenWait for the principle.

Basic treatment

ED may be the precursor and local manifestation of systemic diseases. The effective management of basic diseases, bad life style and mental and psychological factors in patients with ED, especially the basic treatment, is bound to be conducive to the rehabilitation of ED.

1. A good lifestyle is of great significance to the improvement of erectile function. Moderate exercise, reasonable diet, good sleep and weight control can improve vascular function and erectile function, and increase the effect of drug treatment, such asPhosphodiesterase inhibitor type 5 (PDE5i) improvement of erectile function.

two。 For patients with definite underlying diseases, they should be treated before ED or at the same time with ED, such as CVD, diabetes, hyperlipidemia, depression, etc., and pay attention to some antihypertensive drugs, lipid-lowering drugs and antidepressants that treat these basic diseases may cause ED.

3. Patients with ED are more likely to have psychological problems such as decreased happiness, self-confidence and self-esteem. Sexual education, counseling, psychological counseling and treatment are all helpful to the recovery of patients' sexual function.

4. People with ED should be made to understand that sex is an important part of their quality of life and face the problem with their sexual partners. Close contact with the feelings of sexual partners (especially passion) is the first concern, appropriately mobilize the interest of patients and their partners in sexual life, and encourage them to increase the frequency of sexual life under psychological or drug treatment, and gradually learn the skills of sexual life.

Oral drug therapy

PDE5i is the main oral drug for ED. Oral PDE5i has become the first choice for the treatment of ED, and it is easy to be accepted by most patients because of its convenience, safety and effectiveness. PDE5i has two ways: on-demand use and regular use.

Androgen replacement therapy

Patients with primary or secondary male hypogonadism caused by various causes are often complicated with ED. Androgen therapy can not only enhance libido, but also improve erectile function. For ED patients with low testosterone levels, androgen replacement therapy can improve the erectile function of those who do not respond to PDE5i for the first time, and combined with PDE5i may have an enhanced effect.

Antioxidants and drugs to improve microcirculation

With the increase of age and some metabolic diseases such as diabetes, the body is mostly in the state of oxidative stress, resulting in the decrease of NO and the increase of vascular endothelin-1 (ET-1), the decrease of relaxation and the enhancement of contractility of corpus cavernosum smooth muscle of penis, and the functional and organic damage of blood endothelium of small vessels, thus aggravating the degree of ED. In these patients, the effect of PDE5i alone is not good. The combined use of antioxidants and drugs to improve microcirculation can be considered.

Other drugs

Other drugs such as apomorphine, trazodone and other drugs have been confirmed by some studies on ED, but the application is less.

Physiotherapy

Physiotherapy (such as negative pressure suction and micro-energy, etc.) is usually used as an auxiliary means of ED therapy.Patients with poor efficacy can choose or combined with appropriate physiotherapy. Commonly used physiotherapy methods includeVacuum erection device (VED)、Low intensity extracorporeal shock wave therapy (LI-ESWT), low intensity pulsed ultrasound (LIPUS), electrophysiological technology, etc.

Corpus cavernosum injection (ICI)

As a second-line treatment of ED, ICI therapy can be considered when oral drugs are ineffective. The commonly used drugs are prostaglandin E1, papaverine, phentolamine and so on. Combined therapy is often used to improve the efficacy and reduce the adverse reactions of various drugs. At present, the combination of papaverine, prostaglandin E1 and phentolamine has the highest effective rate of 92%.

Transurethral administration

Transurethral administration of vasoactive drugs is mainly based on the consideration of reducing penile trauma, and alprostadil is commonly used at present. There are two different methods of administration: the first is to make a mixture with a cream that promotes penetration and apply it to the external orifice of the urethra to promote the absorption of alprostadil, and its clinical data are very limited. The second method of administration is to put alprostadil into the urethra. 30% of patients can get enough erection for sexual intercourse.

Surgical treatment

Surgical treatment is a third-line treatment of ED for moderate to severe ED patients who are ineffective in first-line and second-line treatment. Due to the poor long-term effect of penile vascular surgery, surgical indications should be strictly selected and adequate preoperative communication should be carried out. In the absence of contraindications, penile prosthesis has good safety and effectiveness, but attention should be paid to prevent the occurrence of intraoperative and postoperative complications.

Traditional Chinese medicine treatment

Traditional Chinese medicine refers to the disease as "impotence", "muscle impotence" and "no use of pubic organs". The disease name "impotence" began at the end of the Ming Dynasty and has been in use ever since. Traditional Chinese medicine in the treatment of impotence, emphasizing the overall concept and syndrome differentiation, according to different syndrome types, enhance erectile function at the same time, improve systemic symptoms. The modern research on the mechanism of impotence of traditional Chinese medicine is mainly focused on regulating hypothalamus-pituitary-gonad axis, improving microcirculation, anti-aging, anti-oxidation and so on.

Treatment of special type of ED

The guidelines agree to put forward a detailed treatment plan for special types of ED, such as ED after pelvic surgery, ED after pelvic fracture and urethral injury (PFUI), ED after spinal cord injury (SCI), ED secondary to hyperprolactinemia and ED after brain disease.

Fig. 1 treatment flow of ED

The health management of ED aims to prevent and control the occurrence and development of ED and related diseases, reduce the medical burden, improve the quality of life, carry out health education for individuals and groups, improve the consciousness and level of self-management, and aim to mobilize the enthusiasm of individuals, collectives and society, and make effective use of limited resources to achieve maximum health effect.

The health management of ED first needs to establish patient health files according to patients' basic data, life style, sexual life status, mental and psychological status, Jiankang physical examination data, disease history and so on. Secondly, clinicians need to collect and track all kinds of information reflecting personal health status, analyze and establish the quantitative relationship between life style, sexual frequency, environment, heredity, psychology, serum index, chronic disease and ED, and use the prediction model to determine the current health status of participants and the development trend of ED, so that participants can know whether there is a risk of ED and related chronic diseases.

reference

1. Guidelines for diagnosis and treatment of erectile dysfunction [J]. Chinese Journal of Men's Science, 2022, 28 (08): 722-755.