ED ED 1 ED 3 Peyronie ED ED ED ED 1 ED 50% ~ 60% 7 2 FSH E 评估阴茎勃起的常规检查 ED 阴茎夜间勃起硬度测定 nocturnal p

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1 751 NJA National Journal of Andrology Zhonghua Nan Ke Xue Za Zhi http / /www. androl. cn Standardization & Guideline R R2-031 A doi /j. cnki. nja erectile dysfunction ED ED ED evidence-based medicine EBM 6 EUA 2015 ED 2 MMAS 40 ~ 70 ED 52% ED 26. 1% % A Ⅰ B ⅡA ⅡB ⅡC C Ⅲ

2 ED ED 1 ED 3 Peyronie ED ED ED ED 1 ED 50% ~ 60% 7 2 FSH E 评估阴茎勃起的常规检查 ED 阴茎夜间勃起硬度测定 nocturnal penile tumescence and rigidity NPTR NPTR 8 ED ED ED 3 ~ 6 2 ~ % 10 min 视听刺激下阴茎硬度测试 visual stimulation tumescence and rigidity VSTR VSTR ED ED 5 ED 16% ~ 78% ED ED PDE5i 1 ED 阴茎海绵体注射血管活性药物 intracavernous injection ICI 试验 ICI ED E1 ED 阴茎彩色多普勒超声检查 color Doppler duplex ultrasonography CDDU CDDU ED ED ED IIEF-5 13 peak systolic velocity PSV ED ED ED 实验室检查 LH PRL resistance index RI ED > 0. 7 mm 75% PSV ED cm /s EDV < 5 cm /s RI > 0. 8 PSV < 30 cm /s EDV > 5 cm RI < international index of erectile function-5 IIEF bulbocavernosus reflex BCR 神经诱发电位检查 17 phosphodiesterase-5 inhibitor end-diastolic velocity EDV

3 753 BCR ED BCR 肝郁肾虚 30 ~ 45 ms 评估阴茎勃起的特殊检查阴茎海绵体灌注测压及造影 ED 阴部内动脉造影湿热瘀滞心脾两虚 ED ED ED PDE5i ED ED 命门火衰脾肾两虚 ED ED 肾气不足肝郁气滞 PDE5i PDE5i 肾阴亏虚 PDE5i ED 80% ED ED 36 PDE5i 5 mg 5 mg IIEF ED

4 PDE5i PDE5i LESWT PDE5i PDE5i ED IIEF PDE5i ED NO PDE5i ED ED ED 2 12 nmol /L PDE5i PDE5i ICI ICI ED 4. 1 PGE h α g h vacuum entrapment device PDE5i VED VED PDE5i PDE5i min low-intensity extracorpreal shock wave therapy LESWT EAU LESWT ED 2 LESWT LESWT ED IIEF-5 PDE5i ED 50%

5 g 4 3 PDE5i ED IIEF ~ 5 min d d PDE5i ED ICI PDE5i ED ED / 4. 2 ED 3 ~ ED ED ED 79. 7% 61 ED 62 ED ED ED

6 Davis-Joseph B Tiefer L Melman A. Accuracy of the initial history and physical examination to establish the etiology of erectile dysfunction. Urology Hatzichristou D Hatzimouratidis K Bekas M et al. Diagnostic steps in the evaluation of patients with erectile dysfunction. J Urol Morales A Heaton JP. Hormonal erectile dysfunction. Evaluation and management. Urol Clin North Am Hatzimouratidis K Amav E Eardley I et al. Guidelines on male sexual dysfunction Erectile dysfunction and premature ejaculation. Eur Urol Feldman HA Goldstein I Hatzichristou DG et al. Impotence and its medical and psychosocial correlates Results of the Massachusetts Male Aging Study. J Urol Esposito K Giugliano F Dio Palo C et al. Effect of lifestyle changes on erectile dysfunction in obese men A randomized con- 8. trolled trail. JAMA Esposito K Giugliano F Mariorino MI et al. Dietary factors 9.. mediterranean diet and erectile dysfunction. J Sex Med Goldstein I Lue TF Padma-Nathan H et al. Oral sildenafil in 31 Meldrum DR Gambone JC Morris MA et al. The link between the treatment of erectile dysfunction. Sildenafil Study Group. N erectile and cardiovascular health The canary in the coal mine. Engl J Med Am J Cardiol Lue TF Giuliano F Montorsi F et al. Summary of the recom- 32 Srini VS Veerachari SB. Erectile dysfunction shock wave therapy. A new modality in the management of erectile dysfunction mendations on sexual dysfunctions in men. J Sex Med Does it improve the outcome J Men 's Health Hatzichristou DG Hatzimouratidis K Ioannides E et al. Nocturnal penile tumescence and rigidity monitoring in young potent 33 Rosen RC. Psychogenic erectile dysfunction. Classification and 213. volunteers Reproducibility evaluation criteria and the effect of management. Urol Clin North Am sexual intercourse. J Urol Wein AJ Kaousi LR Novick AC et al. Campbell-Walsh Urolo- 35. gy 9th Edition. Philadelphia Saunders 2007 vol

