选择性显微阴茎背神经切断术治疗原发性早泄的临床观察

目的:评价显微镜下选择性阴茎背神经切断术治疗原发性早泄(PPE)的效果。方法:2010年9月至2012年10月,选择原发性早泄78例,行显微镜下选择性阴茎背神经切断术,切除分支5支9例,6支17例,7支15例,8支14例,9支8例,10支6例,11支6例,12支3例。术后随访12月。记录治疗前、治疗后患者阴道内射精潜伏时间(IELT)和性交满意度分值。结果:治疗前后IELT分别为(0.86±0.32)min和(6.65±3.9)min,有显著性差异(P<0.01)。治疗前后患者性交满意度分值分别为(7.32±2.52)分和(12.32±3.76)分,有显著性差异(P<0.01)。治疗前后配偶性交满意度分值分别为(4.46±1.36)分和(12.73±1.45)分,有显著性差异(P<0.01)。结论:显微镜下选择性阴茎背神经切断术治疗原发性早泄安全、有效。     

选择性阴茎背神经分支切断术治疗原发性早泄

目的:评价选择性阴茎背神经分支切断术治疗原发性早泄(PPE)的安全性和有效性。方法:2003年9月～2006年12月,对483例PPE实施了选择性阴茎背神经分支切断术,患者年龄21～71岁,平均32岁。术中保留两条分支,其余分支均予以切除。切除分支3支者89例,4支者183例,5支者125例,6支者38例,7支者32例,8支者12例,9支者3例,10支者1例。手术后4周开始性生活,随访3～36月。结果:术后所有病例阴茎敏感性均下降,射精潜伏期延长显效352例,好转93例,无效38例,总有效率92.13%。无切口感染,无切口出血,无勃起功能障碍。结论:选择性阴茎背神经切断术致阴茎敏感性下降效果确切,治疗PPE安全、有效。     

阴茎背神经切断术治疗早泄

目的评价阴茎背神经切断术治疗早泄的效果。方法自1997~2006年门诊早泄患者19例行阴茎背神经切断术治疗早泄。局麻下于阴茎背侧距冠状沟0.5~1cm处做2~3cm横切口,切开深筋膜,暴露左右两侧之阴茎背神经,并切除部分神经分支。记录患者手术前后阴道内射精潜伏时间和夫妻双方性交满意度。结果19例患者术前平均阴道内射精潜伏时间和性交满意度分别为(1.01±0.58)min(0.10~1.90min)和(14.89±6.08)%(5%~25%),术后平均射精潜伏期和性交满意度分别为(4.14±2.99)min(0.40~9.10min)和(57.47±28.28)%(10%~87%),手术前后相比P<0.01。19例中15例有效,有效率为78.95%,4例无效,2例出现术后轻度局部疼痛,1周后缓解。结论阴茎背神经切断术是一种治疗早泄的有效方法,适用于治疗年轻且不合并ED的患者。     

阴茎背神经选择性切断术对阴茎敏感度影响的临床研究

目的 通过阴茎生物震感阈值测定法评估阴茎背神经选择性切断术前后阴茎敏感度的变化.方法 原发性早泄患者92例行阴茎背神经选择性切断术,分别检测术前、术后1个月和术后3个月的阴茎生物震感阈值.结果 阴茎头震感阈值(GPVT):术前为(0.048±0.015)μm,术后1个月为(0.280±0.084)μm,术后3个月为(0.282±0.081)μm;阴茎体震感阈值(PSVT):术前为(0.061±0.014)μm,术后1个月为(0.064±0.022)μm,术后3个月为(0.065±0.020)μm.统计学方差分析:(1)术后1个月GPVT比术前明显升高(P＜0.05);(2)术后3个月GPVT比术前显著升高(P＜0.05);(3)术后1个月和3个月GPVT无明显变化(P＞0.05);(4)术前、术后PSVT无明显变化(P＞0.05).结论 (1)阴茎生物震感阈值测定法是简便、无创、可定量、重复性好的阴茎背神经感觉客观检测方法之一.(2)阴茎背神经选择性切断术后阴茎头敏感度降低、震感阈值提高.(3)阴茎背神经选择性切断术治疗原发性早泄安全、有效.     

