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BACKGROUNDGUIDELINES ON ERECTILE DYSFUNCTION E. Wespes, E. Amar, D. Hatzichristou, F. Montorsi, J. Pryor, Y. Vardi TABLE OF CONTENTS PAGE 1. Background 3 2. Diagnosis 3 3. Treatment 4
3.1 First-line therapy 5 3.2 Second-line therapy 5 3.3 Third-line therapy 6
4. Conclusion 6 5. References 6 6. Abbreviations used in the text 7 BACKGROUND Male erectile dysfunction (ED) (impotence) has been defined as the persistent (lasting for at least 6 months) inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. Although ED is a benign disorder, it is related to physical and psychological health, and has a significant impact on the quality of life of both sufferers and their families. Recent epidemiological data have shown a high prevalence and incidence of ED. The Massachusetts Male Aging Study reported a combined prevalence of 52% for minimal, moderate, and complete ED in non-institutionalized 40-70 year-old men in the Boston area (1). In this study, the individual prevalences were 17.2%, 25.2% and 9.6% for minimal, moderate and complete ED, respectively (1). The same study found that the incidence of ED was 24 new cases per 1000 men. Erection is a neurovascular phenomenon under hormonal control, and includes arterial dilatation, trabecular smooth muscle relaxation and activation of the corporeal veno-occlusive mechanism (2,3). The advances in basic and clinical research during the last 15 years have led to the development of several new treatment options for ED, including new pharmacological agents for intracavernosal, intraurethral and oral use. The recent advent of medical therapy and the poor results of long-term follow-up in reconstructive vascular surgery, have significantly modified the medical management of this disorder (4-6). The current availability of an effective and safe oral therapy for ED and the future availability of other oral drugs, awaiting final approval, in conjunction with the tremendous media interest in the condition, have resulted in an increasing number of men seeking help for ED. As a consequence, many physicians without background knowledge and clinical experience in the diagnosis and treatment of ED are involved in making decisions concerning the evaluation and treatment of these men. The result of this is that some men with ED may undergo little or no evaluation before treatment is initiated, or that men without ED may seek treatment in order to enhance their sexual performance with anti-ED drugs. In such circumstances, the disease causing the symptom (ED) may remain untreated. Such observations made the development of guidelines for the diagnosis and treatment of ED a necessity. The European Association of Urology formed an expert panel to address the shortcomings and problems associated with the diagnosis and treatment of ED. The overall objective of the project was to develop guidelines for clinical evaluation and treatment, based on the evaluation and review of available scientific information, as well as on current research and clinical practice in the field. Moreover, the panel identified critical problems and knowledge gaps, setting priorities for future clinical research. Дата добавления: 2015-09-18 | Просмотры: 455 | Нарушение авторских прав |