Download PDF
Fortschr Neurol Psychiatr 2019; 87(04): 225-233
DOI: 10.1055/a-0747-5892
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

S1-Leitlinie Diagnostik und Therapie der erektilen Dysfunktion

S1-Guideline for Diagnosis and Treatment of Erectile Dysfunction
Carl-Albrecht Haensch
1   Kliniken Maria Hilf, Klinik für Neurologie
,
Max Hilz
2   Universität Erlangen-Nürnberg, Klinik für Neurologie
,
Wolfgang Jost
3   Parkinson-Klinik, PKW
,
Albert Kaufmann
4   Kliniken Maria Hilf, Zentrum für Kontinenz und Neuro-Urologie
,
Thomas Kessler
5   Universitätsklinik Balgrist, Zentrum für Paraplegie
,
Heinz Lahrmann
6   Ordination
› Author Affiliations
Further Information

Publication History

eingereicht 28 June 2018

akzeptiert 18 September 2018

Publication Date:
18 April 2019 (online)

    Permissions and Reprints

Zusammenfassung

Die S1-Leitlinie „Diagnostik und Therapie der erektilen Dysfunktion“ (AWMF-Registernummer 030 / 112) steht in einer vollständig überarbeiteten Neufassung zur Verfügung. Erektile Dysfunktion ist definiert als die fortwährende Unfähigkeit, eine penile Erektion, die für einen befriedigenden Geschlechtsverkehr ausreicht, zu erreichen oder aufrechtzuerhalten. Betroffen sind Millionen Bundesbürger: Bei Männern mit regelmäßiger sexueller Aktivität nimmt die erektile Dysfunktion von 2,3 Prozent in der dritten Lebensdekade auf 53,4 Prozent in der siebten Lebensdekade zu. Die Leitlinie gibt dezidierte Empfehlungen zur adäquaten Diagnose und zur Therapie der erektilen Dysfunktion, die seit der Einführung der Phosphodiesterase-5-(PDE-5-)Hemmer häufig unkritisch erfolgt.

Abstract

The S1-Guideline “Diagnosis and Therapy of Erectile Dysfunction” (Association of the Scientific Medical Societies in Germany (AWMF) registration number 030 / 112) is available in a completely revised version. Erectile dysfunction (ED) is defined as the persistent or recurrent inability to acquire or sustain an erection of sufficient rigidity and duration for sexual intercourse. There is a high prevalence of ED in the general population in Germany. The frequency of sexual activity decreases with age, and sexual problems become more common with aging. Overall, the prevalence of ED is 2.3 % in men 20 to 30 years of age and 53.4 % in men in their 7th decade of life. The guideline offers firm recommendations for the diagnosis and treatment of patients suffering from ED. The introduction of new oral therapies has completely changed the diagnostic and therapeutic approach to ED, which is often carried out in a uncritical way.

Schlüsselwörter

Erektile Dysfunktion - Phosphodiesterase-5-Hemmer - Erektionsstörung - Sexuelle Aktivität