阴茎背神经切断术治疗原发性早泄

目的探讨阴茎背神经切断术的手术方法和效果。方法选取我院2005～2008年,采用阴茎背神经切断术治疗原发性早泄病例218例,结合国内外资料及本组病例进行回顾性分析。结果本组病例诊断明确,有确定的手术指征,术后1个月开始过性生活,疗效显著167例,好转36例,有效率93．12％,无效15例,性伴侣满意度87％。结论阴茎背神经切断术经临床实践认为,治疗原发性早泄安全有效,是治疗原发性早泄的有效方法。     

改良式阴茎背神经切断术治疗原发性早泄

目的 探讨改良式阴茎背神经切除术的效果.方法 回顾分析广州、乐清、哈尔滨三家三级医院在2008年7月到2010年5月期间开展的338例该项手术.对术后的疗效,并发症给予客观的评价.结果 对338例原发性早泄患者中的87例经2年以上随访,显效率59.8%.术后射精潜伏期没有明显变化5例,阴茎麻木感2例,勃起功能障碍1例,阴茎血肿1例,切口感染2例.结论 改良式阴茎背神经切断术治疗原发性早泄安全,有效.     

阴茎背神经传导速度测定在阳萎诊断中的价值

对98例男性进行阴茎背神经传导速度测定。19名具有正常性功能的健康成年男子(Ⅰ组)阴茎背神经传导速度均值为20.05±1.95m/s。11名心理性阳萎患者(Ⅱ组)及4名经会阴前列腺切除术后仍具有性功能者(Ⅵb组),阴茎背神经传导速度均值分别为18.64±3.31及17.0±2.92m/s,与正常组无显著差别。5名具有糖尿病史的阳萎患者(Ⅲ组)、11名外伤性阳萎患者(Ⅳ组)及6名经会阴前列腺如切除术后发生阳萎患者(Ⅵa组)阴茎背神经传导速度均值分别为11.0±5.02、10.09±3.94及9.0±2.65m/s,均显著低于正常组。异常率分别为80％、100％及100％。而42名病因未定的阳萎患者(Ⅴ组)阴茎背神经传导速度均值为11.71±4.13m/s,亦显著低于正常组。异常率亦高达83.3％。结果表明,有可能利用阴茎背神经传导速度测定来评价勃起的周围神经病变。     

原发性早泄病人阴茎头兴奋性与阴茎背神经局部解剖学关系

目的研究原发性早泄病人阴茎头敏感度与阴茎背神经局部解剖学的关系。方法收集2015年1月至12月在我院泌外二科行阴茎背神经选择性切断术的47例病人,术前阴茎生物震感测定仪检测阴茎头敏感度,对测定结果和手术中游离出阴茎背神经结果进行统计学分析。结果 47例病人手术中发现阴茎背神经数目为6支1例,8支7例,9支7例,10支6例,11支12例,12支5例,13支6例和14支3例。术前病人满意率(32±6)%,性伴侣满意度(25±9)%。术后显效42例,占89.36%,好转4例,占8.51%;无变化者1例,占2.13%。术后病人满意率(85±9)%,性伙伴满意率(82±11)%。阴茎头敏感度最大3.47V,最小1.59V,平均2.63V。术前阴茎头敏感度、阴茎体敏感度均与术中阴茎背神经数目成负相关性,阴茎头与阴茎体敏感度无明显相关性。结论 (1)阴茎生物震感阈值测定法是一种无创、可定量和重复性好的阴茎背神经兴奋性筛选方法;(2)本研究中病人阴茎头敏感度平均值为2.63V,阴茎体敏感度平均值为3.06V;(3)本研究结果提示阴茎头敏感度越高的部位阴茎背神经分布越多,越稠密。     

阴茎背神经选择性切断术联合系带内羊肠线植入术治疗原发性早泄的疗效分析

早泄（premature ejaculation,PE）被认为是成年男性中最常见的性功能障碍,其发病率高达22．7％,严重影响患者的生活质量和自尊心。目前对早泄缺乏有效的治疗方法,传统的行为疗法及药物疗法均因疗效不稳定或药物不良反应而导致临床应用受到限制。近年来,国内许多专家采用选择性阴茎背神经切断术治疗原发性早泄取得了良好的效果,但总体有效率仅为78．9％～87．5％,仍有部分患者不能单纯通过手术得到有效的治疗。     

改良式阴茎背神经切断术治疗原发性早泄128例

早泄是射精障碍中最常见的疾病,发病率占成年男性的14%～41%[1].尽管早泄的定义尚有争议,但通常以男性的射精潜伏期或女性在性交中达到高潮的频度来评价.传统的观点认为早泄大都是心理性原因所致,多采用性行为疗法,口服药物、局部涂药等,疗效因人相差很大.近年来研究发现,阴茎感觉过敏或阴茎感觉神经兴奋性增高等器质性因素也是引起早泄的病因,我们以Tullii等[2]报道的阴茎背神经切断术为基础,并加以改良,从而降低阴茎的敏感度、延长射精潜伏期,治疗原发性早泄,自2001年9月～2005年7月共实施了128例,报告如下.     

