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Erektile Funktionsstörungen

Epidemiologie, Physiologie, Ätiologie, Diagnostik und Therapie

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Zusammenfassung

Die erektile Dysfunktion stellt eine häufige, altersabhängige und mit zahlreichen Komorbiditäten assoziierte Funktionsstörung des Mannes dar. Wichtig sind körperliche Untersuchung, Labordiagnostik und vaskuläre Abklärung. Interdisziplinäre Kooperationen sind zur Neurologie bei vermuteter neurogener Ätiologie und zur Psychiatrie bei unauffälligen organischen Untersuchungsbefunden sinnvoll.

Eine kausale Therapie ist durch Hormonersatz oder Psychotherapie in Einzelfällen erfolgreich. Die orale Pharmakotherapie stellt die Therapie mit der höchsten Patientenpräferenz und Erfolgsquote dar. Dabei sind die peripher wirksamen 5-Phosphodiesterasehemmer(Sildenafil, Tadalafil, Vardenafil) den zentral wirksamen Pharmaka (Apomorphin, Yohimbin) hinsichtlich der Effektivität überlegen. Die lokale Pharmakotherapie (MUSE, SKAT) wird bei unzureichendem Ansprechen der oralen Pharmakotherapie oder Kontraindikationen eingesetzt. Hilfsmittel wie die Vakuumtherapie oder operative Interventionen wie die Schwellkörperprothetik ergänzen das therapeutische Repertoire.

Abstract

Erectile dysfunction is a common, age-dependent functional disturbance of men associated to various comorbidities. Interdisciplinary cooperation with neurologists in cases of a suspected neurological aetiology and with psychiatrists in cases with normal organic diagnostic findings is necessary.

Hormone replacement and psychotherapy can cure certain patients. Oral pharmacotherapy is the most effective therapy for erectile dysfunction with the highest patient preference. Oral PDE-5-inhibitors(sildenafil, tadalafil, vardenafil) are superior in effectiveness to centrally acting drugs(apomorphin, yohimbine). Local pharmacotherapy (MUSE, ICI) is a second line therapy in cases of failure or contraindications for oral pharmacotherapy. Vacuum therapy and operative procedures(penile implants) complete the therapeutic options of erectile dysfunction.

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Literatur

  1. Angulo J, Cuevas P, Fernandez A et al. (2001) Characterization of Vardenafil, a new PDE5 inhibitor for erectile dysfunction, and comparison of activity with sildenafil. Int J Imp Res 13(S4): 24 (p 64)

    Article  Google Scholar 

  2. Arentewicz G, Schmidt G (Hrsg) (1993) Sexuell gestörte Beziehungen, Konzept und Technik der Paartherapie. Enke, Stuttgart

  3. Bartolo DCC, Jarratt JA, Read NW (1983) The use of conventional electromyography to assess external shincter neuropathy. J Neurol Neurosurg Psychiatry 46: 1115–1118

    CAS  PubMed  Google Scholar 

  4. Beier KM, Bosinski HAG, Hartmann U, Loewit K (Hrsg) (2001) Sexualmedizin, Urban & Fischer, München

  5. Braun M, Wassmer G,Klotz T, Reifenrath B,Mathers M, Engelmann U (2000) Epidemiology of erectile dysfunction: results of the ‚Cologne male Survey’. Int J Imp Res 12: 305–311

    Article  CAS  Google Scholar 

  6. Breza J, Aboseif SR, Orvis BR et al. (1989) Detailed anatomy of penile neurovascular structures: Surgical significance. J Urol 141: 437–443

    CAS  PubMed  Google Scholar 

  7. Boolell M, Gepi-Attee S, Gingell JC, Allen MJ (1996) Sildenafil, an novel effective oral therapy for male erectile dysfunction. Br J Urol 78: 257–261

    Article  CAS  PubMed  Google Scholar 

  8. Brock G, Padma-Nathan H, Seger M (2002) Efficacy and tolerability of vardenafil in males with erectile dysfunction following radical prostatectomy. Eur Urol S1: 152

    Google Scholar 

  9. Brock GB, Mcmahon CG, Chen KK, Watkins V, Anglin G, Watkins S (2002) Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol168 (4): 1332–1336

  10. Buddeberg C (1996) Sexualberatung. Enke, Stuttgart

  11. Derouet H, Caspari D, Rohde V et al. (1999) Treatment of erectile dysfunction with external vacuum devices. Andrologia 31 (S1): 89–94

