高流入性、动脉性阴茎异常勃起(附二例报告)

报告２例高流入性、动脉性阴茎异常勃起病例，并较详细地阐述了其发病机理，诊断和治疗。２例均为外伤后所致及延迟性发作，经选择性阴部内动脉造影证实，海绵体动脉窦状隙瘘是诊断的主要依据。２例均经超选择性海绵体动脉栓塞治疗，术后勃起功能恢复正常。结果认为超选择性海绵体动脉栓塞术是治疗动脉性阴茎异常勃起的安全有效方法。     

利用微弹簧圈选择性动脉栓塞治疗高流量阴茎异常勃起患者勃起功能观察

目的 观察利用微弹簧圈超选择性动脉栓塞治疗高流量阴茎异常勃起对患者勃起功能和性生活质量的影响.方法 会阴部外伤引起阴茎异常勃起患者8例,平均年龄(33.38±12.42)岁,发病距就诊时间2d～8年.根据病史、临床表现、阴茎海绵体血气分析和彩色多普勒超声,诊断为高流量阴茎异常勃起,均在知情同意下通过阴部内动脉造影明确破损动脉,同时利用微弹簧幽选择性动脉栓塞治疗,栓塞后阴茎恢复疲软状态,临床治愈.采用国际勃起功能评分表(IIEF-5)和性生活质量调查表(SLQQ-QOL)对患者发病前,栓塞术后6个月、18个月随访评价勃起功能和性牛活质量.结果 患者栓寨后3个月开始有规律性生活,6个月和18个月IIEF.5评分分别为(19.57±5.35)分和(19.14±5.24)分,与异常勃起发病前(19.86±4.84)分相比无统计学差异(P>0.05).患者栓塞后6个月和18个月SLQQ-QOL评分分别为(34.14±7.73)分和(32.43±8.66)分,与发病前比较无显著差异(P>0.05).结论 微弹簧圈超选择性阴茎海绵体动脉栓塞术对治疗高流量阴茎异常勃起安伞有效,术后对年轻患者勃起功能无显著影响.     

外伤后高流入性阴茎异常勃起2例报告

高流入性、动脉性阴茎异常勃起较少见 ,非缺血和无疼痛为其特点。我们收治 2例外伤后的高流入性异常勃起 ,结合文献 ,对其发病特点、机理、诊断及治疗进行讨论。例 1　 4 1岁 ,已婚。因阴茎持续勃起 2 6天于2 0 0 0年 1月入院。发病前一月会阴部有硬物撞击史 ,当时仅感会阴部轻     

高流量性阴茎异常勃起的诊治(附3例报告)

目的 探讨高流量性阴茎异常勃起的诊断和治疗方法。方法 复习3例高流量性阴茎异常勃起，2例会阴部外伤所致，1例原因不明。行体检、血气分析、阴茎彩色超声、阴部内动脉血管造影等检查，并分别行阿拉明注射、穿刺放血、阴茎头．阴茎海绵体分流、明胶海绵动脉瘘栓塞等治疗。结果 2例明确诊断为高流量性阴茎异常勃起，右侧动脉瘘栓塞后勃起完全消失，随访短期内勃起功能恢复。1例诊断模糊，行分流手术后勃起不完全消退，随访2年内发生勃起功能障碍。结论 选择性阴部内动脉造影和栓塞治疗是高流量性阴茎异常勃起有效的诊治方法。     

高流量性阴茎异常勃起

目的 探讨高流量性阴茎异常勃起的诊断及治疗方法。方法 高流量性阴茎异常勃起患者5例，年龄18～54岁。症状均为阴茎无痛性、持续性勃起。查体见阴茎呈半勃起状态，给予刺激后勃起强度增加。均行海绵体穿刺抽血，血气分析呈动脉血特征。4例经会阴彩超检查发现一侧海绵体动脉裂口及附近灶性高流速漩涡。5例行阴部内动脉血管造影均有造影剂外渗。5例均先行保守疗法，无效后行超选择性阴部内动脉栓塞治疗。结果 栓塞后5例阴茎立即呈悬垂状，1例术后12h复发，经再次栓塞后治愈，术后完全恢复疲软时间5～42d。术后2周～4个月性功能及勃起硬度恢复如初。随访11～143个月，5例均无复发。结论　海绵体穿刺血气分析、彩超、阴部内动脉血管造影检查是高流量性阴茎异常勃起有效的诊断手段，超选择性阴部内动脉栓塞具有较好的治疗效果。     

