【医脉通】2017+BSSM指南:男性勃起功能障碍的管理.pdf
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1、British Society for Sexual Medicine Guidelines on the Management ofErectile Dysfunction in Men2017Geoff Hackett,MD,1Mike Kirby,MD,2Kevan Wylie,MD,3Adrian Heald,MD,4Nick Ossei-Gerning,MD,5David Edwards,MD,6and Asif Muneer,MD,FRCS(Urol)7ABSTRACTBackground:This is an update of the 2008 British Society
2、for Sexual Medicine(BSSM)guidelines.Aim:To provide up-to-date guidance for U.K.(and international)health care professionals managing malesexual dysfunction.Methods:Source information was obtained from peer-reviewed articles,meetings,and presentations.A search ofEmbase,MEDLINE,and Cochrane Reviews wa
3、s performed,covering the search terms“hypogonadism,”“eugonadal or hypogonadism or hypogonadal or gonadal,”and“low or lower testosterone,”starting from 2009with a cut-off date of September 2017.Outcomes:We offer evidence-based statements and recommendations for clinicians.Results:Expert guidance for
4、health care professionals managing male sexual dysfunction is included.Clinical Translation:Current U.K.management has been largely influenced by non-evidence guidance fromNational Health Service departments,largely based on providing access to care limited by resources.The 2008BSSM guidelines to da
5、te have been widely quoted in U.K.policy decision making.Conclusions:There is now overwhelming evidence that erectile dysfunction is strongly associated with car-diovascular disease,such that newly presenting patients should be thoroughly evaluated for cardiovascular andendocrine risk factors,which
6、should be managed accordingly.Measurement of fasting serum glucose,lipidprofile,and morning total testosterone should be considered mandatory in all newly presenting patients.Patientsattending their primary care physician with chronic cardiovascular disease should be asked about erectileproblems.The
7、re can no longer be an excuse for avoiding discussions about sexual activity due to embarrassment.Hackett G,Kirby M,Wylie K,et al.British Society for Sexual Medicine Guidelines on the Management ofErectile Dysfunction in Men2017.J Sex Med 2018;XX:XXXeXXX.Copyright?2018,International Society for Sexu
8、al Medicine.Published by Elsevier Inc.All rights reserved.Key Words:Erectile Dysfunction;Epidemiology;Risk Factors;Hypogonadism;Diagnosis;Therapy;CoronaryHeart Disease;Cardiovascular Disease;Type 2 Diabetes;Color Duplex Ultrasound;Summary of ProductCharacteristicsINTRODUCTIONThe current U.K.manageme
9、nt of erectile dysfunction(ED)islargely evidence-based medicine and this guideline updates theprevious 2008 British Society for Sexual Medicine(BSSM)publication on the management of ED.The major resource usedfor National Health Service(NHS)reference has been the HealthService Circular(HSC)1999,1-3a
10、non-evidence-based documentdefining guidance for good clinical practice,largely on economicgrounds,for those patients qualifying for treatment under theU.K.NHS.Guidance by the National Institute for Health andCare Excellence(NICE)is the strongest influence,but NICE canonly review issues identified b
11、y the Department of Health ratherthan those highlighted by clinicians.The guidelines presentedReceived October 11,2017.Accepted January 8,2018.1Heartlands Hospital,Birmingham,United Kingdom;2Prostate Center,London,United Kingdom;3Porterbrook Clinic,Sheffield,United Kingdom;4Salford Royal Hospital,Sa
12、lford,United Kingdom;5University Hospital,Cardiff,United Kingdom;6General Practice Chipping Norton Health Center,Chipping Norton,UnitedKingdom;7Division of Surgery and Internventional Science,University College London,and National Institute for Health Research,Biometric Research,UniversityCollege Ho
13、spital,London,United KingdomCopyright 2018,International Society for Sexual Medicine.Published byElsevier Inc.All rights reserved.https:/doi.org/10.1016/j.jsxm.2018.01.023J Sex Med 2018;-:1e281 here were developed by a multidisciplinary expert panel from theCommittee of the BSSM.The principal aim of
14、 these guidelines isto enable physicians and other health care professionals tomanage ED in line with recent evidence,modern research,andclinical opinion,while adhering to the correct interpretation ofcurrent Department of Health regulations.Source informationwas obtained from peer-reviewed articles
15、,meetings,and pre-sentations,A search was performed,covering the search terms“hypogonadism,”“eugonadal or hypogonadism or hypogonadalor gonadal,”and“low or lower testosterone,”starting from 2009with a cut-off date of September 2017.Embase,MEDLINE,andthe Cochrane Central Register of Controlled Trials
16、 databaseswere searched,with a limitation to reviews,meta-analyses,ormeta-analysis of randomized controlled trials.A total of 4,202records were identified and screened for relevance,of which 71publications were selected for inclusion.ED BACKGROUNDEpidemiologyED has been defined as the persistent ina
17、bility to attain and/or maintain an erection sufficient for sexual performance.Although ED is not usually perceived as a life-threateningcondition,it is closely associated with many important phys-ical conditions and may affect psychosocial health.As such,EDhas a significant impact on the quality of
18、 life of patients andtheir partners.4Several large epidemiological studies have shown a highprevalence and incidence of ED worldwide.4e6In the Massa-chusetts Male Aging Study,the prevalence of ED was 52%innon-institutionalized 40-to 70-year-old men in the Boston area:17.2%,25.2%,and 9.6%for minimal,
19、moderate,and completeED,respectively.4The incidence of ED,calculated fromlongitudinal data in the Massachusetts Male Aging Study,was 26new cases per 1,000 per year.7A large European study of menaged 30e80 years reported a prevalence of 19%.6In theMens Attitude to Life Events and Sexuality Study,whic
20、hincluded 20-to 75-year-old men from 8 countries(UnitedStates,United Kingdom,Germany,France,Italy,Spain,Mexico,and Brazil),the ED prevalence,assessed by International Indexof Erectile Function(IIEF),ranged from 22%in the UnitedStates to 10%in Spain.8All studies showed a steep age-relatedincrease.The
21、se epidemiological studies provide different esti-mates of the prevalence of ED,which can be explained by themethodological designs in the different surveys.In particular,theestimates were influenced by the development of the IIEF andsimilar assessment tools in 1998,and minor changes in thedefinitio
22、n of the condition.The age and the socio-economicstatus of the populations also differed between the studies.Risk FactorsPenile erection is a complex neurovascular phenomenon underhormonal control that includes arterial dilatation,trabecularsmooth-muscle relaxation,and activation of the corporal ven
23、o-occlusive mechanism.9The development of ED is attributableto neuronal,vascular,hormonal,and metabolic factors,mediatedthrough endothelial and smooth-muscle dysfunction.The riskfactors for ED(age,sedentary lifestyle,obesity,smoking,dyslipidemia,and the metabolic syndrome),are very similar tothe est
24、ablished risk factors for cardiovascular disease.10,11In addition to the risk factors for ED,ED itself is a cardio-vascular risk factor conferring a risk equivalent to a currentmoderate level of smoking.The fact that ED is found morecommonly in men with hypertension,dyslipidemia,acutecoronarysyndrom
25、e,diabetesmellitus(DM),metabolicsyndrome,and lower urinary tract symptoms(LUTS)/benignprostatic hyperplasia(BPH)led to the recognition that ED is animportant marker of future cardiovascular risk.10,11ED is asso-ciated with the severity of ischemic heart disease,in terms ofplaque burden,and number of
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