Application of micronised acellular dermal matrix for primary premature ejaculation: A preliminary study

This study aimed to explore the efficacy of injection of micronised acellular dermal matrix (MADM) particles for treating primary premature ejaculation. This study was a prospective single-arm clinical trial. Thirty patients who met the surgical indications were enrolled. MADM particles, mixed in platelet-rich plasma, were injected into Buck's fascia to spread over the dorsal penile nerve, suppress the influx of nerve impulses and, thus, reduce penis sensitivity. We evaluated the changes according to intravaginal ejaculation latency time using a stopwatch and a premature ejaculation diagnostic tool. Meanwhile, we also recorded sexual partner satisfaction and adverse events. All patients recovered well after surgery with no complications such as infections or allergies. The mean intravaginal ejaculation latency time before surgery was 0.72 ± 0.28 min, compared with 2.41 ± 0.54 min, 2.64 ± 0.41 min, 2.79 ± 0.25 min and 2.89 ± 0.35 min at, respectively, 4, 8, 16 and 20 weeks after surgery. The premature ejaculation diagnostic values and sexual partner satisfaction had significantly improved after treatment. Injection of MADM particles is an effective, safe and simple method for treating premature ejaculation.     

Effect of acute dapoxetine administration on the pudendal motoneuron reflex in anesthetized rats: comparison with paroxetine

PURPOSE: Pudendal motoneuron reflex discharges elicited by bilateral electrical stimulation of the dorsal nerves of the penis were used as an experimental model of the expulsion reflex of ejaculation to investigate the effect of acute intravenous delivery of dapoxetine, a short acting selective serotonin reuptake inhibitor, in anesthetized rats. Dapoxetine was compared with paroxetine, the selective serotonin reuptake inhibitor of reference. MATERIALS AND METHODS: Stimulating electrodes were placed bilaterally on the dorsal nerves of the penis and a recording electrode was placed on the motor branch of the pudendal nerve to monitor pudendal motoneuron reflex discharges in urethane anesthetized rats. Pudendal motoneuron reflex discharges induced by penile dorsal nerve stimulation were measured before and 60 minutes after a single intravenous injection of dapoxetine or paroxetine, each tested at 3 doses (1, 3 and 10 mg/kg) or after a single injection of vehicle. RESULTS: At all doses tested dapoxetine significantly lengthened the latency of pudendal motoneuron reflex discharges following bilateral stimulation of the dorsal nerves of the penis in comparison with vehicle, whereas only the 1 mg/kg dose of paroxetine was effective. The amplitudes of pudendal motoneuron reflex discharges were significantly decreased only in rats treated with 3 mg/kg dapoxetine compared to vehicle. CONCLUSIONS: Acute systemic delivery of selective serotonin reuptake inhibitors is capable of modulating the expulsion reflex of ejaculation in anesthetized rats with dapoxetine appearing to be more effective than paroxetine. These findings support the beneficial effect of on-demand administration of dapoxetine for premature ejaculation.     