超选择阴部内动脉栓塞术治疗高血流性阴茎异常勃起

目的 分析2例外伤后高血流性阴茎异常勃起的治疗,提高高血流性阴茎异常勃起的诊断、处理能力.方法 2007年10月至2008年10月2例患者因尿道扩张及会阴部外伤后出现阴茎无痛性持续性勃起;经阴茎海绵体穿刺血气分析分析鉴别疾病类型,血常规、肝肾功能等检查排除其他致病因素,阴茎彩色超声多普勒及超选择性阴茎内动脉造影发现异常血流;采用阴茎海绵体穿刺放血、局部冰敷、持续阴茎内注射药物等保守治疗无效后行阴部内动脉栓塞术.结果 2例患者分别栓塞术后4d、2d阴茎疲软,随访6个月、12个月勃起功能正常,均无复发.结论 阴茎穿刺血气分析、彩色超声多普勒及阴部内动脉造影术是诊断高血流性阴茎异常勃起的有效诊断方法,超选择阴部内动脉栓塞术具有良好的治疗效果.     

高流量阴茎异常勃起的诊断和治疗(附5例报告)

目的 探讨高流量阴茎异常勃起的诊断和治疗.方法 总结我院自2001年至2007年收治的5例高流量阴茎异常勃起病例的病因、诊疗过程,并检索CNKI<中国期刊全文数据库>2001年-2007年文献,荟萃分析高流昔阴茎异常勃起的病因、诊断和治疗方法.结果 4例患者为会阴部外伤,1例为性交后出现.3例行高选择性阴部内动脉造影术及可吸收性明胶海绵选择性阴部内动脉栓塞术,随访8～12个月,勃起功能恢复;其余2例等待观察,随访12个月,勃起功能恢复.结论 高流量阴茎异常勃起诊断主要依据体格检查、阴茎海绵体超声、海绵体血气分析.不需急诊治疗,应依据患者要求,选择保守治疗或动脉栓塞术.     

老年自发性高流量阴茎异常勃起(附1例报告及文献复习)

目的 :探讨高流量阴茎异常勃起的病因与发病机制 ,提高对高流量阴茎异常勃起的诊断和治疗的认识。　方法 :报告 1例老年自发性高流量阴茎异常勃起病人的临床资料。　结果 :动脉血管造影提示右侧阴茎海绵体动脉破裂 ,海绵体血气分析结果正常。行明胶海绵体栓塞术 ,术后阴茎很快转入疲软状态。　结论 :老年自发性高流量阴茎异常勃起 (非缺血性 )较少见 ,保守治疗无效时需采用血气分析和动脉造影确定出血部位后行栓塞或海绵体动脉结扎术。     

高血流量阴茎异常勃起(5例报告及文献复习)

目的探讨高血流量阴茎异常勃起临床诊疗程序。方法5例阴茎异常勃起患者，经病史和体检，海绵体穿刺血气分析，彩色多普勒超声和超选择血管造影确诊为高血流量阴茎异常勃起，超选择阴部内动脉造影监视下动脉栓塞治疗，IIEF-5评分随访远期效果。结果4例有骑跨伤或会阴部钝性外伤史，血气分析结果接近动脉血。超声显示5例患者患侧海绵体动脉血流速度显著增加。超选择阴部内动脉造影4例患1者在阴部内动脉海绵体支末端形成动静脉瘘(2例左侧和2例右侧)；1例非外伤患者发现为海绵体血管瘤自发破裂。5例患者即时行明胶海绵动脉栓塞治疗，4例成功。1例失败患者改用微钢圈栓塞成功。随访结果无阴茎异常勃起复发，IIEF-5评分1例有中度勃起功能障碍。结论超选择性阴部内动脉栓塞是治疗高血流量阴茎异常勃起首选治疗方法。     

选择性动脉栓塞治疗动脉性阴茎异常勃起(5例报告)

