闭合性阴茎海绵体破裂七例诊治分析

目的探讨阴茎海绵体破裂原因和最佳诊治方法。方法报告7例闭合性阴茎海绵体破裂临床资料。7例均行彩色多普勒超声检查，2例加做MRI检查。手术6例，其中3例采用冠状沟近侧环形切口，3例采用阴茎血肿最明显处直切口探查，清除血肿行白膜修补；1例因拒绝手术保守治疗。结果7例治疗后恢复均顺利，手术患者无伤口感染和尿漏。随访3个月～1年，1例保守治疗患者有阴茎硬结、痛性勃起；6例手术患者无阴茎硬结、歪曲畸形，无痛性勃起，性功能正常。结论彩色多普勒超声检查是诊断阴茎海绵体破裂可靠的辅助检查，MRI为另一辅助检查，两者互补。白膜修补手术创伤小、恢复快、效果佳，应是首选的治疗方法。     

彩色多普勒超声诊断阴茎折断16例临床分析

目的探讨彩色多普勒超声诊断阴茎折断的价值。方法回顾性分析16例经手术证实阴茎折断患者的超声声像图资料。结果 16例患者彩色多普勒超声均诊断为阴茎折断,与术中表现相符,诊断符合率100%;白膜破裂、阴茎海绵体断裂、阴茎深筋膜与白膜间血肿为阴茎折断典型彩色多普勒超声表现。结论彩色多普勒超声诊断阴茎折断准确率高,可作为临床辅助诊断首选。     

低流量型阴茎异常勃起11例报告

阴茎异常勃起是指在无性交或刺激情况下，阴茎勃起持续时间过久，并伴有疼痛或企图性交时产生的疼痛。本科1985年8月至2007年12月收治经阴茎海绵体穿刺及血气分析、阴茎海绵体彩色多普勒超声检查，确诊低流量型阴茎异常勃起11例，现报告如下。     

阴茎折断的诊断和治疗——附12例报告

目的：总结阴茎折断的临床特征、诊断要点及治疗体会,以提高阴茎折断的诊治水平。方法：对12例阴茎折断患者临床资料进行总结分析。结果与结论：12例中,有明确受伤原因11例。体格检查可见阴茎折断部位皮肤青紫色,局部肿胀,压痛明显,呈不同程度的成角偏曲。10例采用手术治疗,其中折断位置明确的6例采用阴茎纵形切口修补海绵体,余4例采用冠状沟与血肿间环形脱套式切口探查,手术均成功,术后7d切口拆线,均为Ⅰ级愈合,无发生严重并发症。2例患者拒绝手术治疗仅予保守治疗。12例的住院时间为7～14d,平均8d。随访3个月～5年,行手术治疗的10例患者,1例失访,余9例恢复良好,无出现勃起功能障碍、排尿困难及勃起疼痛等并发症;行保守治疗的2例患者,1例恢复良好,另1例的阴茎有轻微弯曲。阴茎折断的诊断主要依据是典型病史及临床表现,手术是可靠和有效的治疗方法。     

阴茎折断9例报告

自 1994年 7月至 2 0 0 1年 8月 ,我们共收治阴茎折断 9例 ,全部经手术治愈 ,现报告如下。1　临床资料本组 9例 ,年龄 18～ 4 7岁 ,平均 34.5岁。受伤至就诊时间 2～ 2 2小时 ,平均 6小时。致伤原因为性生活时阴茎撞击女性耻骨联合或会阴部 8例 ,手淫时阴茎过度弯曲 1例。均有典型表现 :听到阴茎折断之响声 ,局部疼痛 ,阴茎迅速疲软继之瘀血肿胀 ,远端弯向健侧 ,皮肤青紫 ,均无血尿及排尿困难。5例接受超声检查 ,发现白膜缺损 (0 .2～ 1cm) ,有不同程度的低回声 (血凝块 )。2　治疗方法8例于入院后均在局麻下急诊手术治疗。取距血肿中心点远…     

闭合性阴茎海绵体破裂的诊断和治疗

目的探讨闭合性阴茎海绵体破裂的诊断和治疗。方法回顾性分析5年来收治的6例阴茎折断患者的临床资料。结果6例均有典型的临床表现，均依据病史和体检确诊。单侧阴茎海绵体破裂4例，左阴侧茎海绵体破裂伴尿道海绵体被膜撕裂1例，双侧阴茎海绵体破裂伴尿道断裂1例。均行急诊手术修补。4例随访9个月到5年，无疼痛、硬结和成角，其中1例有轻度阴茎勃起不坚和勃起角度减小。结论闭合性阴茎海绵体破裂的诊断主要依据典型病史和临床表现，辅助检查可有选择的使用。急诊手术可减少并发症的发生。     