7 Skeldon SC Detsky AS Goldenberg SL et al. Erectile dysfunction and undiagnosed diabetes hypertension and hypercholesterolemia. Ann Fam Med Porst H Gacci M Büttner H et al. Tadalafil once daily in men with erectile dysfunction An integrated analysis of data obtained from 1913 patients from six randomized double-blind placebocontrolled clinical studies. Eur Urol Buvat J Hatzichristou D Boess FG et al. Continuation and effectiveness of tadalafil once daily during a 6-month observational study in erectile dysfunction The EDATE study. Int J Clin Pract Rubio-Aurioles E Kim ED Rosen RC et al. Impact on erectile function and sexual quality of life of couples A double-blind randomized placebo-controlled trial of tadalafil taken once daily. J Sex Med itor therapy. J Sex Med Gruenwald I Appel B Kitrey ND et al. Shockwave treatment of erectile dysfunction. Ther Adv Urol Hellstrom WJ Gittelman M Jarow J et al. An evaluation of semen characteristics in men 45 years of age or older after daily dosing with tadalafil 20mg Results of a multicenter randomized double-blind placebo-controlled 9-month study. Eur Urol Jarvi K Dula E Drehobl M et al. Daily vardenafil for 6 months has no detrimental effects on semen characteristics or reproductive hormones in men with normal baseline levels. J Urol Hellstrom WJ. Current safety and tolerability issues in men with erectile dysfunction receiving PDE5 inhibitors. Int J Clin Pract Aliaev Lu G Vinarov AZ Akhvlediani ND. Choice of treatment of erectile dysfunction associated with hypogonadism. Urologiia Montague DK Jarow JP Broderick GA et al. AUA guideline on the management of erectile dysfunction Diagnosis and treatment recommendations. American Urological Association Education and Research 2015 update Uche-Holub E Thierling U Giessing M et al. Intracavernous injection A treatment modality for erectile dysfunction. Hautarzt Chen J Sofer M Kaver I et al. Concomitant use of sildenafil and a vacuum entrapment device for the treatment of erectile dysfunction. J Urol Raina R Agarwal A Allamaneni SS et al. Sildenafil citrate and vacuum constriction device combination enhances sexual satisfaction in erectile dysfunction after radical prostatectomy. U- rology Vardi Y Appel B Jacob G et al. Can low-intensity extracorporeal shockwave therapy improve erectile function A 6-month follow-up pilot study in patients with organic erectile dysfunction. Eur Urol Vardi Y Appel B Kilchevsky A et al. Does low intensity extracorporeal shock wave therapy have a physiological effect on erectile function Short-term results of a randomized doubleblind sham controlled study. J Urol Gruenwald I Appel B Vardi Y. Low-intensity extracorporeal shock wave therapy a novel effective treatment for erectile dysfunction in severe ED patients who respond poorly to PDE5 inhib Li D Jiang X Zhang X et al. Multicenter pathophysiologic investigation of erectile dysfunction in clinic outpatients in China. Urology Kupelian V Link CL McKinlay JB. Association between smoking passive smoking and erectile dysfunction Results from the Boston Area Community Health BACH Survey. Eur Urol Lee AC Ho LM Yip AW et al. The effect of alcohol drinking on erectile dysfunction in Chinese men. Int J Impot Res Weber MF Smith DP O'Connell DL et al. Risk factors for erectile dysfunction in a cohort of Australian men. Med J Aust Hyde Z Flicker L Hankey GJ et al. Prevalence and predictors of sexual problems in men aged years A population-based study. J Sex Med Gao J Zhang X Su P et al. Relationship between sexual dysfunction and psychological burden in men with infertility A large observational study in China. J Sex Med

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i ED 3 ED 3 ED ED 17 ED 17 MMPs B00017140 2003 6 i 1 2 3 ED 3 ED 3 ED 5 5 6 9 10 12 12 13 13 14 14 15 16 16 16 ED 17 ED 17 CIEF-5 21 23 27 MMPs 28 29 31 31 31 31 34 MMPs 34 MMP 34 MMP 35 MMP 36 MMP 38 MMP 39 43 43 44 44 46 ii 50