Der Urologe, Ausgabe A

, Volume 42, Issue 10, pp 1345–1350 | Cite as

Erektile Dysfunktion—Wertigkeit neurophysiologischer Diagnoseverfahren

Zusammenfassung

An der Entstehung der erektilen Dysfunktion sind neurogene, insbesondere autonome Störungen, entscheidend beteiligt. Eine Erektion wird parasympathisch und sympathisch, vornehmlich über nichtcholinerge, nichtadrenerge Neurotransmitter und schließlich mit Hilfe der Aktivierung von zyklischen Monophosphaten induziert. Durch die resultierende Erschlaffung der glatten Gefäß- und Schwellkörpermuskulatur kommt es zur Tumeszenz und Rigidität und damit zur Erektion.

Die Diagnostik neurologischer Ursachen der erektilen Dysfunktion sollte eine ausführliche Anamneseerhebung und neurologische Untersuchung beinhalten. Klassische neurophysiologische Untersuchungen, wie etwa die Nadelmyographie des M. sphincter ani externus, Latenzbestimmungen des N. pudendus oder die Messung des Bulbokavernosusreflexes, reflektieren die Funktion der schnellleitenden, dick bemarkten Nervenfasern und sind oft nicht aussagekräftig, da sie nicht die kleinkalibrigen Nervenfasern beurteilen. Die Untersuchung dieser für die Erektion wesentlichen kleinkalibrigen Nervenfasern, z. B. mit Hilfe einer psychophysischen quantitativen Thermotestung, kann die Diagnostik der neurogenen erektilen Dysfunktion bereichern. Daneben kann die Beurteilung der Herzfrequenzvariabilität in Ruhe, während metronomischer Atmung (6/min), Valsalva-Manöver, sowie nach aktivem Aufstehen, hilfreich sein, eine autonome Neuropathie als Ursache einer erektilen Dysfunktion zu erfassen.

Schlüsselwörter

Erektile Dysfunktion Neurophysiologische Testung Autonome Neuropathie Small fiber neuropathy Thermotest Herzfrequenzvariabilität 

Abstract

Neurogenic, particularly autonomic disorders, frequently contribute to the etiology and pathophysiology of erectile dysfunction. Parasympathetic and sympathetic outflow mediates erection. Noncholinergic, nonadrenergic neurotransmitters induce activation of cyclic monophosphates, leading to relaxation of smooth muscles of the corpora cavernosa and by this to tumescence and rigidity, i.e. erection. The diagnosis of neurologic causes of erectile dysfunction requires a detailed history and neurologic examination. Conventional neurophysiological procedures evaluate the function of rapidly conducting, thickly myelinated nerve fibers only. Therefore, techniques such as sphincter ani externus electromyography, latency measurements of the pudendal nerve or bulbocavernosus reflex studies frequently do not contribute to the diagnostic process. The evaluation of small nerve fibers that are essential for erection, for example by means of psychophysical quantitative thermotesting, might improve the diagnosis of neurogenic causes of erectile dysfunction. In addition, the assessment of heart rate variability at rest, during metronomic breathing, Valsalva maneuver, and active standing might be helpful to identify an autonomic neuropathy as the cause of erectile dysfunction.

Keywords

Erectile dysfunction Neurophysiological testing Autonomic neuropathy Small fiber neuropathy Thermotest Heart rate variability 
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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Neurologische Klinik der Universität Erlangen-Nürnberg
  2. 2.New York University School of Medicine, Dept. of NeurologyNew York
  3. 3.Neurologische Klinik der Universität Erlangen-NürnbergKopfklinikErlangen

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