电刺激阴茎背神经和海绵体内注射药物诱导大鼠阴茎海绵体内压反应

目的:评价阴茎海绵体内压(ICP)监测在电刺激阴茎背神经和海绵体内注射罂粟碱诱导大鼠阴茎勃起反应中的应用。方法:选取性成熟雄性SD大鼠8只,20%氨基甲酸己酯(1000mg/kg)腹腔注射麻醉下,暴露阴茎并解剖阴茎背神经(DN),将充满肝素盐水并连接于压力传感器的25G针头插入一侧海绵体,取另一30G头皮针插入对侧海绵体,分别用于测定ICP和注射血管活性药物。分别以电刺激海绵体神经(刺激参数:电压4V,波幅0.5ms,频率16Hz,持续20s)和海绵体内注射罂粟碱(0.4mg)诱发阴茎勃起,采用SMUPPC型生物信号处理系统记录ICP变化。结果:麻醉大鼠的ICP基线水平为(12.3±3.1)mmHg(1mmHg=0.133kPa),DN电刺激后约30～60sICP明显升高[(36.4±2.3)mmHg,P<0.05],电刺激结束后缓慢下降至基线水平。海绵体内注射罂粟碱后5～8min可诱发ICP明显升高[(28.4±6.1)mmHg,P<0.05]。结论:监测电刺激大鼠DN及海绵体内药物注射诱发的ICP,为阴茎勃起这一复杂神经血管活动的动物模型在体实验研究提供了一种客观准确的科学工具,对于进一步研究阴茎勃起生理和勃起功能障碍的发病机制,评价治疗勃起功能障碍新疗法的疗效等具有重要意义。     

脱细胞异体真皮在阴茎增粗效果下对原发性早泄的影响

目的探讨应用人脱细胞异体真皮(human acellular dermal mantrix,HADM)在阴茎增粗方案中治疗男性原发性早泄的疗效及安全性。方法采用回顾性分析我院2017年3月~2019年8月收治的94例原发性早泄患者,通过阴茎神经电生理结果划分阴茎皮肤高敏感型及混合型早泄患者作为本次课题研究对象,评估内容包括手术前后阴茎体感诱发电位(DNSEP/GPSEP)潜伏期、阴茎交感皮肤反应(PSSR)潜伏期、阴茎中段周径(疲软)、中国早泄指数-5评分(CIPE-5)、阴道内射精潜伏期(IELT)、国际勃起功能评分问卷-5(IIEF-5)以及患者与性伴侣的满意度。结果对比患者术前及术后3月各项指标,除IIEF-5外,术后患者阴茎中段周径(疲软)明显增粗、阴茎体感诱发电位(DNSEP/GPSEP)潜伏期、阴茎交感皮肤反应(PSSR)潜伏期、IELT明显延长、CIPE-5及性伴侣的满意度明显改善,有统计学意义(P<0.05)。结论在应用脱细胞异体真皮阴茎增粗方案中,治疗男性原发性阴茎皮肤高敏感型及混合型早泄效果显著,患者阴道内射精潜伏期时间明显增长,同时,性生活质量显著提升,并发症极少,安全有效。因此,值得在当今临床中应用和推广。     

Neuroanatomy of the male urethra and perineum

OBJECTIVE: To describe the topography of the perineal nerves from their pudendal origin to their course into the male genitalia, with specific attention on the course of the perineal nerve along the ventral penis, including branches into bulbospongiosus muscle and corpus spongiosum. MATERIALS AND METHODS: The study comprised 18 normal human fetal penile specimens at 17.5-38 weeks of gestation (determined by fetal heel-to-toe length). Specimens were fixed in formalin, embedded in paraffin wax and serially sectioned at 6 micro m. The penile specimens contained the whole penis from the glans to the crural bodies, beneath the pubic arch and the perineum up to the anal verge. Immunocytochemistry was assessed on selected sections with antibodies against the neuronal markers S-100 and nitric oxide synthase (nNOS). Three-dimensional computer reconstruction of serial sections allowed an in-depth analysis of the neuroanatomy of the fetal penis, perineum and surrounding structures. RESULTS: After the pudendal nerve leaves the pudendal canal it gives rise to the perineal nerve branches in the ischiorectal fossa. Perineal nerves travel alongside the ischiocavernous and bulbospongiosus muscles and before reaching the latter, nerve branches course into the bulbospongiosus muscle. During its pathway within this muscle, fine nerve fibres course into the corpus spongiosum by piercing through the junction of the muscle. At the penoscrotal area, the perineal nerves give branches to the scrotum, funnelling into the interscrotal septum. Perineal nerves continue their pathway over the ventral side of penis covering the ventral surface of corpus spongiosum. Branches of the dorsal nerve of the penis at the junction of corpus cavernosum and corpus spongiosum assemble into a network with the perineal nerves. All perineal nerves from their main trunk at the ischiorectal fossa until their interaction with dorsal nerve of penis at the base of penis were nNOS negative. After the interaction with the dorsal nerve of penis, they become nNOS positive. CONCLUSION: Integrating neuroanatomical knowledge about the perineal nerves and their communication with the dorsal nerve of penis should facilitate a strategic approach to reconstructive procedures on the penis. Special care should be taken at the junction between the corpora cavernosa and spongiosa, where the dorsal nerve joins the perineal nerve, and at the proximal bulbospongiosus muscle, thereby protecting the fine nerves piercing into the cavernosa spongiosa.     

