目的 探讨骨盆骨折合并后尿道损伤及其修复手术对性功能的影响和枸橼酸西地那非治疗的效果.方法 41例骨盆骨折合并后尿道损伤导致尿道狭窄的患者,采用IIEF-5评分表对其勃起功能状况进行自我评分,测定时间分别为回顾创伤前,创伤后(入院时),尿道修复手术后拔管后2周以及口服枸橼酸西地那非治疗3个月后4个时间点;血管活性药物注射下阴茎Doppler超声(PPUD)检测阴茎海绵体血流动力学,区分动脉性、静脉性和非血管性ED.尿道修复手术后给予西地那非口服治疗,每次100mg,每周3次,连续3个月.结果 所有患者创伤后均存在不同程度的勃起功能障碍,其发生率为95.1%,所有患者在受伤前后的IIEF-5评分比较,差异有统计学意义;尿道修复手术后IIEF-5评分有轻度下降,但术前和术后比较差异无统计学意义;西地那非治疗后IIEF-5评分明显提高,差异有统计学意义:手术后患者ED的程度与狭窄部位无明显关系.ED患者手术后IIEF-5评分与狭窄长度有一定的关系,长度越长,评分越低,但差异并没有统计学意义.采用西地那非治疗有效率为81.0%:疗效与年龄无关;但与ED程度有关,即ED程度越轻,疗效越好.治疗后IIEF-5评分呈非血管性＞动脉性＞静脉性,但差异无统计学意义.总副反应发生率19.5%,所有患者均能耐受,完成服药治疗过程.结论 尿道损伤往往伴有性功能的创伤,而尿道修复手术对性功能也可能有一定的影响,其中包括诸多因素,如:患者年龄和狭窄长度等.西地那非对不同程度和不同类型的性功能障碍均有治疗作用,且方便和安全.%Objective To investigate occurrence of erectile dysfunction (ED) in patients with pelvic fracture urethral distraction defects (PFUDD) who underwent urethroplasty, and the efficacy of sildenafil citrate in treatment of these patients. Methods Erectile function of 41 patients with urethral stricture who suffered from PFUDD were assessed by IIEF-5. Assessments were made at 4 time points including at the time of prior to injury, two weeks after urethroplasty, and three months post-treatment with sildenafil. Pharmacopenile duplex ultrasonography (PPUD) was used to examine blood flow of the cavernosum for differential diagnosis of arterial erectile dysfunction (ED), venous ED and non-vascular ED. All patients were treated with oral sildenafil, 100 mg once daily, three times a week, for three months. Results The incidence of ED following injury was 95.12%. There were significant differences in the IIEF-5 scores pre and post injury. There were no significant changes in scores following surgery. It suggested that stricture location has no obvious influence on the severity of ED post-urethroplasty and that is, the longer the stricture the lower the score, these differences did not reach statistical significance. Sildenafil had a success rate of approximately 81%, which might be independent of age. Drug treatment seemed most effective for those with less severe ED at the outset. There was no significant difference in scores post-treatment between those who had vascular or non-vascular ED. The incidence of total side effects due to sildenafil was 19.5%. Conclusion Urethral trauma is frequently associated with ED. Sildenafil citrate is useful drug for treatment of ED in these patients and appears to be well tolerated.
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