阴茎勃起机制的实验研究

为了进一步了解阴茎勃起机制，以３１条犬为对象，对阴茎海绵体的特征进行了研究。以２～１０Ｖ，１０～３０Ｈｚ的正方波刺激盆神经（ＰＮＳ），观察阴茎海绵体内压（ＩＣＰ）、动脉血流（Ａｆ）和静脉血流（Ｖｆ）的变化，以及阻断腹主动脉后ＰＮＳ时ＩＣＰ、Ａｆ和Ｖｆ的变化。结果发现ＩＣＰ在ＰＮＳ结束后的变化趋势是阴茎海绵体的本身特征。证明了阴茎海绵体是阴茎勃起的功能主体，并首次提出，在勃起过程中可能存在着动脉抗返流机制     

会阴肌在阴茎勃起中的作用

以犬为模型对会阴肌在阴茎勃起中的作用进行研究。结果显示阴茎基础海绵体压为：１．１５±０．３５ｋＰａ，单独刺激盆神经时，会阴肌不收缩时阴茎海绵体压为１０．３６±２．３７ｋＰａ。单独刺激阴部神经时，阴茎海绵体压为：３．８±１．１４ｋＰａ。联合刺激二神经，会阴肌收缩最强时阴茎海绵体压可达４６．３３±１６．５２ｋＰａ，阴茎达到硬勃起期，可见会阴肌及阴部神经是增加阴茎勃起硬度的重要因素，盆神经是阴茎勃起的基础。     

Possible function of the frenulum of prepuce in penile erection

Fremulum of prepuce was the ruffle of foreskin while there was little about the function of fremulum. This study discusses the possible function of the frenulum of prepuce in penile erection. Twelve patients had premature ejaculation (PE) whose frenula were short. Two patients suffered unsatisfied intercourse whose frenula were damaged and departed 12 or 6 months earlier. We prolonged the short frenulum and reconstructed the ruptured frenulum. All patients reported satisfied sexual intercourse after 3-6 months. It is concluded that the frenulum is important in penile erection. PE might be treated by lengthening the frenulum.     

包皮系带异常与阴茎勃起时间的关系(附14例报告)

目的:探讨包皮系带与阴茎勃起时间的关系.方法:对12例早泄伴有包皮系带过短的患者,行系带延长术;2例系带断裂后自然愈合,房事时间延长,勃起不满意,行系带重建术.结果:术后随访3～6月,12例早泄伴系带过短者阴茎勃起时间由不足2 min延长至(10±3)min;系带断裂者自感勃起充分,勃起时间由(26±6)min缩短为(18±4)min.结论:包皮系带异常可能与勃起时间有关,系带过短可能是早泄的一个解剖学因素,可以通过系带延长增加勃起时间,治疗早泄.     

Effects of transanal pelvic plexus stimulation on penile erection: clinical implications

Objective To determine the ability of transanal pelvic plexus stimulation (TPPS) in inducing penile tumescence in patients with non-neurogenic erectile dysfunction (ED) and to compare the erection degree with papaverine-induced erection. Patients and methods The cavernous electrical activity (CEA) in 21 men with non-neurogenic erectile dysfunction was measured during TPPS by electromyography of corpus cavernosum and the erection degree of penis (flaccid, semi-rigid, rigid) was noted. The stimulation amplitude was increased from 20 to 100 mA. All patients also underwent intracavernous papaverine injection and further CEA recordings were obtained. Results Twelve and nine patients were diagnosed with vasculogenic (VED) and non-vasculogenic ED (NVED), respectively. TPSS led to a penile erectile response in 12 patients (57%), whereas papaverine injection caused erection in 16 (76.2%) patients. The mean baseline CEA (16.9 ± 9.1 mV) did not change with TPPS, but papaverine significantly decreased the mean CEA to 12.3 ± 4.9 mV (P < 0.001). CEA recordings of 16 (76.2%) patients revealed a significant decrease after papaverine injection, however seven (33.3%) patients showed significant CEA decrease in response to TPPS. Both TPPS and papaverine were observed to have a higher effect in patients with NVED in terms of inducing penile erection and decreasing CEA compared to their effects in patients with VED. Conclusion TPPS induces penile erection and decreases CEA for some extent, but to a lesser degree compared to papaverine. As further improvements are achieved in the methodology of TPPS, it may be a valuable method in the evaluation patients with erectile dysfunction.     

