Clinical necessity-diagnosis and treatment of erectile dysfunction with traditional Chinese and western medicine
The clinical efficacy of the simple western medicine treatment model has some limitations, and the individual diagnosis and treatment meet the clinical requirements. The Urology Committee of the Chinese Society of Integrated traditional Chinese and Western Medicine has issued the "expert consensus on the diagnosis and treatment of erectile dysfunction with integrated traditional Chinese and western medicine". Psychological evaluation, self-evaluation of penile hardness and measurement of penile nocturnal erectile hardness play an important role in the diagnosis of ED. The ideal treatment of western medicine for ED should be safe, effective, simple and economical. Type 5 phosphodiesterase inhibitor (PDE5i) is the first-line drug for the treatment of ED. Androgen can be used to treat patients with erectile dysfunction caused by endocrine dysfunction. The European Association of Urology (EAU) has used LESWT as a first-line treatment for vascular erectile dysfunction, which is expected to fundamentally repair the pathological injury of the penis.
Guide reading
Erectile dysfunction (ED) bothers many men and seriously affects the physical and mental health of male patients. The pathogenesis of ED is complex, and the clinical efficacy of simple western medicine treatment mode has some limitations. Integrated traditional Chinese and western medicine has unique advantages in the diagnosis and treatment of ED, which meets the clinical requirements of individual diagnosis and treatment, and can provide accurate diagnosis and treatment for patients, so as to improve the effectiveness of ED treatment. The Urology Committee of the Chinese Society of Integrated traditional Chinese and Western Medicine issued the "expert consensus on the diagnosis and treatment of erectile dysfunction with integrated traditional Chinese and western medicine" for clinical reference.
ED refers to the continuous inability of the penis to achieve or maintain enough erection to achieve a satisfactory sexual life; in traditional Chinese medicine, impotence refers to the condition that men are weak during sexual intercourse, or lift but not firm, or firm and not long, unable to have sex normally.
The Massachusetts male Aging study (MMAS) reports that the overall prevalence of ED in men aged 40 to 70 in the Boston area is 52%. In China, according to an epidemiological survey of three cities, the results showed that the total prevalence rate of ED was 26.1%, of which 40.2% were men over 40 years old. According to the reported data at home and abroad, the prevalence rate of ED increases with age, and the sick population tends to be younger.
Routine diagnostic methods include medical history collection, physical examination and laboratory examination.
Expert consensus and suggestions:Detailed records of the medical history of patients with ED, focusing on sexual life history, past medical history, mental, psychological and family factors; detailed physical examination, focusing on tongue and pulse examination, secondary sexual characteristics development examination, reproductive system examination, local nerve sensation and so on.
Routine laboratory examination including sex hormone and thyroid function; psychological evaluation, self-evaluation of penis hardness and nocturnal erection hardness test play an important role in the diagnosis of ED; penile cavernosum color Doppler ultrasound examination and penile nerve electrophysiological examination can be selected.
According to the etiology, patients can be diagnosed as psychological erectile dysfunction, endocrine erectile dysfunction, neuroerectile dysfunction and vascular erectile dysfunction.
The ideal treatment of ED should be safe, effective, simple and economical to achieve comprehensive rehabilitation. Sex and health education runs through the whole process of ED treatment, including lifestyle improvement, psychological adjustment, behavior training and so on. Patients with definite underlying diseases should be treated, such as cardiovascular disease, diabetes, endocrine abnormalities, depression, etc., and should be treated at the same time with ED or prior to ED.
First-line drug treatment: type 5 phosphodiesterase inhibitor (PDE5i) is currently the first-line drug for the treatment of ED. It improves erection by improving the diastolic function of corpus cavernosum smooth muscle cells and increasing cavernous blood perfusion. The effective rate of organic erectile dysfunction is up to 80%, and it also has a good effect on psychological erectile dysfunction.
Second-line drug therapy: patients with erectile dysfunction caused by endocrine dysfunction can be treated with androgen; when hyperprolactinemia, dopamine receptor agonists should be used after excluding other pituitary tumors, such as bromocriptine and cabergoline. In addition, there are drugs such as yohimbine and phentolamine, which can act locally, as well as central drugs, such as apomorphine and trazodone, but they are not routinely used in clinic.
Vacuum erectile device therapy (VED): as a non-invasive treatment, it can be used in the treatment of ineffective PDE5i or in combination with PDE5i. It is especially suitable for elderly patients who occasionally have sex.
Low energy extracorporeal shock wave therapy (LESWT): in recent years, LESWT is becoming a new treatment for ED. The European Association of Urology (EAU) has taken LESWT as a first-line treatment for vascular erectile dysfunction. This treatment is expected to fundamentally repair the pathological injury of the penis and thus cure ED.
Low intensity pulsed ultrasound (lipus): relying on non-thermal effects to promote vascular and nerve regeneration, inhibit inflammation and promote stem cell activation, it is considered to be an ideal treatment for the penis of ED patients to obtain spontaneous erectile function, and it is recommended for mild to moderate ED patients.
Prosthesis implantation surgery: the advantage is high satisfaction, does not affect sexual pleasure, ejaculation and urination, and the postoperative maintenance effect is longer than vascular reconstruction surgery, so it is recommended as the first choice of surgery.
Expert consensus and suggestions:The treatment of ED should adhere to the principle of joint participation of husband and wife and simultaneous treatment of etiology and psychology. PDE5i is the first-line drug of ED, combined with other methods can increase the therapeutic effect, such as oral administration of traditional Chinese medicine, vacuum vacuum suction, drug injection, low-energy ultrasound, low-energy shock wave therapy, etc. For patients with oral drugs and other treatments that are ineffective or unable to accept existing treatments, prosthesis implantation is the last option.
TCM syndrome differentiation of impotence, the majority of young and middle-aged patients, emotional injury, damp-heat invasion, blood stasis is the main pathogenesis. Elderly patients with high body failure, often deficiency or deficiency syndrome accounted for the majority, kidney yin and yang deficiency, spleen and kidney deficiency, life door fire failure, blood stasis, phlegm-dampness obstruction and other pathogenesis.
Expert consensus and suggestions:According to the syndrome differentiation of traditional Chinese medicine, patients with ED can be treated with traditional Chinese medicine alone or combined with western medicine. With the understanding of pathophysiology and disease process of ED in traditional Chinese medicine and western medicine, the individualized treatment scheme of integrated traditional Chinese and western medicine has achieved good therapeutic effect in clinic.
References:
[1]。 Expert consensus on diagnosis and treatment of erectile dysfunction with combination of traditional Chinese and western medicine [J]. Chinese Journal of surgery of Integrated traditional Chinese and Western Medicine, 2022 June 28 (06): 763-768.
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