Reflexionen über 50 Jahre Sexualmedizin in der Urologie mit Fokus auf männliche Sexualstörungen

Hartmut Porst

doi:10.1055/a-0953-5034

Aktuelle Urologie, Table of Contents

Aktuelle Urol 2019; 50(03): 248-267
DOI: 10.1055/a-0953-5034

Übersicht

Reflexionen über 50 Jahre Sexualmedizin in der Urologie mit Fokus auf männliche Sexualstörungen

Reflexions on 50 Years of Sexual Medicine in Urology Focusing on Male Sexual Dysfunctions

Authors

Hartmut Porst

European Institute for Sexual Health (EISH), Privatinstitut für Urologie und Sexualmedizin, Hamburg

Abstract

Zusammenfassung

Diagnose und Therapie männlicher Sexualstörungen zeitigten in den letzten 50 Jahren enorme Fortschritte. Beginnend mit der Entwicklung hydraulischer Penisimplantate 1973 stehen mittlerweile verschiedene effektive und gut verträgliche konservative Behandlungsmethoden wie die PDE-5-Hemmer Avanafil, Sildenafil, Tadalafil und Vardenafil, die transurethrale Applikation von PGE1 (MUSE), die Selbstinjektionstherapie mit den vasoaktiven Substanzen Alprostadil, Papaverin/Phentolamin (Bimix), PGE1/Papaverin/Phentolamin (Trimix/Triple Drug) oder VIP (Aviptadil)/Phentolamin-Invicorp) zur Verfügung. In jüngster Zeit hat die Li-ESWT eindrucksvolle Ergebnisse sowohl bei PDE-5i-Non-Respondern als auch Respondern sowie teilweise auch bei IPP gezeigt. In der Behandlung der Ejakulatio präcox stehen mit dem oralen Dapoxetin und dem topischen Xylocain/Prilocain Spray mittlerweile 2 effektive Medikamente zur Verfügung, welche in schweren EP-Fällen miteinander kombiniert werden können oder mit PDE-5-Hemmern bei Männern mit EP und ED. Hormonelle Störungen wie Hypogonadismus, Hyperprolaktinämien und Schilddrüsenstörungen können mit Sexualstörungen vergesellschaftet sein und mittels T-Substitution, Prolaktinhemmern oder schilddrüsenspezifischen Medikamenten erfolgreich behandelt werden. Während vaskuläre Eingriffe bei ED wie Dorsalvenenligaturen/Resektionen und arterielle Revskularisationsverfahren die 80er- und 90er-Jahre des letzten Jahrhunderts dominierten, gelten sie heute als überholt und werden bei schwerer organischer ED durch die modernen dreiteiligen aufblasbaren Penisimplantate ersetzt, deren mittlerweile hoher technischer Standard 10-Jahresüberlebensraten um die 70 % erlauben.

Abstract

Diagnosis and therapy of male sexual dysfunctions made enormous progress over the last 50 years. Starting with the development of hydraulic penile implants in 1973 meanwhile several effective and well-tolerated conservative treatments such as the PDE-5 inhibitors avanafil, sildenafil, tadalafil and vardenafil, transurethral PGE1 (MUSE) and self-injection therapy with a variety of vasoactive drugs like alprostadil, papaverine/phentolamine (bimix), PGE1/papaverine/phentolamine (trimix/triple drug) or VIP (aviptadil)/phentolamine-Invicorp) have been developed for the treatment of ED. More recently Li-ESWT has provided impressive results both in PDE-5i responders and non-responders and partly also in Peyronie’s disease. Regarding premature ejaculation (PE) meanwhile with oral dapoxetine and topical lidocaine/prilocaine spray two effective treatment options are officially available which may be combined in men with severe PE and with PDE-5 inhibitors in men with PE and ED. Hormonal disorders such as hypogonadism, hyperprolactinemia and thyroid disorders may be linked to male sexual disorders and successfully treated with T-substitution, prolactin inhibitors or thyroid specific medications.Whereas vascular surgery for ED such as deep dorsal vein ligation/resection or arterial revascularization procedures dominated the 80ies and 90ies last century they have been considered outdated and are replaced in severe ED of organic etiology by the modern new three piece inflatable penile implants whose high technical standard meanwhile provide 10 years survival rates of about 70 %.