目的:介绍选择性栓塞术治疗动脉性阴茎异常勃起的经验。方法:2011年2月至2015年5月收治了5例因会阴部创伤致阴茎异常勃起的患者,平均年龄35(25~37)岁,创伤后2~5 d发病。所有的患者都经过体格检查、血气分析、阴茎多普勒超声检查,患者术前进行IIEF-5问卷调查。患者都经过3周保守治疗失败,接受选择性动脉栓塞治疗,栓塞治疗后继续局部压迫及冰敷等保守治疗。术后6、12个月所有患者再次接受IIEF-5问卷调查。结果:所有患者创伤前勃起功能正常[(IIEF-5(24.60±0.55)分],1例患者术后立即疲软,4例患者需要3~17 d的保守治疗后治愈。没有患者再次接受动脉栓塞治疗。平均随访27.2(13~48)个月,没有患者复发。患者术后6、12个月IIEF评分正常[(24.00±1.00)、(24.20±0.82)分],与创伤前相比无统计学差异。结论:选择性动脉栓塞是治疗动脉性阴茎异常勃起的有效手段,而且不影响患者勃起功能。患者治疗后并不会立即无痛疲软,可延长术后保守治疗时间,不急于再次手术。     

阴茎异常勃起的诊断和治疗

目的 :探讨阴茎异常勃起的诊断及治疗方法。方法 :对收治的 12例阴茎异常勃起病人进行回顾性分析。结果 :12例病人经治疗后 ,9例 (75 % )勃起完全消退 ,1例 (8% )部分消退 ,2例 (17% )无效。其中 4例 (33% )并发勃起功能障碍。　结论 :阴茎海绵体穿刺抽吸血液行血气分析、彩色多普勒以及造影检查在阴茎异常勃起的诊断和鉴别诊断中有很高价值 ;选择性海绵体动脉栓塞和阴茎海绵体阴茎头分流术分别是治疗高血流性和低血流性阴茎异常勃起的可靠方法。     

Spontaneous detumescence and full restoration of erection in a patient with high‐flow priapism with persistent arterial–lacunar fistula after repeated selective embolisation—A case report

High‐flow priapism is a rare condition mainly caused by perineal trauma. Laceration of cavernosal artery results in a formation of arterial–lacunar fistula with unregulated blood flow causing prolonged erection. We present a case of a 25‐year‐old man with high‐flow priapism and concurrent erectile dysfunction treated with repeated selective embolisation with only a partial effect. When no further embolisation was possible, we assumed on conservative management even through the fistula was still present. Spontaneous detumescence occurred 9 months, and erectile function has fully restored 24 months after the injury. To the best of our knowledge, spontaneous detumescence with full restoration of erection even through the persistent arterial–lacunar fistula has not been reported previously. Therefore, we propose conservative approach after embolisation to be an option.     

Priapism - etiology, pathophysiology and management

The understanding of erectile physiology has improved the prompt diagnosis and treatment of priapism. Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation and failure to subside despite orgasm. Numerous etiologies of this condition are considered. Among others a disturbed detumescence mechanism, which may due to excess release of contractile neurotransmitters, obstruction of draining venules, malfunction of the intrinsic detumescence mechanism or prolonged relaxation of intracavernosal smooth muscle are postulated. Treatment of priapism varies from a conservative medical to a drastic surgical approach. Two main types of priapism; veno-occlusive low flow (ischemic) and arterial high flow (non-ischemic), must be distinguished to choose the correct treatment option for each type. Patient history, physical examination, penile hemodynamics and corporeal metabolic blood quality provides distinction between a static or dynamic pathology. Priapism can be treated effectively with intracavernous vasoconstrictive agents or surgical shunting. Alternative options, such as intracavernous injection of methylene blue (MB) or selective penile arterial embolization (SPEA), for the management of high and low flow priapism are described and a survey on current treatment modalities is given.     

Priapism

Priapism is a prolonged, painful, penile erection that fails to subside despite orgasm. An erection lasting longer than 4-6 h is considered to be priapic; nevertheless, pain does not usually ensue until 6-8 h have elapsed. Priapism is considered a failure of the detumescence mechanism, which may be due to excess release of contractile neurotransmitters, obstruction of draining venules, malfunction of the intrinsic detumescence mechanism, or prolonged relaxation of intracavernosal smooth muscle. There are essentially two main types of priapism: high flow (non-ischemic) and low flow (ischemic). Low flow priapism is the more common form, and it is associated with a decrease in venous outflow and vascular stasis that, in turn, cause tissue hypoxia and acidosis. This form of priapism is usually quite painful because of tissue ischemia. Penile blood aspirated from cavernous spaces appears dark in color. Immediate treatment is necessary or penile fibrosis will ensue. High flow priapism is usually due to trauma, although, on rare occasions it has been idiopathic or due to sickle cell disease. The hallmark of this type of priapism is an increase in arterial inflow in the setting of normal venous outflow. Aspirated penile blood is noted to be bright red and has a high pO(2). This form of priapism is not usually painful because it is non-ischemic. Treatment is dependent on the wishes of the patient but is not mandatory. International Journal of Impotence Research (2000) 12, Suppl 4, S133-S139.     

