爱思唯尔期刊《欧洲泌尿学》（European Urology）最近刊登了美国南伊利诺伊州大学医学院一份关于治疗男性勃起功能障碍（ED）的研究。研究首次发现，磷酸二酯酶5型（PDE5）抑制剂对治疗接受保留神经根治性前列腺切除术男性ED非常有效。
男性前列腺病患者在接受保留神经根治性前列腺切除术后，会有非常高的风险患上勃起功能障碍疾病，这主要是由于神经生理性阻断有关。作为细胞内信号传导的第二信使，环磷酸腺苷 (cAMP)和环磷酸鸟苷(cGMP)在细胞的生命活动中有重要的意义，细胞内cAMP和cGMP水平的调控是由环化酶的合成和磷酸二酯酶(PDEs)的水解作用来实现。磷酸二酯酶5抑制剂（PDE5 ）能增加细胞内cAMP水平、cGMP水平，或同时增加二者的水平。
该研究遍及了欧洲，美国，加拿大和南非的87个研究中心，历时三年。研究发现PDE5对男性阴茎海绵体的神经源性有松弛作用。对于那些接受保留神经根治性前列腺切除术的患者ED非常有效，这也是第一次研究发现PDE5抑制剂在治疗接受保留神经根治性前列腺切除术男性ED的疗效。
原始出处：
European Urology，doi:10.1016/j.eururo.2008.08.062，Tobias S. K?hler and Kevin T. McVary
The Relationship between Erectile Dysfunction and Lower Urinary Tract Symptoms and the Role of Phosphodiesterase Type 5 Inhibitors
Tobias S. K?hler and Kevin T. McVary
Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois, USA bDepartment of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) and the potential interplay of phosphodiesterase type 5 inhibitors (PDE5-I) have clinical implications for both patient screening and treatment.
To describe the current literature assessing the LUTS–ED relationship and the role of PDE5-I from both a basic science and clinical intervention perspective.
We focused on data recently published (1990–2008) describing epidemiologic and mechanistic manuscripts of the LUTS–ED relationship with emphasis on papers involving PDE5-I—particularly those using level 1 evidence clinical trials. Base key words used included BPH, LUTS, ED, and phosphodiesterase inhibitors in combination with such secondary key words as nitric oxide, autonomic hyperactivity, Rho-kinase, atherosclerosis, and mechanism. We abstracted >200 articles and reviewed >100.
The large overlap of elderly men with both LUTS and ED likely stems from a cause-and-effect relationship. Thus far, four proposed mechanisms attempt to explain the relationship between LUTS and ED. Multiple studies showing that PDE5-I improved LUTS have been performed. Understanding the role of PDE5-I in the LUTS and ED relationship affects patient screening and treatment but also raises further research questions.
The future use of phosphodiesterase inhibitors as either prophylaxis or as a primary treatment for LUTS looms as a possibility and may not be limited to men.