Schlüsselwörter

Männliche sexuelle Störungen - Erektile Dysfunktion - Ejakulationsstörungen - Hypogonadismus - Hyperprolaktinämie

Keywords

male sexual dysfunction - erectile dysfunction - ejaculatory disorders - hypogonadism - hyperprolactinemia

Full Text

References

Literatur
1 Reisman Y, Porst H, Lowenstein L. et al. (eds) The ESSM Manual of Sexual Medicine. Amsterdam: Medix Publishers; 2015
2 Zorgniotti AW, Lefleur RS. Autoinjection of the corpus cavernosum with a vasoactive drug combination for vasculogenic impotence. J Urol 1995; 133: 39-41
3 Zorgniotti AW, Lizza EF. Effect of large doses of the nitric oxide precursor L-arginine on erectile dysfunction. Int J Impotence Res 1994; 6: 33-36
4 Zorgniotti AW. Experience with buccal phentolamine mesylate for impotence. Int J Impotence Res 1994; 6: 37-41
5 Wagner G, Green R. Impotence, Physiological, Psychological, Surgical. Diagnosis and Treatment. New York: Plenum Press; 1981
6 Scott FB, Bradley WE, Timm GW. Management of erectile impotence. Use of implantable inflatable prosthesis. Urology 1973; 2: 80-88
7 Furlow WL. Inflatable penile prosthesis: Mayo Clinic experience with 175 patients. Urology 1979; 13: 166-171
8 Wilson SK, Delk JR, Salem EA. et al. Long-term survival of inflatable penile prostheses: single surgical group experience with 2.384 first-time implants spanning two decades. J Sex Med 2007; 4: 1074-1079
9 Michal V, Kramar R, Pospichal J. Direct arterial anastomosis to the cavernous body in the treatment of erectile impotence. Rozhal Chir 1973; 52: 587-591
10 Michal V, Kramar R, Pospichal J. et al. Arterial epigastricocavernous anastomosis for the treatment of sexual impotence. World J Surg 1977; 1: 515-520
11 Virag R, Zwang G, Dermange H. et al. Vasculogenic impotence: A review of 92 cases with 54 surgical operations. Vasc Surg 1981; 15: 9
12 Virag R. Intracavernous injection of papaverine for erectile failure. Lancet 1982; 2: 938
13 Adaikan PG, Kottegoda SR, Ratnam SS. A possible role for prostaglandin E1 in human penile erection. In: Abstract Book Second World Meeting on Impotence, Abstr.2.6 Prague: 1986
14 Adaikan PG, Kottegoda SR, Ratnam SS. Is vasoactive intestinal polypeptide the principal transmitter involved in human penile erection?. J Urol 1986; 135: 638-690
15 Porst H. Review Article. The rationale for prostaglandin E1 in erectile failure: A survey of world-wide experience. J Urol 1996; 155: 802-815
16 Porst H, Buvat J, Meuleman E. et al. Intracavernous Alprostadil Alfadex – an effective and well tolerated treatment for erectile dysfunction. Results of a long-term European study. Int J Impotence Res 1998; 10: 225-231
17 Brindley GS. Cavernosal alpha-blockade: A new treatment for investigating and treating erectile impotence. Br J Psychiatry 1983; 143: 332-337
18 Goldstein I, Borges FD, Fitch WP. et al. Rescuing the failed papaverine/phentolamine erection: A proposed synergistic action of papaverine, phentolamine and prostaglandin E1. J Urol 1990; 143: 4 , Suppl: abstr. 304A
19 Goldstein I, Lue TF, Padma-Nathan H. et al. for the Sildenafil Study Group: Oral Sildenafil in the treatment of erectile dysfunction. New Engl J Med 1998; 338: 1397-1404
20 Porst H, Rosen R, Padma-Nathan H. et al. , and the Vardenafil Study Group. The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Int. J. Impotence Res 2001; 13: 192-199
21 Porst H. IC351 (tadalafil, Cialis): update on clinical experience, Int. J. Impotence Res 2002; 14: 57-64
22 Porst H, Sharlip ID, Hatzichristou D. et al. Extended Duration of Efficacy of Vardenafil When Taken 8 Hours Before Intercourse: A Randomized, Double-blind , Placebo-controlled Study. Eur. Urol 2006; 50: 1086-1095
23 Porst H, Padma-Nathan H, Giuliano F. et al. Efficacy of Tadalafil for the Treatment of Erectile Dysfunktion at 24 and 36 hours after dosing: A Randomized Controlled Trial. Urology 2003; 62: 121-125