闭合性阴茎海绵体断裂的诊治体会（附11例报告）

[目的] 探讨闭合性阴茎海绵体断裂的诊断和治疗体会. [方法] 2000年7月至2009年1月共收治11例闭合性阴茎海绵体断裂,诊断明确后均行急诊手术治疗. [结果] 手术时间30～60 min.术中出血量10～50 mL.术后住院5～9 d.随访3～24个月,无阴茎弯曲、阴茎硬结、勃起不坚、勃起疼痛、排尿困难、勃起功能障碍发生,性生活正常. [结论] 闭合性阴茎海绵体断裂患者伤后应尽快诊断,减少不必要的检查,以急诊手术治疗为好.使用可吸收缝线缝合海绵体白膜,可降低术后纤维化的发生.     

彩色多普勒超声诊断阴茎折断2例报告

1病例报告 例1,30岁,阴茎勃起时手淫致阴茎肿胀、疼痛5h入院。体检发现距冠状沟近侧3cm处阴茎向右背侧成角畸形约120°。阴茎局部肿胀呈紫色,触压痛。超声显示阴茎腹侧偏左白膜回声中断,裂口约0．56cm,尿道海绵体未见异常,彩色血流充盈佳。超声提示：阴茎折断（白膜断裂）,局部软组织肿胀。超声定位下急诊手术。     

阴茎折断伤15例手术疗效观察

目的:探讨急诊手术治疗阴茎折断伤的方法与远期效果。方法:回顾分析15例阴茎折断伤患者的临床资料和随访情况。结果:15例均有典型病史和临床表现,其中阴茎淤血、肿胀和剧烈疼痛、偏向对侧10例,阴茎呈S型肿胀4例,阴茎向下垂弯1例;淤血、肿胀局限于阴茎8例,扩散至阴囊及会阴7例;伴尿道损伤5例,其中4例伴肉眼血尿及排尿困难。均急诊手术修补,随访6个月～2年,13例阴茎无勃起不坚、勃起弯曲、勃起疼痛及皮下结节,无纤维瘢痕化,无尿道狭窄,性交满意;1例阳痿;1例勃起不坚。结论:早期手术治疗能减少阴茎折断伤的并发症,改良修补术具有简单、安全、创伤小、出血少、手术时间短、拆线疼痛轻微的优点。     

非血管性勃起功能障碍患者阴茎-尿道海绵体血管连接的彩色多普勒研究

目的 探讨非血管性勃起功能障碍(ED)患者阴茎-尿道海绵体血管连接(CSS)的形态及血流动力学特征.方法 应用彩色多普勒超声(CDUS)检测22例非血管性ED患者阴茎CSS形态和血流动力学状况.结果 勃起前所有病例阴茎均可观察到1～3支CSS,且都为朝向尿道海绵体的低速动脉频谱;勃起后阴茎可观察到CSS达4～8支,亦均为朝向尿道海绵体的动脉频谱,但其收缩期峰值速度(PSV)高于勃起前(P<0.001),RI则低于勃起前(P<0.05).阴茎勃起时CSS的PSV及RI均低于CA(P<0.001),但其PSV明显高于尿道海绵体动脉(UA)(P<0.001),而RI低于后者(P<0.001).结论 非血管性ED患者阴茎CSS为血流方向朝向尿道海绵体的动脉连接.     

急性闭合性阴茎损伤的MRI临床应用

目的分析急性闭合性阴茎损伤的MRI表现,探讨其在阴茎损伤中的临床应用价值。方法回顾性分析2015年1月至2019年12月收治的、并经MRI平扫检查的12例阴茎闭合性损伤患者的临床及MRI影像资料。结果2例单纯阴茎皮下血肿,MRI表现为阴茎皮层肿胀,不同范围的皮下血肿在T1WI表现为等或稍高信号,T2WI为高信号。8例阴茎海绵体及白膜破裂(阴茎折断),其中1例合并尿道海绵体轻度损伤,MRI表现为低信号白膜连续性中断,裂隙间可见长短不一的高信号影,以T2WI及T2-FS(T2压脂序列)显示清晰;相应阴茎海绵体内可见不同程度的血肿,T1WI等信号为主,T2WI及T2-FS混杂等高信号为主,部分可见低信号区;Buck筋膜下可见范围不同的血肿。2例海绵体、白膜破裂合并Buck筋膜破裂,MRI除了显示白膜及Buck筋膜中断,以及海绵体内、Buck筋膜下血肿之外,还可见沿着皮下浅筋膜层广泛水肿或血肿信号达阴囊、会阴部及耻骨联合周围软组织。与临床手术结果对照,本组MRI诊断定位及定性准确度均为100%。结论MRI检查可以清楚显示闭合性阴茎损伤的部位和范围,为临床治疗提供精确依据。     

