Post Date December, 03 2023
（1） Medical treatment
Treatment of systemic diseases: for example, early patients with diabetes, if the diet is properly controlled, insulin or oral hypoglycemic drugs are used, the sexual function can be rapidly improved.
Discontinuation of drugs that affect sexual function: Many drugs, such as antihypertensive drugs, antipsychotics, diuretics, hormones, anticholinergics, and cardiovascular system drugs, can cause impotence, so discontinuation of these drugs will be beneficial to the recovery of sexual function; However, before discontinuation, it is necessary to weigh the patient's overall condition to determine whether to continue treatment for the primary disease, reduce the dose, switch to other drugs, or completely stop using the drug.
Endocrine therapy includes the following aspects: a) Application of sex hormones or gonadotropins: For patients with primary testicular insufficiency, testosterone can be used as a replacement treatment; "For diseases of the hypothalamus or pituitary gland, both gonadotropins and luteinizing hormone releasing hormone (LH-RH) can be used.". Testosterone propionate has a half life of 5 to 7 hours in plasma, so frequent medication is required, which is troublesome. If long-term medication is desired, long-term testosterone such as testosterone Yu or cyclopentyl propionate can be selected.
b) Adrenocortical hormone or thyroid hormone: Suitable for adrenal cortex or hypothyroidism.
c) Dopamine synergists or dopamine-like drugs should be used in patients with hyperprolactinemia caused by hypothalamic or pituitary disorders. About 5-19% of impotent patients have hyperprolactinemia and can be treated with bromocriptine.
d) Correct metabolic disorder: such as diabetes ketosis and metabolic acidosis.
e) Endocrine gland surgery: Surgical treatment can help restore sexual function, such as thalamic and pituitary tumors, male and female hypercortisolosis, or hyperthyroidism.
Non Hormone Drug Therapy: α－ The adrenergic blocker Yohimbine, which selectively blocks presynaptic activity α－ 2 receptors, but Wang interferes with postsynaptic α－ 1 receptor, thereby enhancing norepinephrine release from nerve endings and reducing penile venous reflux. The commonly used dose is 6 mg, t. i。 d。， If gastric or neurological symptoms occur and cannot be tolerated, the dose should be reduced to 2 mg, t. i。 d。， And gradually increase (double weekly) until it reaches 18 mg per day for at least 18 weeks. Other commonly used a-blockers, such as phentolamine, phenoxybenzylamine, or prazosin, have no similar effects.
（2） Penile prosthesis implantation
Doctors have long sought an ideal surgical treatment for patients who are completely unable to erect.
In 1973, Scott et al. successfully developed a hollow prosthesis that can be filled and expanded by liquid. In 1975, Small and Carrion developed a semi rigid silicone rubber rod prosthesis. These two types of penile prosthesis have become the most commonly used at present, and the implantation site is also agreed that it is the most ideal to implant the two main silicon columns into both sides of the sponge body in parallel. In recent years, two new types of expandable prostheses have been introduced. Its characteristics are that the three components of the above-mentioned columnar silicon capsule, infusion pump, and fluid reservoir are assembled in a single prosthesis, which can reduce the incidence of mechanical failures even if placed in a surgical position. One type of penis prosthesis is called FlexiFlate. The other type is called a Hydroflex penis prosthesis.
Recently, there is a new prosthesis called OmniPhase, which uses a mechanical knob to adjust the penis from a flaccid state to a renal hard position without filling and discharging liquid. The prosthesis consists of a curved area and a regulating device. Although penis prosthesis implantation into the cavernous body has been recognized as an effective method for the treatment of impotence, with various improvements, the function has become more perfect, but there is still no perfect ideal prosthesis, which needs to be further improved in the future.
（3） Intracavernous injection of vasoactive drugs
Papaverine is a powerful smooth muscle relaxant. Injecting it into the cavernous body can cause arterial dilation and relaxation of the trabecular smooth muscle of the cavernous body, thereby increasing the inflow of blood to the penis and inducing an erection. It is suitable for vascular, neurological, endocrine, and stubborn mental impotence, with an effective rate of 70 to 97%.
The method is to stretch the penis along the inner side of the thigh, and use a 30 # needle to vertically puncture the root of the penis into the sponge to inject liquid medicine. The drug used and the starting dose are determined based on the cause of impotence and the patient's penile brachial artery index. Neurogenic and psychogenic impotence is treated with papaverine (30mg/ml) only, with an initial injection dose of 0.25mg; For other types of impotence, a mixture of papaverine (25mg/ml) and phentolamine (0.83mg/ml) was used, with an initial dose of 0.25ml. The initial dose of vascular impotence with a penile blood pressure index less than 0.85 is 0.5 ml. After injection, gently massage the penis to evenly distribute the drug within the sponge. The patient can then go home, encourage sexual activity, and monitor their reactions and side effects. If the effect is not significant, the dose can be doubled until a functional erection is achieved, with each dose not exceeding 1. Limited to 5ml. If neurological or psychiatric impotence is not effective with simple papaverine injection, a combination treatment can be tried again. If functional erections can be obtained after injection, self injection can be tried in the future. Follow up on medication and physical examination shall be conducted monthly, and liver function test shall be conducted every 3 days. Intracavernous injection of drugs to induce erection has been proven to effectively restore erectile function in many impotent patients. The patient can inject himself under the guidance of a doctor, but it should be noted that there is a possibility of sustained or abnormal erections, which should be treated promptly to avoid the risk of penile spongy fibers.