Management strategy for arterial priapism: therapeutic dilemmas

PURPOSE: We present 7 cases of arterial high flow priapism and propose management algorithms for the condition. MATERIALS AND METHODS: We studied 2 children and 5 adults with posttraumatic arterial priapism. Blood gas analysis and color Doppler ultrasonography of the corpora cavernosa confirmed the diagnosis in 4 adults, while 1 patient had already undergone cavernous artery ligation in elsewhere. In the children perineal compression resulted in detumescence, a sign that is proposed to be indicative of the diagnosis of arterial priapism (piesis sign) complementing physical examination. Mechanical compressive force was applied to the perineum of 1 boy, while the other received a watchful waiting program. All adults participated in an observation regimen except 1, who decided to undergo immediate embolization of the internal pudendal artery. RESULTS: Perineal compression led to the resolution of priapism in 1 child, while spontaneous resolution was noted in the other. An adult noticed spontaneous penile detumescence 3 to 4 months after trauma, which was attributable to site specific venous leakage and decreased, inflow in the contralateral cavernous artery. The patient underwent venous surgery and is on an intracavernous injection regimen. Successful embolization of the internal pudendal artery was performed immediately in 1 man and in the other 4 months after trauma due to social inconvenience. Adult patient 3 is still on the watchful waiting protocol (42 months), while the one who underwent cavernous artery ligation is receiving treatment for erectile dysfunction. CONCLUSIONS: Absent of long-term damaging effects of arterial priapism on erectile tissue combined with the possibility of spontaneous resolution or progressive concomitant hemodynamic abnormalities associated with blunt perineal trauma are suggestive of the introduction of an observation period in the management algorithm of high flow priapism. Such a period may help avoid unnecessary intervention and determine the impact of priapism on patient personal life. Perineal compression may be also added as part of the physical examination as a sign specifically indicative of arterial priapism.     

Embolization therapy in two subtypes of priapism

Two subtypes of priapism have been described based on the pathophysiologic mechanism. The more common type, termed stasis priapism, is characterized by a low flow state in which inadequate venous outflow creates an acidotic hypoxic environment leading to a painful prolonged erection. The other less common subtype, high flow priapism, is arteriogenic. We used embolization therapy in one case with long lasting stasis priapism and in the other with high flow priapism due to bilateral arteriosinusoidal fistulae in the penis. In both cases we used polyvinyl alcohol for embolization and sexual potency preservation. Priapism is the persistence of erection that does not result from sexual desire. Hauri et al. described two variants of priapism [4]. In high flow priapism (non-ischaemic) there is unregulated arterial inflow to the lacunar spaces due to a lacerated cavernous artery associated with previous perineal and penile trauma. In stasis priapism, the second type, the basis abnormality could be due to a more pronounced or prolonged blood entrapment inside the vascular spaces of the corpora cavernosa sustained by an unknown cause [2]. There are many treatment methods especially for low flow ischaemic variant [3]. We report two different kinds of priapism and embolization therapy in both of them with polyvinyl alcohol.     

阴茎异常勃起的诊断及治疗（附13例报告）

目的：探讨阴茎异常勃起的病因、诊断、分型及治疗.方法：阴茎异常勃起患者13例,年龄20～61岁,平均36岁.勃起时间16～240 h.平均128 h.根据阴茎海绵体血气分析,阴茎海绵体超声多谱勒检查,放射性核素显像,选择性阴部内动脉造影等检查对患者进行诊断和分型.根据分型及病情轻重分别给以保守治疗、选择性阴部内动脉栓塞术、阴茎海绵体灌洗术等治疗.结果：5例高流量型阴茎异常勃起患者均有外伤史,8例低流量型阴茎异常勃起病因较为复杂.所有患者经相应治疗后阴茎勃起消失.随访2～24个月,5例高流量型患者均保留良好的勃起功能,7例低流量型患者有不同程度的勃起功能减退.结论：详细的病史、阴茎海绵体血气分析、彩色多谱勒超声检查、阴部内动脉造影是区分高流量型和低流量型阴茎异常勃起的重要方法.高流量型阴茎异常勃起可采取保守治疗和选择性阴部内动脉栓塞术治疗.而阴茎海绵体灌洗术是治疗低流量型阴茎异常勃起的较好选择.