非穿透性阴茎损伤的超声表现

目的 观察非穿透性阴茎损伤的声像图特点。方法 回顾性分析我院经手术病理及临床随访证实的21例非穿透性阴茎损伤患者的超声表现。结果 14例阴茎折断,超声可见其中13例阴茎白膜破裂;1例白膜周边低回声区,未见明确白膜连续性中断。1例尿道海绵体破裂并尿道断裂及尿道海绵体动静脉破裂,超声可见阴茎尿道线状高回声连续性中断。1例阴茎海绵体血肿,超声可见双侧海绵体内大小不等、边缘不规则的高回声区。2例阴茎背深静脉损伤,超声可见阴茎白膜与Buck筋膜之间均匀低回声区。3例阴茎海绵体动脉假性动脉瘤,超声可见一侧阴茎海绵体内不规则无回声区。结论 超声不仅可评价阴茎折断、阴茎海绵体和尿道海绵体损伤,还能检测阴茎血管损伤,为非穿透性阴茎损伤选择临床治疗方案提供依据。     

Cavernosal arterial anatomic variations and its effect on penile hemodynamic status.

OBJECTIVE: With continuous improvements in ultrasound technology, small vessels with remarkably slow blood flow that may not be assessed by color Doppler ultrasonography, can be evaluated using power Doppler ultrasonography. In the present study, penile arterial anatomic variations were determined with power Doppler ultrasonography and its impact on penile hemodynamic status. METHODS: A total of 54 patients with erectile dysfunction were evaluated with power Doppler ultrasonography. The effects of vascular anatomic variations and the structure of the corpora cavernosa and tunica albuginea on vascular status were assessed on both sides. RESULTS: A normal penile vascular system was observed in 35.2% and 25% of 54 patients (mean age: 46.6+/-11.5 years) at the radix and mid-shaft of the penis, respectively. Pure arterial component was observed in 40.7% (22/54) and 47.2% (17/36) of the patients at the base and mid-shaft of the penis, respectively. Penile arterial insufficiency was severe in 9.2 and 5.5% of the patients at the base and mid-shaft of the penis, respectively, whereas intrapenile truncus was found in six patients (5.5%), the ratio of single cavernosal artery, intrapenile and extrapenile bifurcations were 69.4, 7.4 and 12.0%, respectively. Twenty (18.5%) dorso-cavernosal perforators, 15 (13.9%) cavernoso-dorsal and 30 (27.8%) intercavernosal branches were found. Peak systolic blood flow velocity values were decreased in 12 of 36 patients (33.3%) distally, while increased blood flow was observed in 11 (30.5%). CONCLUSIONS: Hemodynamic parameters might be variable at either side of the penis and depend on intrapenile arterial anatomic variations. Parameters determined using power Doppler ultrasonography should be evaluated from the proximal to distal side of the penis to obtain reliable and standard results. However, variations of penile arterial anatomy and its effect on penile hemodynamic changes should not be overlooked especially in the patients who are candidates for penile reconstructive or vascular surgery.     

Penile compartment syndrome: a possible explanation for penile pain in peyronie disease shown by penile sonography.

OBJECTIVE: Our purpose was to describe sonographic findings in patients with Peyronie disease that may explain persistent penile pain in these patients. We propose the term penile compartment syndrome for use in radiology and urology practice to describe this condition. METHODS: Thirty-five consecutive patients were examined. All these patients had clinically "mature" plaques with Peyronie disease. Penile duplex sonography was performed as part of the patient evaluation before possible corrective surgery. RESULTS: All patients had the classic sonographic finding of plaques in the tunica albuginea. Persistent venous insufficiency was noted in 3 patients (8.6%); we observed arterial insufficiency during dynamic evaluation of blood flow in 2 (5.8%); and in 2 cases, a low peak systolic velocity was accompanied by an abnormal cavernous artery structure. Four patients (11.4%) had extensive circular plaques in the tunica albuginea, limiting expansion of the cavernous body during erection, as shown by a constant cavernous body diameter of the affected side compared with an increasing diameter of the unaffected side during the progressive phases of erection. Patients with a constricting ring of plaques had persistent penile pain during erection as well as after injection during penile duplex sonography. CONCLUSIONS: Peyronie disease is caused by replacement of penile tunica albuginea tissue with inelastic scarring. One manifestation of Peyronie disease is painful erection. In patients with persistent erectile pain, we found circumferential inelastic scarring of the tunica albuginea. The findings of penile compartment syndrome on penile sonography may influence the urologist's choice of surgical technique for treating Peyronie disease.     

