增龄大鼠阴茎组织中一氧化碳含量与细胞凋亡的相关性研究

目的:通过研究不同月龄大鼠阴茎组织内细胞凋亡及CO含量变化,进一步探讨勃起功能障碍发生机制。方法:雄性Wistar大鼠24只分为3组(每组8只),成年组(8月龄)、老年组(16月龄)和衰老组(24月龄)。取阴茎组织用苏木精-伊红(HE)染色,原位末端转移酶标记法(TUNEL)检测细胞凋亡,改良双波长法检测CO含量。结果:增龄大鼠阴茎组织中细胞凋亡显著增多(成年组:4.38±1.06,老年组:9.38±1.69,衰老组:18.50±1.60),CO含量减少[成年组:(12.19±0.87)nmol/μg,老年组:(7.93±0.63)nmol/μg,衰老组:(5.68±0.62)nmol/μg],组间差异均有显著性(P<0.05)。CO含量与细胞凋亡的变化呈现良好的负相关性(r=-0.889,P<0.01)。结论:增龄大鼠阴茎组织中细胞凋亡与CO含量呈负相关,CO可能通过调控细胞凋亡机制从而参与了雄性性功能障碍的发生。     

Ex vivo relaxation effect of Cuscuta chinensis extract on rabbit corpus cavernosum

The effect of Cuscuta chinensis extract on the rabbit penile corpus cavernosum (PCC) was evaluated in the present study. Penises obtained from healthy male New Zealand white rabbits (2.5–3.0 kg) were precontracted with phenylephrine (Phe, 10 µmol l⁻¹) and then treated with various concentrations of Cuscuta chinensis extract (1, 2, 3, 4 and 5 mg ml⁻¹). The change in penile tension was recorded, and cyclic nucleotides in the PCC were measured by radioimmunoassay (RIA). The interaction between Cuscuta chinensis and sildenafil was also evaluated. The result indicated that the PCC relaxation induced by Cuscuta chinensis extract was concentration-dependent. Pre-treatment with an nitric oxide synthase (NOS) inhibitor (Nω nitro-L-arginine-methyl ester, L-NAME), a guanylyl cyclase inhibitor (1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, ODQ), or a protein kinase A inhibitor (KT 5720) did not completely inhibit the relaxation. Incubation of penile cavernous tissue with the Cuscuta chinensis extract significantly increased cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP) in the PCC. Moreover, the Cuscuta chinensis extract significantly enhanced sildenafil-induced PCC relaxation. In conclusion, the Cuscuta chinensis extract exerts a relaxing effect on penile cavernous tissue in part by activating the NO-cGMP pathway, and it may improve erectile dysfunction (ED), which does not completely respond to sildenafil citrate.     

超声检查在阴茎折断诊断中的应用

目的 分析阴茎折断的声像图特征,探讨超声对其诊断价值.方法 分析12例阴茎折断的二维声像图和血流信号特点,其中3例陈旧性阴茎折断患者经阴茎根部注入酚妥拉明,观察阴茎海绵体动脉血流频谱的特征.结果 所有患者患侧阴茎海绵体白膜连续性中断.急性阴茎折断患者的中断部位为不均质低回声或混合回声,该处白膜外可见混合团状回声,内无血流信号;阴茎浅筋膜层软组织肿胀;陈旧性阴茎折断患者中断部位呈强回声伴回声衰减,内无血流信号,注药后见阴茎向患侧弯曲.结论 超声能显示中断部位、血肿大小及血流情况等,可为临床治疗提供依据.     

MRI评价胎儿胼胝体缺如及其合并畸形

目的 利用MRI评价胎儿胼胝体缺如及其合并畸形。方法 对81胎MRI诊断胼胝体缺如胎儿，分析胼胝体缺如类型，观察其合并颅脑畸形类型及数目。结果 81胎中，单纯胼胝体缺如47胎、合并畸形34胎；合并蛛网膜囊肿12胎，Dandy-Walker畸形7胎，小脑发育不良5胎，神经元移行异常5胎，大枕大池4胎，室管膜下囊肿4胎，脑实质出血2胎，脑裂畸形、脑穿通畸形及脑膜膨出各1胎。结论 MRI可显示胼胝体缺如胎儿及其合并其他颅脑畸形，为评估胎儿预后提供更多信息。     

血红素氧合酶在糖尿病大鼠阴茎海绵体的表达

目的 检测血红素氧合酶1和2( HO-1/HO-2)在糖尿病(DM)大鼠阴茎海绵体(CC)的表达变化,探讨其在糖尿病相关勃起功能中的作用.方法 SD雄性大鼠50只,随机取30只制作糖尿病模型,余20只为正常对照.4周和8周后用阿扑吗啡试验评价大鼠勃起功能;免疫组织化学法及Western blot法检测HO-1、HO-2在大鼠CC内的表达部位及水平.结果 DM大鼠勃起次数在4周(2.17±0.94)和8周(0.85±1.07)时与对照组[4.0±1.15(4周);4.2±1.32(8周)]比均下降(P＜0.01),HO-1在4周(32.87±3.22)和8周(20.65±2.34)时的表达高于相应对照组[13.52±3.25(4周);12.35±2.29(8周)],P＜0.01,但8周较4周表达降低(P＜0.01),HO-2在4周(14.32±1.21)和8周(8.82±2.35)时的表达均低于相应对照组[20.91±2.07(4周);21.02±2.10(8周)],P＜0.01,且随时间逐渐加重(P＜0.01);对照组间差异无统计学意义(P＞0.05).结论 糖尿病造成大鼠勃起功能下降,可能与HO在DM大鼠CC内的表达降低密切相关.     