24 Porst H, Giuliano F, Glina S. et al. Evaluation of the Efficicay and Safety of Once a Day Dosing of Tadalafil 5 mg and 10 mg in the Treatment of Erectile Dysfunction: Results of a Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Eur Urol 2006; 50: 351-359
25 Lue TF, Zeineh SJ, Schmidt A. et al. Neuroanatomy of penile erections: Its relevance to iatrogenic impotence. J Urol 1984; 131: 273-280
26 Lue TF, Hricak H, Marich KW. et al. Vasculogenic impotence evaluated by high-resolutions ultrasonography and pulsed doppler spectrum analysis. Radiology 1985; 155: 777-781
27 Lue TF, Schmidt A, Tanagho EA. Electrostimulation and penile erection. Urol Int 1985; 40: 60-64
28 Lue TF, Hellström WJG, McAninch JW. et al. Priapism: a refined approach to diagnosis and treatment. J Urol 1986; 136: 104-108
29 vLu Z, Lin vG, Reed-Maldonado A. et al. Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis. Eur Urol 2017; 71: 223-233
30 Giuliano F. Neurophysiology of erection and ejaculation. J Sex Med 2011; 8 (Suppl. 04) 310-315
31 Giuliano F, Clément P. Serotonin and premature ejaculation: from physiology to patient management. Eur Urol 2006; 50: 454-66
32 Giuliano F, Clèment P. Pharmacology for the treatment of premature ejaculation. Pharmacol Rev 2012; 64: 621-644
33 Saenz de Tejada I. Mechanisms for the regulation of penile smooth muscle contractility. In: Lue TF. (ed.) World Book of Impotence. London-Japan: Smith Gordon/Nishimura Company; 1992: 39-48
34 Saenz de Tejada I. Molecular mechanisms for the regulation of penile smooth muscle contractility. Int J Impot Res 2000; 12 (Suppl. 04) S34-38
35 Waldinger MD. Premature ejaculation: Definition and drug treatment. Drugs 2007; 67: 547-568
36 Waldinger MD. The neurobiological approach to premature ejaculation. J Urol 1998; 168: 2359-1267
37 Waldinger MD, Quinn P, Dilleen M. et al. Ejaculation disorders: A multinational population survey of intravaginal ejaculation latency time. J Sex Med 2005; 2: 492-497
38 Waldinger MD, Zwinderman AH, Olivier B. et al. Proposal for a definition of lifelong premature ejaculation based on epidemiological stopwatch data. J Sex Med 2005; 2: 498-507
39 Hoesl CE, Woll EM, Burkart M. et al. Erectile dysfunction (ED) is prevalent, bothersome and underdiagnosed in patients consulting urologists for benign prostatic syndrome (BPS). Eur Urol 2005; 47: 511-517
40 Gacci M, Eardley I, Giuliano F. et al. Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 2011; 60: 809-825
41 Gacci M, Andersson KE, Chapple C. et al. Latest Evidence on the Use of Phosphodiesterase Type 5 Inhibitors for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Eur Urol 2016; 70: 124-133
42 Montorsi P, Ravagnani PM, Galli S. et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J 2006; 27: 2632-2639
43 Porst H, Burnett A, Brock G. et al. SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med 2013; 10: 130-171
44 Corona G, Rastrelli G, Burri A. et al. First-generation phosphodiesterase type 5 inhibitors dropout: a comprehensive review and meta-analysis. Andrology 2016; 4: 1002-1009
45 Kitrey ND, Gruenwald I, Appel B. et al. Penile Low Intensity Shock Wave Treatment is Able to Shift PDE5i Non-responders to Responders: A Double-Blind, Sham Controlled Study. J Urol 2016; 195: 1550-1555
46 Clavijo RI, Kohn TP, Kohn JR. et al. Effects of Low-Intensity Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2017; 14: 27-35
47 vLu Z, Lin vG, Reed-Maldonado A. et al. Low-intensity Extracorporeal Shock Wave Treatment Improves Erectile Function: A Systematic Review and Meta-analysis. Eur Urol 2017; 71: 223-233
48 Rizk PJ, Krieger JR, Kohn TP. et al. Low-Intensity Shockwave Therapy for Erectile Dysfunction. Sex Med Rev 2018; 6: 624-630
49 Gao L, Qian S, Tang Z. et al. A meta-analysis of extracorporeal shock wave therapy for Peyronie's disease. Int J Impot Res 2016; 28: 161-166