输尿管镜下钬激光联合筋膜扩张器治疗尿道狭窄33例体会

【目的】探讨输尿管镜下联合应用钬激光和筋膜扩张器治疗尿道狭窄的临床疗效。【方法】对33例尿道狭窄的患者在输尿管镜直视下用钬激光进行尿道内切开术以及用筋膜扩张器进行尿道扩张术。【结果】本组33例患者手术获得成功,11例1年内无复发,18例仍需定期尿道扩张,排尿良好,4例排尿困难,进行二次手术。【结论】输尿管镜下联合运用钬激光和筋膜扩张器治疗尿道狭窄是一种较好的治疗方法,创伤小,安全性高,近期疗效肯定。     

Color Doppler sonographic findings in penile fracture

We performed color Doppler sonographic examination on 4 patients, 3 of whom had preliminary diagnoses of penile fracture and 1 of whom had undergone an operation due to penile fracture a year previously. Color Doppler sonography helped evaluate the relationships between the hematoma and the vascular structures and aided in differential diagnosis of the vascular injuries that may accompany tunical rupture (or have similar clinical presentations) and Mondor's disease; thus, this method has a crucial role in choosing the treatment approach. Color Doppler sonography may also assist in the follow-up of patients after surgical or conservative treatment.     

Ultrasound diagnosis of penile fracture

BACKGROUND: Rupture of the corpus cavernosum, penile fracture, is an uncommon occurrence. Diagnosis is straightforward when classical historical and physical examination findings are present. However, atypical presentations can make the diagnosis difficult. OBJECTIVES: Review the literature supporting use of ultrasound for the diagnosis of penile fracture. Review of the ultrasonographic findings in patients with penile fracture. CASE REPORT: A 32-year-old man presented with penile ecchymosis after sex but lacking several historical and physical examination elements for a diagnosis of penile fracture. Ultrasound performed by the treating physician revealed rupture of the tunica albuginea and presence of a hematoma, leading to a diagnosis of penile fracture. Conclusion: Ultrasound is a simple, efficient, and non-invasive imaging method to assist in the diagnosis of penile fracture.     

高频彩色多普勒超声在阴囊、睾丸疾病中的诊断价值

目的探讨高频彩色多普勒超声在阴囊、睾丸疾病中的诊断价值。方法对151例经手术及病理证实的阴囊、睾丸疾病声像图和彩色血流进行回顾性分析。结果151例中包括:睾丸肿瘤6例(其中精原细胞瘤3例、胚胎细胞癌1例、畸胎瘤1例、恶性淋巴瘤1例);睾丸囊肿1例;睾丸微石症4例;睾丸炎5例;睾丸结核4例;睾丸扭转5例;睾丸创伤10例;附睾肿块35例(其中附睾囊肿21例、附睾炎性结节11例、附睾结核3例);鞘膜积液39例(其中睾丸鞘膜积液27例、精索鞘膜积液4例、精索睾丸鞘膜积液6例、交通性鞘膜积液2例);隐睾6例(均为腹股沟型);精索静脉曲张36例(其中21例为左侧、7例为右侧、8例为双侧);均经手术及病理证实。结论高频彩色多普勒超声能显示各种阴囊、睾丸疾病的声像图和血供特点,为临床诊断提供了重要价值。     

高血压大鼠阴茎白膜弹性纤维改变对勃起功能影响的研究

目的了解高血压大鼠白膜中弹性纤维改变对勃起功能的影响。方法选择16周龄雄性自发性高血压大鼠(SHR)20只和同系正常血压大鼠(WKY)10只,利用阿扑吗啡诱导勃起试验,将大鼠分为高血压勃起功能障碍组(SHR-ED)、高血压组(SHR)及正常对照组(Control),利用维多利亚蓝-丽春红染色法对不同处理组的阴茎海绵体标本进行弹性纤维的染色,利用彩色图文系统进行分析,以累积光密度(IOD)作为测量指标。结果 SHR大鼠死亡2只,余下SHR-ED组11只,SHR组7只,Control组10只。各处理组间阴茎白膜弹性纤维存在统计学差异(F=79.024,P=0.000),SHR-ED组阴茎白膜弹性纤维IOD含量少于SHR组(P=0.000),SHR组阴茎白膜弹性纤维IOD含量小于Control组(P=0.000)。结论高血压可以导致白膜弹性纤维的减少,高血压大鼠白膜弹性纤维减少到一定程度将导致勃起功能障碍。