Hhcy大鼠阴茎海绵体内cAMP,cGMP含量及研究

目的:探讨高同型半胱氨酸血症大鼠阴茎海绵体组织内cAMP,cGMP含量的变化并研究其对阴茎勃起功能影响。方法:取40只成年雄性大鼠,随机分成两组,分为正常对照组和Hhcy组。Hhcy组给予3%高蛋氨酸饲料喂养,正常组给予普通饲料喂养,饲养四周后后分别注射阿扑吗啡进行大鼠阴茎勃起功能实验,抽取血清检测Hhcy含量,麻醉后取阴茎海绵体测量cAMP,cGMP含量。结果:Hhcy组血清中同型半胱氨酸含量显著高于正常组,大鼠阴茎组织中cAMP,cGMP含量显著低于正常组。结论:高同型半胱氨酸血症大鼠阴茎海绵体中cAMP,cGMP含量降低。高同型半胱氨酸血症是阴茎勃起功能障碍的危险因素。     

Management of male erectile dysfunction: a review

Male erectile dysfunction is common although some patients are embarrassed and delay seeking medical advice. Recent improvements in the understanding of the anatomy, physiology and pharmacotherapy of penile erections, and the introduction of intracavernosal pharmacotherapy has resolved most of the controversies regarding the aetiology of erectile dysfunction. Impotence is equally divided into organic and psychogenic causes. Arterial insufficiency, alcoholism, venosinusoidal, neurological and endocrine disorders are known to cause organic erectile dysfunction. Two most popular options in the management of erectile dysfunction are intracavernosal injections with vasoactive drugs like papavarine, phentolamine, and prostaglandin EI with discontinuation rates of 40-50%, and the use of external vacuum devices whose limitations include failure to achieve and maintain full erection. The use of inflatable penile prostheses is successful but limited with periprosthetic infection and cylinder erosion through the skin or urethra. Surgical procedures have included revascularisation of penile vessels without good results. Surgical ligation of penile veins for venosinusoidal incompetence has been successful compared to excision and embolisation which has disappointing results. Currently the role of oral medications in the treatment of erectile dysfunction is limited. However, there are now several new agents including sildenafil, a phosphodiasterase inhibitor, which is undergoing clinical trials that appear to be effective.     

阴茎折断的诊断及处理

目的总结阴茎折断患者临床资料,以提高对阴茎折断的诊治水平。方法回顾性分析12例阴茎折断患者的症状体征、辅助检查、治疗及预后,进行文献复习。结果 10例明确描述听到折断甘庶样声音,所有患者阴茎迅速疲软,随即出现阴茎肿胀,广泛瘀血。查体发现阴茎皮肤肿胀,阴茎皮肤青紫色。8例通过超声检查中有3例报告海绵体白膜缺损(0.5~1.0 cm)。12例均手术成功,随访3个月至5年,5例3个月内表现为勃起时酸胀感,7例患者表现为无痛性硬结,无勃起功能障碍,佩罗氏病,排尿困难及勃起疼痛等并发症,IIEF平均评分为22.6分。结论阴茎折断具有典型的病史及临床表现,超声具有一定的诊断价值。手术疗法对阴茎折断后勃起功能的恢复疗效确切且安全可靠,及时的手术治疗无性功能障碍发生。     

西咪替丁对大鼠阴茎组织中NOS含量的影响

目的 探讨西咪替丁对大鼠阴茎海绵体组织内一氧化氮合酶(NOS)含量的影响。方法 把3月龄大鼠共16只分为实验组和对照组，分别向每组大鼠阴茎海绵体内每天注射西咪替丁和生理盐水。共15d。然后处死大鼠。取阴茎海绵体组织进行NOS的含量测定。结果 实验组大鼠的NOS活性明显低于对照组。结论 西咪替丁对阴茎海绵体组织中NOS的含量有抑制作用。从而可导致大鼠阴茎勃起功能障碍(ED)。     

Evaluation and treatment of sexual dysfunction in men with diabetes mellitus.

Sexual dysfunction is common among men with Type I and Type II diabetes. Tests of nocturnal penile tumescence (NPT) combined with waking tumescence and questionnaires can more accurately differentiate between primary organic and primary psychogenic impotence. This ability to differentiate the etiology of erectile dysfunction avoids the inappropriate use of penile injections and costly surgical procedures which are unnecessary in treatment of diabetic patients with primary psychogenic impotence. In patients with primary organic impotence, several new treatments are available which result in high patient satisfaction.     