    PubMed  Google Scholar 

  12. Derouet H, Nolden W,Jost WH, Osterhage J, Eckert R, Ziegler M (1998) Treatment of erectile dysfunction by an externous ischiocavernous muscle stimulator. Eur Urol 34 (4): 355–359

    Article  CAS  PubMed  Google Scholar 

  13. Eardley I, Edwards A, Hole J, Macdonagh R, Wright P (2003) Comparative efficacy of sildenafil citrate and apomorphine in men with erectile dysfunction: A randomised crossover study. Int J Impot Res 15(S6): 3

    Google Scholar 

  14. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, Mckinlay JB (1994) Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 151: 54–61

    CAS  PubMed  Google Scholar 

  15. Foreman MM, Wernicke JF (1990). Approaches for the development of oral drug therapies for erectile dysfunction. Semin Urol 8: 107–112

    CAS  PubMed  Google Scholar 

  16. Goldstein AMB, Padma-Nathan, H (1990) The microarchitecture of the intracavernosal smooth muscle and the cavernosal fibrous skeleton. J Urol 144: 1144–1146

    CAS  PubMed  Google Scholar 

  17. Goldstein I, Young J, Segerson T, Thibonnier M (2002) Long-term efficacy and safety of Vardenafil in diabetic men with erectile dysfunction. Diabetes 51(S2): A98

    Google Scholar 

  18. Guiliano F, Chevret-Measson M, Tsatsaris A, Reitz C, Murino M, Thonneau P (2002) Prevalence of erectile dysfunction: results of an epidemiological survey of a representative sample of 1004 men. Eur Urol 42: 382–389

    Article  PubMed  Google Scholar 

  19. Hartmann U (1997) Psychological subtypes of erectile dysfunctions: results from statistical analyses and clinical practice. World J Urol 15: 56–64

    CAS  PubMed  Google Scholar 

  20. Hartmann U (2000) Psychosomatische Aspekte bei Erektionsstörungen. Dtsch Ärztebl 97: B-534–538

  21. Heaton JPW (2000) Apomorphine: an update of clinical trials. Int J Impot Res 12(S4): 67–73

    Article  Google Scholar 

  22. Hoyndorf S, Christmann F (1998) Kognitive Verhaltenstherapie bei sexuellen Funktionsstörungen. In: Hautzinger M (Hrsg.) Kognitive Verhaltenstherapie bei psychischen Störungen, Beltz Psychologie Verlags Union, Weinheim

  23. Kim N, Hang Y, Moreland R, Kwak S (2000) Cross-regulation of intracellular cGMP and cAMP in cultured human corpus cavernosum smooth muscle cells. Mol Cell Biol Res Comm 4: 10–14

    Article  CAS  Google Scholar 

  24. Kiff ES, Swash M (1984) Normal proximal and delayed distal conduction in the pudendal nerves of patients with idiopathic (neurogenic) faecal incontinence. Br J Surg 71 614–616

  25. Kirby M, Jackson G, Betteridge J, Friedli K (2001) Is erectile dysfunction a marker for cardiovascular disease? Int J Clin Pract 55 (9): 614–618

    CAS  PubMed  Google Scholar 

  26. Lewis R, Jordan G (2002) Surgery for erectile dysfunction. In: Campbells, Urology, 8th edn, vol 2. Saunders, Philadelphia

  27. Kockott G (2002) Diagnostik und Therapie sexueller Funktionsstörungen. In: Hartwich P, Haas S (Hrsg) Sexuelle Störungen und Probleme bei psychisch Kranken. Wissenschaft & Praxis, Sternenfels

  28. Lizza EF, Rosen RC (1999) Definition and classification of erectile dysfunction. Report of the Nomenclature committee of the International society of impotence Research. Int J Impotence Res 11: 141–143

    Article  CAS  Google Scholar 

  29. Lue TF, Tanagho EA (1988)Functional anatomy and mechanism of penile erection in the treatment of venogenic impotence. In: Tanagho EA, Lue TF, Mcclure RD (eds) Contemporary management of male impotence and infertility. Williams & Wilkins, Baltimore, pp 65–69