Key words

Erectile dysfunction - PDE-5 inhibitors - Sexual activity
 

  • Literatur

  • 1 NIH Consensus Development. Panel on Impotence. NIH consensus conference: impotence. J Am Med Ass 1993; 270: 83-90
    CrossrefPubMedGoogle Scholar
  • 2 Lizza EF, Rosen RC. Definition and classification of erectile dysfunction. Report of the nomenclature committee of the international society of impotence research. Int J Impotence Res 1999; 11: 141-143
    CrossrefPubMed
  • 3 Braun M, Wassmer G, Klotz T. et al. Epidemiology of erectile dysfunction: results of the „Cologne male Survey“. Int J Imp Res 2000; 12: 305-311
    CrossrefPubMedGoogle Scholar
  • 4 Feldman HA, Goldstein I, Hatzichristou DG. et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54-61
    CrossrefPubMedGoogle Scholar
  • 5 Guiliano F, Chevret-Measson M, Tsatsaris A. et al. Prevalence of erectile dysfunction in France: results of an epidemiological survey of a representative sample of 1004 men. Eur Urol 2002; 42: 382-389
    CrossrefPubMedGoogle Scholar
  • 6 Davis-Joseph B, Tiefer L, Melman A. Accuracy of the initial history and physical examination to establish the etiology of erectile dysfunction. Urology 1995; 45: 498-502
    CrossrefPubMedGoogle Scholar
  • 7 Rosen RC, Leary M, Altwein J. et al. LUTS and male sexuality: Findings from the multinational survey of the aging male (MSAM-7). Int J Imp Res 2002; 14 (Suppl. 3): S 25
    CrossrefPubMedGoogle Scholar
  • 8 Rosen RC, Riley A, Wagner G. et al. The international index of erectile function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822-830
    CrossrefPubMedGoogle Scholar
  • 9 Rosen RC, Cappelleri JC, Smith MD. et al. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999; 11: 319-326
    CrossrefPubMedGoogle Scholar
  • 10 Lewis R, Jordan G. Surgery for erectile dysfunction. In: Campbells Urology. , 8th. edition, Vol. 2. Philadelphia: Saunders; 2002
    Google Scholar
  • 11 Bartolo DCC, Jarratt JA, Read NW. The use of conventional electromyography to assess external sphincter neuropathy. J Neurol Neurosurg Psychiatry 1983; 46: 1115-1118
    CrossrefPubMedGoogle Scholar
  • 12 Jost WH. , Hrsg. Neurologie des Beckenbodens – Neurourologie. Bremen: Uni-Med Verlag; 2004
    Google Scholar
  • 13 Kiff ES, Swash M. Normal proximal and delayed distal conduction in the pudendal nerves of patients with idiopathic (neurogenic) faecal incontinence. Br J Surg 1984; 71: 614-616
    CrossrefPubMed
  • 14 Opsomer RJ, Guerit JM, Wiese FX. Pudendal cortical somatosensory evoked potentials. J Urol 1986; 135: 1216-1217
    CrossrefPubMed
  • 15 Wellmer A, Sharief MK, Knowles CH, Misra VP, Kopelman P, Ralph D, Anand P. Quantitative sensory and autonomic testing in male diabetic patients with erectile dysfunction. BJU International 1999; , 83: 66-70 .
    PubMed
  • 16 Buddeberg C. Sexualberatung. Stuttgart: Enke; 1996
    Google Scholar
  • 17 Hartmann U. Psychosomatische Aspekte bei Erektionsstörungen. Dtsch Ärztebl B 2000; 97: 534-538
    PubMedGoogle Scholar
  • 18 Kockott G. Diagnostik und Therapie sexueller Funktionsstörungen. In: Hartwich P, Haas S. , Hrsg. Sexuelle Störungen und Probleme bei psychisch Kranken. Sternenfels: Verlag Wissenschaft & Praxis; 2002
    Google Scholar
  • 19 Esposito K, Guigliano F, Di Palo C. et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. J Am Med Ass 2004; 291: 2978-2984
    CrossrefPubMedGoogle Scholar
  • 20 Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, Vardi Y, Wespes E. European Association of Urology. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol 2010; 57: 804-814
    CrossrefPubMedGoogle Scholar
  • 21 Kostis JB, Jackson G, Rosen R. et al. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol 2005; 96: 313-321
    CrossrefPubMedGoogle Scholar
  • 22 Jackson G, Rosen RC, Kloner RA. et al. The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine. J Sex Med 2006; 3: 28-36
    CrossrefPubMedGoogle Scholar
  • 23 Mikhail N. Management of erectile dysfunction by the primarycare physician. Clev Clin J Med 2006; 72: 293-311
    PubMedGoogle Scholar
  • 24 Rosenberg MT. Diagnosis and management of erectile dysfunction in the primary care setting. Int J Clin Pract 2007; 61: 1198-1208
    CrossrefPubMedGoogle Scholar
  • 25 Beckman TJ, Abu-Lebdeh HS, Mynderse LA. Evaluation and medical management of erectile dysfunction. Mayo Clin Proc 2006; 81: 385-390
    CrossrefPubMedGoogle Scholar
  • 26 Montague DK, Jarow JP, Broderick GA. et al. The management of erectile dysfunction: an update. Baltimore: American Urological Association, Education and Research, Inc.; 2007
    Google Scholar
  • 27 Boolell M, Gepi-Attee S, Gingell JC. et al. Sildenafil, an novel effective oral therapy for male erectile dysfunction. Br J Urol 1996; 78: 257-261
    CrossrefPubMedGoogle Scholar
  • 28 Fink HA, Mac Donald R, Rutks IR. et al. Sildenafil for male erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med 2002; 162: 1349-1360
    PubMedGoogle Scholar