应用阴囊皮瓣矫治小儿隐匿阴茎

目的 探讨利用阴囊皮瓣矫治小儿隐匿阴茎的疗效.方法 于阴茎腹侧纵行切开狭窄环,距冠状沟约0.5 cm环状切开包皮内板,将包皮脱套至阴茎根部.完全切除异常附着筋膜,裁剪包皮包绕冠状沟.于阴茎阴囊交界处向阴囊两侧切开,将两侧阴囊皮瓣上移覆盖阴茎根部.缝合包皮,重建阴茎阴囊角,阴囊成形.结果 2009年3月至2011年7月采用阴囊皮瓣矫治隐匿阴茎患儿24例,术后尿道外口粘连2例,经尿道扩张后排尿正常;包皮远端轻度坏死1例,经门诊换药2周后好转,余21例手术效果良好.随访6个月至2年,所有患儿均未发现阴茎回缩,阴茎外观塑形良好,勃起时无侧弯、旋转.结论 应用阴囊皮瓣矫治小儿隐匿阴茎可最大程度地显露阴茎,塑形效果良好,并发症较少,是一种较为理想的手术方法.     

半脱套松解法治疗隐匿阴茎疗效探讨

目的:探讨一种改良简化隐匿阴茎术式,既有较好手术效果,又减少减轻各种术后并发症。方法:58例隐匿阴茎患者,平均年龄6.8(3～15)岁。术式包括矫正狭窄包皮口使阴茎头完全显露、半脱套法翻转包皮并矫形、沿白膜表面切除发育不良条索带达阴茎悬韧带前端、使阴茎体释放但不作白膜固定。结果:所有患者均一次性手术成功,手术时间平均33(15～45)min,术后阴茎体外长度从术前平均1.4(0.5～2.8)cm增至3.9(3.2～8.5)cm。所有患者术后随访1～3年,包括阴茎外观、长度和自我感觉等,均效果满意。该术式简便、并发症少且术后恢复快。手术不影响阴茎根部深处神经血管和阴茎悬韧带等,不损伤阴茎本身结构及功能。结论:该术式简单有效,术后效果较好,尤其适合过度担忧手术并发症、将来性功能和生育问题的部分患者。     

2型糖尿病大鼠血浆同型半胱氨酸与阴茎海绵体内NOS和内源性CO的相关性研究

目的:研究2型糖尿病性大鼠血浆同型半胱氨酸(Hcy)与阴茎海绵体内NOS和内源性CO的相关性。方法:选取3月龄雄性Wistar大鼠50只,随机选取10只为对照组(A组);高糖高脂饲料饲养4周后从其他40只大鼠中筛选出30只构建成功的糖尿病(DM)大鼠模型,随机分成3组:DM大鼠组(B组);胰岛素治疗组(C组)和叶酸+维生素B12治疗组(D组)。8周及12周后注射阿朴吗啡观察各组大鼠阴茎勃起情况。12周后测各组大鼠血浆总Hcy含量及阴茎海绵体内NOS活性和CO含量。结果:与A组比较,B组大鼠血浆Hcy浓度明显升高,阴茎勃起功能明显降低,阴茎海绵体NOS活性和CO含量均下降,差异有显著性(P<0.01)。2型DM大鼠中高Hcy血症发生率为55%。与B组比较,C组和D组中大鼠血浆Hcy浓度显著下降,阴茎勃起功能、阴茎海绵体NOS活性均升高(P<0.01),Hcy与NOS(rA=-0.89,rB=-0.76,rC=-0.91,rD=-0.91)及CO含量(rA=-0.82,rB=-0.77,rC=-0.93,rD=-0.81)均呈负相关。结论:2型DM大鼠血浆中的高Hcy可能是引起阴茎海绵体NOS活性下降、CO含量下降,进而导致DM ED发病的分子机制之一。胰岛素、叶酸和维生素B12可以改善DM大鼠的勃起功能,提高阴茎海绵体NOS活性和CO含量。     

Pedicled skin flap of foreskin for phalloplasty in the management of completely concealed penis

Objective

To evaluate the effect of pedicled skin flap of foreskin for phalloplasty in the management of completely concealed penis.

Methods

We retrospectively reviewed 97 consecutive patients with completely concealed penis, which had been surgically corrected between November 2004 and January 2012. All patients were repaired using 2 surgical methods: 18 with Shiraki's operation and 79 with a technique of pedicled foreskin skin flap.

Results

With 1 month to 7 years (mean 18 months) follow-up, the 18 cases treated by Shiraki's operation had satisfactory exposed penile shaft but too much incision and obvious edema. The 79 cases treated by pedicled foreskin skin flap uniformly reported satisfaction with the operative results. They found the surgical repair was successful in appearance and improved hygiene, accessibility, and penile exposure. There was no recurrence to the pre-treatment condition, or any chordee, penile distortion, trapped penis, erectile abnormalities, or voiding complications in any case. The pedicled skin flap was without ischemia or necrosis and yielded no post-operative wound infections, wound separation, or unsightly scarring. Slight edema and swelling of the flap were common, but these issues completely resolved by 3 weeks.

Conclusion

Numerous operative procedures have been described and adopted for the management of completely concealed penis, but the pedicled skin flap phalloplasty can achieve maximum utilization of prepuce to assure coverage of the exposed penile shaft. It has fewer complications, achieving marked aesthetics and often functional improvement. This suggests pedicled foreskin skin flap for phalloplasty is a relatively ideal means for treating completely concealed penis.