50 Montorsi F, Brock G, Lee J. et al. Effect of nightly versus on-demand vardenafil on recovery of erectile function in men following bilateral nerve-sparing radical prostatectomy. Eur Urol 2008; 54: 924-931
51 Nelson CJ, Scardino PT, Eastham JA. et al. Back to baseline: erectile function recovery after radical prostatectomy from the patientsʼ perspective. J Sex Med 2013; 10: 1636-1643
52 Iacono F, Giannella R, Somma P. et al. Histological alterations in cavernous tissue after radical prostatectomy. J Urol 2005; 173: 1673-1676
53 Li H, Matheu MP, Sun F. et al. Low-energy Shock Wave Therapy Ameliorates Erectile Dysfunction in a Pelvic Neurovascular Injuries Rat Model. J Sex Med 2016; 13: 22-32
54 Lindau ST, Schumm LP, Laumann EO. et al. A study of sexuality and health among older adults in the United States. N Engl J Med 2007; 357: 762-774
55 Porst H, Montorsi F, Rosen RC. et al. The Premature Ejaculation Prevalence and Attitudes (PEPA) Survey: Prevalence, Comorbidities, and Professional Help-Seeking. Eur. Urol 2007; 51: 816-824
56 Serefoglu EC, McMahon CG, Waldinger MD. et al. An evidence-based unified definition of lifelong and acquired premature ejaculation: report of the second International Society for Sexual Medicine Ad Hoc Committee for the Definition of Premature Ejaculation. Sex Med 2014; 11: 1423-1441
57 Burri A, Giuliano F, McMahon C. et al. Female partner's perception of premature ejaculation and its impact on relationship breakups, relationship quality, and sexual satisfaction. J Sex Med 2014; 11: 2243-2255
58 Porst H, McMahon CG, Althof SE. et al. Baseline characteristics and treatment outcomes for men with acquired or lifelong premature ejaculation with mild or no erectile dysfunction: Integrated analyses of two phase 3 dapoxetine trials. J Sex Med 2010; 7: 2231-2242
59 Porst H, Burri A. Novel Treatment for Premature Ejaculation in the Light of Currently Used Therapies: A Review. Sex Med Rev 2019; 07: 129-140
60 Wyllie MG, Powell JA. The role of local anaesthetics in premature ejaculation. BJU Int 2012; 110: E943-948
61 Sun Y, Luo D, Yang L. et al. Efficacy of Phosphodiesterase-5 Inhibitors in Men With Premature Ejaculation: A New Systematic Review and Meta-analysis. Urology 2015; 86: 947-954
62 Porst H. Review. An overview of pharmacotherapy in premature ejaculation. J Sex Med 2011; 8 (Suppl. 04) 335-341
63 McMahon CG, Jannini E, Waldinger M. et al. Standard operating procedures in the disorders of orgasm and ejaculation. J Sex Med 2013; 10: 204-229
64 Rubio-Aurioles E, Bivalacqua TJ. Standard operational procedures for low sexual desire in men. J Sex Med 2013; 10: 94-107
65 Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol 2009; 29: 259-266
66 Buvat J, Maggi M, Guay A. et al. Testosterone deﬁciency in men: Systematic review and standard operating procedures for diagnosis and treatment. J Sex Med 2013; 10: 245-284
67 Wu FC, Tajar A, Beynon JM. et al. Identiﬁcation of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010; 363: 123-135
68 Zitzmann M, Faber S, Nieschlag E. Association of specific symptoms and metabolic risks with serum testosterone in older men. J Clin Endocrinol Metab 2006; 91: 4335-4343
69 Buvat J, Montorsi F, Maggi M. et al. Hypogonadal men nonresponders to the PDE5 inhibitor tadalafil benefit from normalization of testosterone levels with a 1% hydroalcoholic testosterone gel in the treatment of erectile dysfunction (TADTEST study). J Sex Med 2011; 8: 284-293
70 Köhler TS, Kim J, Feia K. et al. Prevalence of androgen deficiency in men with erectile dysfunction. Urology 2008; 71: 693-697
71 Maggi M, Buvat J, Corona G. et al. Hormonal causes of male sexual dysfunctions and their management (hyperprolactinemia, thyroid disorders, GH disorders, and DHEA). J Sex Med 2013; 10: 661-677
72 Dekkers OM, Lagro J, Burman P. et al. Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis. J Clin Endocrinol Metab 2010; 95: 43-51