Somatosensory Evoked Potentials in Patients With Primary Premature Ejaculation

Purpose

Premature ejaculation has been believed to be psychological in the majority of patients. With few exceptions organic conditions are rarely implicated. We investigated the possible role of sensory function in patients with primary premature ejaculation to determine whether there is an etiological basis for this condition.

Materials and Methods

We performed somatosensory evoked potentials from the penis in 34 patients with primary premature ejaculation and in 30 normally potent men. The latencies and amplitudes of the evoked potentials were measured at the penile shaft (dorsal nerve) and at the glans penis.

Results

Mean latency of dorsal nerve and glans penis somatosensory evoked potentials was 1.51 and 6.80 (significant) msec. shorter, respectively, in the patients than in the normal subjects. In the normal subjects the mean latency of glans penis somatosensory evoked potentials was 0.99 msec. longer than that of the dorsal nerve (not significantly different) but in patients the mean latency in the glans penis was 4.30 msec. shorter (p <0.001). Mean amplitude of glans penis somatosensory evoked potentials was less than that of the dorsal nerve in both groups. However, mean amplitudes of dorsal nerve and glans penis somatosensory evoked potentials were significantly greater in patients than in normal men.

Conclusions

Patients with premature ejaculation have hypersensitivity and hyperexcitability of the glans penis, which may give rise to uncontrolled ejaculation and are believed to be organic implications for premature ejaculation.     

Anesthetic block of the dorsal penile nerve inhibits vibratory-induced ejaculation in men with spinal cord injuries

OBJECTIUES: We investigated which nerve pathways are necessary to achieve ejaculation using penile vibratory stimulation (PVS) in men with spinal cord injury (SCI). METHODS: Eight men with SCI were selected based on the presence of a bulbocavernosus reflex (BCR) and consistent antegrade ejaculation with PVS. Level of injury was cervical (4), upper thoracic (4), and lower thoracic (1). Mean age was 30.4 years (range 22 to 38). Usual responses to PVS included autonomic dysreflexia (4), erection (4), and consistent somatic responses such as abdominal contractions (8). Local anesthesia of the dorsal penile nerves (penile block) was achieved using 1% plain lidocaine injection. Effective penile block was confirmed by loss of the BCR. Two PVS ejaculation trials were performed: one trial during the penile block and one trial when the penile block had worn off. In 4 subjects, the bladder contents were analyzed for retrograde ejaculation. RESULTS: With the penile block, ejaculation was inhibited in 100% of the subjects. None of the bladder washings demonstrated sperm, indicating absence of retrograde ejaculation. None of the subjects exhibited their usual erectile response, somatic responses, or signs of autonomic dysreflexia. After the penile block wore off, PVS induced ejaculation in all subjects. If subjects usually had erection, somatic responses, or signs of autonomic dysreflexia, these also returned. CONCLUSIONS: Our data suggest that ejaculatory response to PVS in SCI men requires the presence of intact dorsal penile nerves.     

神经调节治疗神经源性排便功能障碍

目的 探讨神经调节技术治疗脊髓损伤后神经源性排便障碍的临床疗效.方法 2006年1月至2008年4月,我们应用神经调节技术治疗脊髓损伤后便秘9例,其中应用S3骶神经调节治疗1例,阴茎或阴蒂背神经调节治疗8例,通过Wexner便秘评分评价疗效.结果 1例患者接受骶神经调节治疗后,便秘症状明显改善,Wexner便秘评分从术前平均22分降低到术后平均9分.4例患者接受阴茎或阴蒂背神经调节治疗后有效,调节前Weber便秘评分平均19分,接受12周的阴茎或阴蒂背神经调节后Weber评分降低到平均11分.随访期问患者便秘症状及生活质量持续改善.结论 神经调节技术可以改善部分神经源性排便障碍患者的便秘症状,但目前尚无有效指标能够预测神经调节治疗神经源性排便障碍的效果,此项技术仍需要高质量的大样本随机对照研究来确证其治疗神经源性排便障碍的有效性.