Late complications of spontaneous urethral erosion of a malleable penile prosthesis in a young patient

While oral agents are currently suggested for the initial treatment of erectile dysfunction, penile prosthesis implantation (malleable or inflatable) is accepted as a third-line therapy if intracorporeal injection and intraurethral treatment fail as a secondary choice. Urethral erosion of the malleable penile prosthesis is a well-known complication, mostly due to the indwelling catheter. We report a case of urethral erosion of the malleable penile prosthesis after 23 years. The patient was a 45-year-old man without any underlying risk factors. He subsequently underwent a unilateral rod extraction under regional anaesthesia. It appears that urethral erosion of penile prostheses can appear at any time post operation, without any known facilitative factors and in any age group. Furthermore, simple office manoeuvres may not be possible in some patients.     

The role of penile prosthetic surgery in the modern management of erectile dysfunction

The management of erectile dysfunction looks set to be revolutionised with the introduction of effective oral therapies. There will remain, however, some men who do not respond to conservative measures. This article reviews the important role of penile prosthetic surgery as a treatment option in these patients.     

粉防己碱治疗糖尿病性勃起功能障碍的研究

目的研究粉防己碱治疗糖尿病性勃起功能障碍（ED）的效果。方法选择月龄、体重以及身体其它的各项指标均相同的45只健康雄性大鼠作为研究对象,随机分为糖尿病组、正常组以及治疗组,对糖尿病组以及治疗组进行建模处理,对正常组进行常规喂养,对三组大鼠的性勃起功能进行比较。结果糖尿病ED大鼠组阴茎海绵体MaxICP/MAP明显低于正常大鼠组（P〈0.05）;治疗组阴茎海绵体MaxICP/MAP明显高于糖尿病组（P〈0.05）。结论利用粉防己碱来对糖尿病性勃起功能障碍进行治疗时,主要是通过对钙通道进行阻滞,来确保阴茎的勃起功能正常,且疗效相对较好,可以临床推广。     

选择性光前列腺汽化术和经尿道前列腺电切术治疗良性前列腺增生术后阴茎勃起功能影响的比较

目的 通过与经尿道前列腺电切术(TURP)的比较来探讨选择性光前列腺汽化术(PVP)治疗良性前列腺增生(BPH)术后对阴茎勃起功能的影响.方法 PVP和经尿道前列腺电切术(TURP)治疗BPH各48例,应用国际勃起功能障碍问卷-5(IIEF-5)评价患者术前及术后6个月阴茎勃起功能.结果 PVP术后6月阴茎勃起功能障碍(ED)发生率较TURP低,两组差异有显著性.结论 PVP术后ED发生率比TURP低,是一种对阴茎勃起功能非常安全的治疗良性前列腺增生的方法.     

舌形皮瓣阴茎延长术56例临床分析

目的通过对56例手术探讨舌形皮瓣阴茎延长术的优点。方法连续硬膜外麻醉,舌形皮瓣阴茎延长术。结果术后平均延长3.5cm,外形美观,无阴茎勃起功能障碍及稳定性不佳。结论该术式皮瓣血运良好,无坏死,延长效果明显,病人满意。     

性兴奋反应阴茎海绵体测压试验在勃起功能障碍诊断中的应用(附120例报告)

目的探讨VISEK试验在诊断勃起功能障碍（ED）中的应用价值。方法120例ED患者接受了VISEK试验。阴茎海绵体内注射罂粟硷10mg；未诱发勃起者，药物剂量增至30mg。根据药物试验结果，将试验阳性者确定为心理性ED，并根据其海绵体压力、波幅形态以及药物剂量将心理性ED分为轻、中、重三度。2次检查均阴性者，行阴茎彩色多普勒超声和海绵体造影检查。结果心理性ED占81．6％，其中轻度、中度和重度者分别占20．4％，59．2％和20．4％。22例接受阴茎多普勒超声或海绵体造影检查提示，正常8例，动脉性ED4例，静脉性ED3例，动脉静脉混合性ED7例。结论VISEK试验有助于鉴剐心理性与器质性ED。其结果对评估心理性ED严重程度并对患者选择有针对性的治疗有重娶意义。     

异常勃起的局部注射治疗及其治愈后的勃起功能探讨（附31例报告）

目的总结去甲肾上腺素阴茎海绵体注射治疗异常勃起,探讨长时间异常勃起对勃起功能的影响及其他并发症.方法1988年8月至1999年8月用去甲肾上腺素0.5mg海绵体注射治疗31例36次异常勃起.异常勃起发生时间7～120小时,平均23.7小时,并对患者作了随访.结果全部治愈,无明显不良后果.4例患者失访,27例作了长期随访,随访时间8月～11年,平均5.4年.患者短期内勃起功能与发病前无显著差别.但6个月后,异常勃起＞36小时的11例患者中有9例发生勃起功能障碍,而＜36小时的1 6例患者中有5例有勃起功能障碍(P＜0.05).且长时间异常勃起者中有4例发生海绵体纤维化.结论海绵体内注射去甲肾上腺素是治疗异常勃起有效而安全的方法.超过36小时的异常勃起可能导致勃起功能障碍,与海绵体的纤维化可能有一定的关系.     