  30. Michal V, Simana J, Rehak J, Masin J (1983) Haemodynamics of erection in man. Physiologia Bohemoslovaca 32: 497–499

    CAS  PubMed  Google Scholar 

  31. Montorsi F et al. (2000) AMS Three-Piece Inflatable Implants for erectile dysfunction: A long-term Multi-institutional study in 200 consecutive patients. Eur Urol 37: 50–55

    CAS  Google Scholar 

  32. Montorsi F et al. (2003) Tadalafil in the treatment of ED following bilateral nerve-sparing radical retropubic prostatectomy. Int J Impot Res 15(S6): 4

    Article  Google Scholar 

  33. NIH (1993) NIH Consensus Conference: impotence.NIH Consensus development panel on impotence. JAMA 270: 83

    PubMed  Google Scholar 

  34. Opsomer RJ, Guerit JM, Wiese FX (1986) Pudendal cortical somatosensory evoked potentials. J Urol 135: 1216–1217

    CAS  PubMed  Google Scholar 

  35. Padma-Nathan H, Hellstorm WJ, Kaiser FF et al. (1997) Treatment of men with erectile dysfunction with transurethral alprostadil Medicated Urethral system for erection (MUSE) Study group. N Engl J Med 336: 1–7

    CAS  Google Scholar 

  36. Porst H, Huebler D, Padma-Nathan H, Varense L, Anglin G, Giuliano F (2002) Tadalafil allows Men with erectile dysfunction to have sexual intercourse up to 36 hours postdose. Int J IMP Res 14(S4): S60

    Article  Google Scholar 

  37. Porst H, Young JM, Schmidt AC, Buvat J, International Vardenafil Study Group (2003) efficacy and tolerability of vardenafil for erectile dysfunction in patient subgroups. Urology 6283: 519–523

    Article  Google Scholar 

  38. Rampin O, Giuliano F (2001) Brain control of penile erection. World J Urol. 19: 1–8

  39. Rendell MS, Rajfer J, Wicker PA, Smith MD (1999) Sildenafil for treatment of erectile dysfunction in men with diabetes-a randomized controlled trial. Sildenafil diabetes study group. JAMA 281: 421–426

    Article  CAS  PubMed  Google Scholar 

  40. Rosen RC, Leary M, Altwein J et al. (2002) LUTS and Male sexuality: Findings from the multi-national survey of the aging male (MSAM-7). Int J Imp Res 14(S3): S25

    Article  Google Scholar 

  41. Rosen RC, Riley A, Wagner G et al. (1997) The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 49: 822–830

    CAS  PubMed  Google Scholar 

  42. Rosen RC, Lane RM, Menace M (1999) Effects of SSRI’s on sexual function: A critical review. J Clin Psychopharmacol 19: 67–85

    CAS  PubMed  Google Scholar 

  43. Saenez de Tejada I, Emmick J, Anglin G, Fredlund P, Pullman W (2001) The effect of on demand Tadalafil (IC351) treatment of erectile dysfunction in men with diabetes. Eur Urol 39(S5): 16

    Google Scholar 

  44. Stief C, Ueckert S, Becker A et al. (2000) Effects of sildenafil on c-AMP and c- GMP levels in isolated human cavernous and cardiac tissue. Urology 55: 146–150

    Article  CAS  PubMed  Google Scholar 

  45. Wessels H, Lue TF, McAninch JW (1996) Penile length in the flaccid and erect states: Guidelines for penile augmentation. J Urol 156: 995–997

    Article  PubMed  Google Scholar 

  46. Yassin A, Diede HE, Saad F, Traish A (2003) Combination therapy of tadalafil and testosteron in hypogonadal non-responders. Int J Impot Res 15(S6): 27

    Article  Google Scholar 

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Authors and Affiliations

  1. Urologische Universitätsklinik, Homburg/Saar

    H. Derouet

  2. Universitäts-Nervenklinik—Neurologie, Homburg/Saar

    J. Osterhage

  3. Universitäts-Nervenklinik—Psychiatrie und Psychotherapie, Homburg/Saar

    H. Sittinger

  4. Urologische Universitätsklinik, 66421, Homburg/Saar

    H. Derouet

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  1. H. Derouet
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  2. J. Osterhage
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  3. H. Sittinger
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Correspondence to H. Derouet.

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Derouet, H., Osterhage, J. & Sittinger, H. Erektile Funktionsstörungen. Urologe [A] 43, 197–209 (2004). https://doi.org/10.1007/s00120-003-0527-9

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