Diagnosis and treatment of impotence

I. IntroductionImpotence is actually not a disease but a complication of many diseases. Understand the mechanism of penile erection, then understand why many symptoms of the disease can cause impotence. In recent years, research on impotence into a hot topic, but also gradually uncover the mystery of the impotence of this chapter for the causes of impotence, and some commonly used in clinical diagnosis to make a simple description.Two erectile mechanismA. Arterial - penis erection necessarily need to be adequate arterial perfusion, I observed the beginning of penile erection, the penis is just swell, which means that at this time arterial blood flow increases. Sponge body pressure gradually rose again when the pressure continues to increase, due to increased resistance to blood flow and gradually decreased.B. vein - when blood flow increases, the pressure gradually Spongiform l, located on the albuginea venous plexus of the oppressed, relative decrease in venous return. When the pressure gradually to blood pressure (SBP) approaching, the time arterial blood flow, venous return is reduced. Sponge the body of accumulated certain amount of blood to maintain its pressure. So when there is an abnormal vein or sponge body pressure is not enough, veins can not be closed, continuing to sponge the body's blood back to the body artery, the clinical manifestations erection can not be sustained.C. Spongiform - When the blood flow increases, Spongiform got to expansion, relaxation, to accommodate the increase in the blood, I observed the beginning of penile erection, there is swelling (diameter thicker, extended length) is Spongiform expansion. Diabetes, atherosclerosis, high cholesterol, aging will involve Spongiform atelectasis. Its expansion incomplete results, certain blood poured limited, and second, can not oppress veins, vein remains open; penis can not be stored blood.D. neural and hormonal regulation - in addition to nocturnal penile tumescence nerve path is not clear at present, but due to sexual stimulation through the brain, the spinal cord to the erection center (S2-4), and then by the same side nerve pelvic N, Cavernous N reached penis, prompting the arteries dilate, dilation of the sponge body erectile response. As for the male hormone, but the role in the regulation of erection, and the degree of sexual stimulation, no male hormones, penile erection as you can, but diminished the frequency of sex and sex drive, impotence patients so treated than waking up to give the male hormone.Three. Mei cause impotenceAforementioned mechanism of erection, you should be able to deduce what the complications of the disease have impotence.A. Arterial impotence - which means reduced penile blood flow perfusion; clinical disease have atherosclerosis, high cholesterol, obesity, arterial aneurysm, hypertension and other reasons, others such as pelvic trauma, fibrosis of the internal pudendal artery stenosis, pelvic cavity surgery, resulting in damage to the arteries. Clinically organic impotence to cause maximum arterial perfusion.B. venous leak impotence - namely penile erection, regurgitation venous system, causing an erection can not be and can not be sustained. Initially congenital venous leakage is not normal there is a large vein albuginea penis when it can not be oppressed atresia, this phenomenon among young people, is congenital. Other acquired diseases that whenever Spongiform atelectasis can not be between the sponge body wall and oppression albuginea veins, these diseases including atherosclerosis, diabetes, so Spongiform degeneration itself. Another cause degeneration of the disease itself albuginea, Peyronie's disease, penile cancer, trauma, scleroderma. Also due to neurological and psychological impotence were due to inadequate secretion of neurotransmitters negative, can not make Spongiform expansion is another vein entirely sexual impotence.C. neurogenic impotence - normal erection erotic stimulation is needed by the brain by nerve conduction path formed. As sleepy road problems, impotence Serve nervous. Such as stroke, brain tumors, spinal cord trauma, tumors, disc herniation, peripheral neuropathy (diabetes, chronic alcoholism, vitamin deficiency), or peripheral nerve injury (pelvic surgery, TURP).D. endocrine impotence - Although diabetes is a disease caused by endocrine impotence most common disease, but it causes impotence mechanism is arterial, venous, neuropathic and psychogenic impotence, is not in itself a direct cause of endocrine . Low male hormones in patients with erectile function itself should be intact, but reduced sexual interest in sex. (Libido). Others such as high thyroid, low thyroid and Cushing's Syndrome patients, occasional impotence and reduced libido condition in which the mechanism is currently unknown.E. neurogenic impotence - depression, obsessive-compulsive personality, sexual fear, extreme sex, religion, sexual impotence nerves are formed, which rose cause is unknown, may be sympathetic hyperactivity, and inhibition of neurotransmitter substances.F. the influence of drugs1 anti-hypertensive drugsa. role in central nervous system: methyldopa, clonidine, reserpineb. role of peripheral α-blocker: Prazosin (retrograde ejaculation)2 antidepressantstricyclics, MAO inhibitors (libido), major, minortranquilizers, hypnotics (libido)3. AntiandrogenFour. Impotence diagnosisA. nocturnal penile tumescence test - normal male night average 4 to 5 times erection, erection time average of about 20 to 40 minutes. If you have a problem of erectile tissue, arteries, veins, sponge body, etc., was incomplete on the phenomenon of nocturnal erections, or even nothing. Thus one can know the patient's impotence test is an organic or psychogenic impotence. Sleep at night because the majority of people in the rest of mental activity, usually repressed situation eased erection, the penis that is nocturnal erections.B. penis sponge body injection - injection of drugs, including PGE1, Paparerine, Phentolamine and other vessels and Spongiform vasodilators. Normal injection, due to arterial dilatation and Spongiform expansion, can reach the degree of erection, about five to ten minutes the erection lasts about three minutes later. Thus an injection test can distinguish whether the cause of arterial impotence.C. Color Doppler ultrasound - This method is mainly used to check the blood flow in the inspection erection, artery (Spongiform artery) to expand, blood flow to increase. Before inspection, give the patient as a sponge in vivo injection, since the condition of the penis Dabo. Ultrasound can be seen in the next case Spongiform arteries, blood flow and blood flow velocity pulsation circumstances change (normal> 30 ml / sec, not less than 25ml/sec), which have arterial sentenced Zhu Yang wilt.D. penis sponge body pressure measurement and Spongiform Photography - This method is mainly used to determine whether there is venous insufficiency. Also in the penis from the conditions Dabo (sponge injected), sponge two needle inserted into the body, a measured pressure, an infusion of physiological saline, the penis erection dimensional measurement of physiological saline infusion required speed (normal less than 5 ml / sec). Or because the human penis size are different, the speed dimension fear great variation, can be used to measure the pressure drop rate; make the penis pressure up to 150mmHg, stop the infusion, after 30 seconds depending on how much pressure is reduced sponge body, normally should not exceed 40mmHg . The dimensions and the rate of pressure decrease rate of venous leakage is determined, the time in the contrast agent can be injected into the body sponge, obtained by an X-ray of the site does venous leakage, surgery to facilitate subsequent ligation.E. essential basic neurological examination, such as the feeling of perineal test, touch, sense of difference between two points, vibrating tactile experiments Spongiform anal sphincter reflex, toilet situation, help us to patients general understanding of neurological status. Other patients secondary sexual characteristics, normal male hormone in the blood is also important to check whether or not you want to check one.Above as impotence general common inspection so convenient clinical use, under the flow chart:V. TreatmentSeveral ways, depending on the patient and their likes (patient-oriented treatment).A. oral drugsB. intravitreal injection or urethral sponge placed (Muze) vasodilatorsC. vacuum aspiratorD. arterial reconstructive surgery (not suitable for systemic arterial disease)E. vein ligation (determine abnormal venous return)F. artificial penis (otherwise unsuitable or failure)