糖尿病性阴茎勃起功能障碍动物模型的建立

目的：探讨糖尿病性阴茎勃起功能障碍动物模型的建立方法。方法：应用雄性SD大鼠腹腔内注射链脲佐菌素（STZ）制造糖尿病动物模型。饲养8周，16周，再通过观察各组大鼠注射阿朴吗啡（APO）后的阴茎勃起情况来评价其勃起功能。结果：与C组（对照组）相比，D组（糖尿病组）阴茎勃起次数明显降低，C组与STZ组（注射STZ后不成模组）各病程大鼠的阴茎勃起率为100%，且两组的阴茎勃起次数无显性差异。结论：阿朴吗啡诱发大鼠阴茎勃起实验可用于评价糖尿病大鼠的勃起功能。     

低雄激素状态引起勃起功能障碍的分子机制

雄激素对于维持阴茎海绵体组织正常结构和功能有重要作用,而随着前列腺癌发生率的增长,需要维持低雄激素状态的患者越来越多。在低雄激素状态下,雄激素对阴茎海绵体平滑肌的营养作用下降,平滑肌细胞数量减少、舒张功能下降,致使阴茎血流充盈减少,是导致勃起功能障碍(ED)的重要原因。了解低雄激素状态引起ED的分子机制对于改善需维持低雄激素状态患者的勃起功能具有重要意义。本文就低雄激素状态引起勃起功能障碍的分子机制作一述评,为临床提供一定的参考。     

EFFECTS OF ALCOHOL INTAKE ON PENILE STRUCTURE AND FUNCTION IN RATS

Objective To investigate the effects of alcohol intake on penile structure and function in rats. Methods Thirty adult male Wistar rats were randomly divided into two groups: control group and alcohol intake group. They were administered with 2 mL of normal saline and 40% alcohol solution respectively through gastric tubes every day. Three months later, the animal model of alcohol intake was evaluated by modified Nayagida's method, and the effects of alcohol on the rats were studied by sexual behavior, the number of apomorphine-induced penile erection, level of testosterone in the sera, and the content of penile smooth muscle. Results The scores of animal model of alcohol intake evaluated by Nayagida's method were 0.66±2.05 in the control group and 9.26±5.50 in the alcohol intake group(P<0.05), which indicated that an animal model of alcohol intake was successfully established. Sexual behavior, the number of apomorphine-induced penile erection, testosterone level in the sera, and the content of penile smooth muscle of the alcohol intake group were all statistically different as compared with the control group(P<0.05). Conclusion Alcohol intake induces sexual dysfunction in rats, which may be due to the decline of testosterone level in the sera and decline of penile smooth muscle.     

腹腔镜前列腺癌根治术后勃起功能障碍的预防与治疗

前列腺癌是老年男性最常见的泌尿系统肿瘤之一,在美国居各种恶性肿瘤发病率之首[1]。近年来,我国前列腺癌的发生率呈明显增长趋势[2],其原因可能与人口老龄化、生活水平的提高、饮食结构改变以及诊断技术的改进等因素有关。前列腺癌根     

白膜整形术治疗阴茎弯曲的术式选择和效果分析

目的 探讨不同类型阴茎弯曲的白膜整形术术式选择和疗效.方法 2005年7月至2008年7月,共采用白膜整形术治疗不同类型阴茎弯曲患者8例,平均(34±9)岁,术前弯曲度为(58±10)°,国际勃起功能指数(IIEF-5)评分为15±5.其中运用白膜16点折叠术治疗阴茎下弯3例、阴茎侧弯1例;白膜V-Y改形术治疗阴茎侧弯合并白膜束窄环2例;自体大隐静脉游离移植白膜修补术治疗阴茎硬结症合并阴茎弯曲1例、白膜损伤后瘢痕收缩所致阴茎弯曲1例.手术前后采用IIEF-5评分系统对性功能满意度进行评估.结果 分别于术后3、6、9个月对患者进行随访,患者对手术效果均表示满意;阴茎静息态及勃起后外形良好,弯曲矫正至(11±4)°.IIEF-5评分为21±3,较术前显著提高(P＜0.05).无术后血肿、感染、阴茎感觉异常等并发症发生.结论 对于不同类型的阴茎弯曲,针对性选择不同的白膜整形术进行矫治,可获得良好的治疗效果.

