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。

High-flow priapism: diagnosis,treatment and long-term follow-up

Objective To investigate the diagnosis and treatment of high-flow priapism. Methods Five cases of high-flow priapism (age range,18-54 years) were included.Their symptom was described as devoid of pain or tenderness, incompletely but constantly rigid of the penis which was able to increase rigidity with sexual stimulation.Blood taken from the corpora cavernosa showed an arterial blood sample in all the cases.Perineal color Doppler ultrasound findings included the presence of patent cavernous arteries and the focal area of high flow turbulence along the cavernous arteries in 4 cases.Contrast medium extravasating from a lacerated cavernous artery into surrounding erectile tissue lacunae was found when performing internal pudendal arteriography in all the cases.Initially,conservative therapy was attempted but was unsuccessful.Therefore superselective embolization of the proximal artery supplying arterial fistula was carried out in the 5 cases. Results After embolization the penile erection disappeared immediately.In 1 case,priapism recurred 12 h after the embolization and the second embolization was successful and the interval of complete detumescence was 5 to 42 d.The sexual function and erectile rigidity were normalized in 2 weeks to 4 months after embolization.The follow-up time was from 11 to 143 months.The sexual function was completely preserved in all the 5 cases with no recurrence of priapism. Conclusions Intracavernal blood gas analysis,color Doppler ultrasound and internal pudendal arteriography were effective means for the diagnosis of priapism.The effect of superselective embolization of the internal pudendal artery was satisfactory.