ED 診療ガイドライン

目次はじめに................................................................................................................................................................. iii

1

疫学 .................................................................................................................................................................. 12リスクファクター................................................................................................................................ 21 加齢.................................................................................................................................................................... 22 喫煙.................................................................................................................................................................... 23 高血圧............................................................................................................................................................... 34 糖尿病............................................................................................................................................................... 35 脂質異常症 .................................................................................................................................................... 46 肥満および運動 .......................................................................................................................................... 57 うつ病............................................................................................................................................................... 68 下部尿路症状 / 前立腺肥大症〔lower urinary tract symptoms（LUTS）/
benign prostatic hyperplasia（BPH）〕......................................................................................... 69 薬剤.................................................................................................................................................................... 63

心血管疾患のマーカーあるいは初発症状としての ED ..................................... 94

心血管系のリスクがある患者の管理............................................................................... 105診断 ............................................................................................................................................................... 12
1 基本評価....................................................................................................................................................... 121）診察室の環境など ............................................................................................................................. 122）問診........................................................................................................................................................... 123）合併症...................................................................................................................................................... 124）薬物・嗜好品 ....................................................................................................................................... 125）運動........................................................................................................................................................... 126）勃起機能問診票 .................................................................................................................................. 137）身体所見 ................................................................................................................................................. 138）臨床検査 ................................................................................................................................................. 13● ED 診断のフローチャート ............................................................................................................... 15

2 オプション検査・特殊検査（専門医による）.......................................................................... 15vi

目次6治療 ............................................................................................................................................................... 161 目的................................................................................................................................................................. 16
2 リスクファクターと合併症への対応 .......................................................................................... 16
3 治癒可能な ED の発見と治療 ......................................................................................................... 161）テストステロンの低下.................................................................................................................... 162）若年者の外傷後の動脈性 ED ....................................................................................................... 173）心因性 ED .............................................................................................................................................. 17

4 薬物療法....................................................................................................................................................... 18
PDE5（phosphodiesterase 5）阻害剤 .................................................................................... 18
a．シルデナフィル（バイアグラ ®）............................................................................................ 18
b．バルデナフィル（レビトラ ®）................................................................................................ 19
c．タダラフィル（シアリス ®）..................................................................................................... 19
d．3 剤の比較 ........................................................................................................................................ 20e．効果判定 ........................................................................................................................................... 20
f ．副作用 / 併用禁忌 ........................................................................................................................... 21

5 局所療法....................................................................................................................................................... 221）海綿体注射 ............................................................................................................................................ 222）陰圧式勃起補助具 ............................................................................................................................. 23

6 外科治療....................................................................................................................................................... 231）血管手術 ................................................................................................................................................. 232）プロステーシス挿入術.................................................................................................................... 23● ED 治療のフローチャート ............................................................................................................... 24

文献 ......................................................................................................................................................................... 25
索引 ......................................................................................................................................................................... 32

ED 診療ガイドラインvii