Abstract：

Objective To explore various tunica albuginea plasty for penile curvature and their efficacies. Methods From July 2005 to July 2008, there were a total of 8 patients with a mean age of 34 ±9 years old (range: 23 -47 ) undergoing corrective surgery for various types of penile curvature. Among them, 4 patients (3 with ventral curvature, 1 with lateral curvature) were treated by 16-dot plication technique, 2 patients of lateral curvature with tightening ring in tunica albuginea corrected by V-Y plasty and 2 patients (one caused by Peyronie's disease while the other by tunica scar contracture) repaired by venous graft patch. The pre-and post-operative levels of sexual satisfaction were evaluated by the International Index of Erectile Function ( IIEF-5 ) scoring system. Results All cases were followed up at 3, 6 & 9 months postoperatively. Their mean curvature at maximal erection was ( 58.2 ± 9. 7 ) °. And a postoperative office assessment revealed a functional straight in all patients [mean degree ( 11 ± 4 )°]. One patient ( 12. 5% )reported penile shortening without dissatisfaetion about it. No patients complained of anesthesia or other sensory abnormality on their penile skin. An improvement of IIEF-5 scores was noted (21 ± 3 vs 15 ± 5,P ＜0. 05) and all patients were satisfied with their outcomes. No complications, such as hematoma,infection or erectile dysfunction, occurred. Conclusion To achieve a better penile morphology and functional outcomes with fewer complications, various orthoplasty should be adopted according to the cause,degree and direction of penile curvature.     

国产三件套可膨胀型阴茎假体植入术对勃起功能障碍患者的治疗

目的观察国产三件套可膨胀型阴茎假体对勃起功能障碍(ED)患者康复治疗的临床应用效果。方法选择阴茎阴囊交界处切口植入国产三件套可膨胀型阴茎假体,治疗非手术疗法无效的ED患者29例,其中神经源性ED患者23例,包括截瘫患者18例,外伤所致勃起神经损伤5例;阴茎海绵体动静脉瘘ED4例;阴茎海绵体纤维化ED1例;Klinefeters综合征ED1例。结果29例ED患者,手术均取得成功。术后随访3～36个月,平均18个月。其中1例出现假体内液体渗出并局部感染,2例出现机械性并发症,术后维持性交率28／29。3例原发性动静脉瘘ED患者,经治后使配偶妊娠。结论国产三件套可膨胀型阴茎假体治疗非手术疗法无效的ED患者,隐匿性好,康复效果确切,不影响既往正常的射精功能,且价格低,机械故障率与国外产品相仿,易被国内患者所接受。     

SILDENAFIL-ORAL MEDICATION FOR ERECTILE DYSFUNCTION-A REVIEW

Problem of male erectile dysfunction has been better defined, recognised and being treated in the recent times. However, the intracavernosal injection of vaso-active materials and penile prosthesis implantation were only the viable options available. Sildenafil, which is a specific phosphodiesterase type V inhibitor, enhances erection on sexual arousal by increasing the quantity of cyclic guanosine monophosphate in the corpora cavernosa. This has revolutionized the treatment of erectile dysfunction. Though the drug appears very promising with little side effects, many questions regarding efficacy, safety, misuse and overuse need to be addressed.     

超声定位下小切口修复阴茎折断的临床疗效观察

目的 探讨彩色多普勒超声定位下小切口修复阴茎折断的临床疗效.方法 16例阴茎折断海绵体单处破裂患者采用术前彩色多普勒超声定位,急诊小切口清除血肿、修复白膜,术后评估临床疗效.结果 15例顺利找到白膜裂口,1例转近冠状沟环形脱套式切口,手术均成功.手术时间20～60 min,平均35 min;术后住院3.0～6.0 d,平均住院4.8d;术后3～5 d拔除尿管,排尿通畅.随访6～12个月,1例出现短暂的勃起功能障碍,1例勃起时触及硬结,其余病例无明显并发症发生.结论 彩色多普勒超声检查可定位阴茎海绵体、白膜破裂口位置,选择彩色多普勒超声引导下小切口修复阴茎折断,创伤小,并发症少,可取得满意效果.