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Aktuelle Urol 2019; 50(03): 248-267
DOI: 10.1055/a-0953-5034
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

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
Hartmut Porst
European Institute for Sexual Health (EISH), Privatinstitut für Urologie und Sexualmedizin, Hamburg
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Publication History

Publication Date:
23 July 2019 (online)

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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
 

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