  • 29 Goldstein I, Lue TF, Padma-Nathan H. et al. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998; 338: 1397-1404
    CrossrefPubMedGoogle Scholar
  • 30 Bischoff E, Schneider K. A conscious-rabbit model to study vardenafil hydrochloride and other agents that influence penile erection. Int J Impot Res 2001; 13: 230-235
    CrossrefPubMedGoogle Scholar
  • 31 Brock G, Padma-Nathan H, Seger M. Efficacy and tolerability of vardenafil in males with erectile dysfunction following radical prostatectomy. Eur Urol 2002a Suppl. 1: 152
    PubMedGoogle Scholar
  • 32 Angulo J, Cuevas P, Fernandez A. et al. Characterization of vardenafil, a new PDE5 inhibitor for erectile dysfunction, and comparison of activity with sildenafil. Int J Imp Res 2001; 13 (S 4): 64
    PubMedGoogle Scholar
  • 33 Porst H, Rosen R, Padma-Nathan H. et al. 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 Impot Res 2001; 13: 192-199
    CrossrefPubMedGoogle Scholar
  • 34 Goldstein AMB, Padma-Nathan H. The microarchitecture of the intracavernosal smooth muscle and the cavernosal fibrous skeleton. J Urol 1990; 144: 1144-1146
    CrossrefPubMedGoogle Scholar
  • 35 Goldstein I, Lue TF, Padma-Nathan H. et al. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med 1998; 338: 1397-1404
    CrossrefPubMedGoogle Scholar
  • 36 Goldstein I, Young J, Segerson T. et al. Long-term efficacy and safety of vardenafil in diabetic men with erectile dysfunction. Diabetes 2002; 51 (Suppl. 2): A98
    CrossrefPubMedGoogle Scholar
  • 37 Padma-Nathan H, Hellstrom WJ, Kaiser FE. et al. Treatment of men with erectile dysfunction with transurethral alprostadil, Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med 1997; 336: 1-7
    CrossrefPubMedGoogle Scholar
  • 38 Porst H, Young JM, Schmidt AC. et al. Efficacy and tolerability of vardenafil for erectile dysfunction in patient subgroups. Urology 2003; 62: 519-523
    CrossrefPubMedGoogle Scholar
  • 39 Gresser U, Gleiter CH. Erectile dysfunction: comparison of efficacy and side effects of the PDE-5 inhibitors sildenafil, vardenafil and tadalafil. Eur J Med 2002; 7: 435-446
    PubMedGoogle Scholar
  • 40 Brock GB, McMahon CG, Chen KK. et al. Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol 2002; b 168: 1332-1336
    CrossrefPubMedGoogle Scholar
  • 41 Porst H, Huebler D, Padma-Nathan H. et al. Tadalafil allows men with erectile dysfunction to have sexual intercourse up to 36 hours postdose. Int J Imp Res 2002; 14 (Suppl. 4): S 60
    CrossrefPubMedGoogle Scholar
  • 42 Derouet H, Behre HM, Büttner H. et al. Ergebnisse einer multizentrischen, randomisierten, doppelblinden Crossover-Studie zur Untersuchung der Patientenpräferenz zwischen Tadalafil und Sildenafil. Urologe 2004 A43 (Suppl. 1): S 65
    PubMedGoogle Scholar
  • 43 Saenez de Tejada I, Emmick J, Anglin G. et al. The effect of on demand tadalafil (IC 351) treatment of erectile dysfunction in men with diabetes. Eur Urol 2001; 39 (Suppl. 5): 16
    PubMedGoogle Scholar
  • 44 Young J. Sildenafil citrate (Viagra) in the treatment of erectile dysfunction: a 12-week, flexible-dose study to assess efficacy and safety. Int J Pract 1999; 102 (Suppl.): 6-7
    PubMedGoogle Scholar
  • 45 Heaton JPW, Morales A, Adams MA. et al. Recovery of erectile function by the oral administration of apomorphine. Urology 1995; 45: 200-206
    CrossrefPubMedGoogle Scholar
  • 46 Heaton JPW. Apomorphine: an update of clinical trials. Int J Impot Res 2000; 12 (Suppl 4): 67-73
    PubMedGoogle Scholar
  • 47 Dula E, Bukofzer S, Perdok R. et al. Double-blind, crossover comparison of 3 mg apomorphine SL with placebo and with 4 mg apomorphine SL in male erectile dysfunction. Eur Urol 2001; 39: 558-563
    CrossrefPubMedGoogle Scholar
  • 48 Pavone C, Curto F, Anello G. et al. Prospective, randomized, crossover comparison of sublingual apomorphine (3 mg) with oral sildenafil (50 mg) for male erectile dysfunction. J Urol 2004; 172: 2347-2349
    CrossrefPubMedGoogle Scholar
  • 49 Porst H, Jacob G, Albrecht S Sildenafil. (Viagra) versus Apomorphin in der Behandlung der erektilen Dysfunktion (ED): Multizentrische, offene, randomisierte Crossover- Studie. Urologe 2004 A43 (Suppl. 1): S 65
    PubMedGoogle Scholar
  • 50 Wespes E, Amar E, Hatzichristou D. et al. EAU Guidelines on erectile dysfunction: an update. Eur Urol 2006; 49: 806-815
    CrossrefPubMedGoogle Scholar
  • 51 Derouet H, Caspari D, Rohde V. et al. Treatment of erectile dysfunction with external vacuum devices. Andrologia 1999; 31 (Suppl. 1): 89-94
    PubMedGoogle Scholar
  • 52 Derouet H, Nolden W, Jost WH. et al. Treatment of erectile dysfunction by an externous ischiocavernous muscle stimulator. Eur Urol 1998; 34: 355-359
    CrossrefPubMedGoogle Scholar
  • 53 Montorsi F, Rigatti P, Carmignani G. et al. AMS three-piece inflatable implants for erectile dysfunction: A long-term multi-institutional study in 200 consecutive patients. Eur Urol 2000; 37: 50-55
    PubMedGoogle Scholar