Effects of papaverine on human isolated bladder muscle

Summary Papaverine is a non-specific smooth muscle relaxant and is thought to act at a site beyond the receptor sites on the cell membrane. In this study the relaxing properties of papaverine were tested in isolated muscle strips from the human bladder dome. In carbachol-induced contractions papaverine, even in high concentrations of 10^-4 mol/ 1 had virtually no effects on peak tension generation, whereas the fading was accelerated and the steady state tension at 30 min. was reduced by about 54%. In contrast, high potassium-induced contractions were relaxed by papaverine in a concentration-dependent way; a concentration of papaverine of 10^-4 mol/1 produced full relaxation. These findings might possibly be explained if it is assumed that papaverine blocks calcium ion channels in the cell membrane. However, the observation that rather high concentrations of papaverine were necessary to fully relax high potassium contractions and the fact, that papaverine affects cellular cAMP levels separate this drug from more selective calcium channel blockers. The calcium movements responsible for the peak tension generation in carbachol-induced contractions are obviously not affected by papaverine. Although papaverine had little effect on carbachol-induced contractions in vitro it cannot be excluded that the drug is effective in diseases were noncholinergic mechanisms are involved.     

Effects of papaverine on tension and 45Ca-uptake in isolated urinary bladder

Summary Papaverine is believed to relax smooth muscle by reducing transmembrane calcium transport and cyclic nucleotide phosphodiesterase activity. The present study characterizes the different relaxing effects of papaverine on isolated muscle strips of rat bladder dome. Compared to histamine, norepinephrine and serotonin, carbachol and high potassium induced the most prominent contractions in rat bladder strips. For this reason both agents were used as stimulants. High-potassium-induced muscle contractions were reduced by a lower concentration of papaverine than carbachol-induced muscle concentrations. Compared to verapamil, papaverine, especially in low concentrations, was less potent on both kinds of induced muscle contractions. These tension responses correspond to a difference in ⁴⁵Ca uptake, suggesting a nonspecific blocking property of papaverine on transmembrane calcium channels. The -sympathomimetic effects of isoprenaline on carbachol-induced contractions were not enhanced by verapamil. In contrast, papaverine increased this tension response of isoprenaline on carbachol-induced contraction. From these results it is possible that part of the papaverine action seems to be related to an intracellular mechanism probably to cAMP.     

外用罂粟碱霜加速组织扩张的实验研究

目的　探讨外用罂粟碱霜对组织扩张效率及对扩张组织质量的影响。方法　以小型猪为实验动物 ,将罂粟碱霜用于组织扩张过程 ,分别与罂粟碱全身给药和囊内导入两种方式以及常规扩张进行对照 ,观察在扩张效率、组织微循环、组织结构和超微结构变化等方面的差异。结果　外用组完成扩张历时 (2 8 9± 4 5 )d ,导入组 (34 0± 2 6 )d ,肌注组 (37 6± 4 8)d ,常规扩张组 (38 5± 3 5 )d ,各组差异有显著性意义 (P <0 0 5 ) ;外用组扩张皮瓣成活长度平均为 (13 6 7± 1 2 8)cm ,导入组为 (11 0 7± 0 88)cm ,肌注组为 (10 79± 0 4 9)cm ,常规扩张组为 (9 4 9± 0 77)cm ,各组之间差异有非常显著性意义 (P <0 0 1) ;各组在扩张率、回缩率、皮肤各层厚度等方面差异无显著性意义 (P >0 0 5 ) ;电镜显示外用组包膜中的肌成纤维细胞功能不活跃 ,常规扩张组肌成纤维细胞功能活跃 ,其它组介于两者之间 ;外用组扩张包膜内罂粟碱的浓度为 (3 5± 1 2 ) μg g ,其它各组包膜内及各组血液中均未检测到罂粟碱。结论　外用罂粟碱霜剂能够在组织内达到有效的药物浓度 ,抑制扩张包膜中肌成纤维细胞的功能 ,从而增加平均注水量 ,缩短扩张时间 ,提高扩张效率 ,增加扩张皮瓣的成活长度。其作用连续而持久 ,不增加创伤     

Effect of castration on penile erection in the dog

The reduction in sexual activity in hypogonadal men is at least partially due to a decrease in sexual interest, but it may also involve peripheral mechanisms. In the present experiments, the effects of castration on penile erection in dogs was investigated. The pressure within the corpus cavernosum was measured in intact anaesthetized dogs and in dogs castrated 2 weeks or more than 6 months previously. It was found that there was no significant difference between intact and castrated dogs in the magnitude or time course of increase in corpus cavernosal pressure induced by pelvic nerve stimulation or in the inhibitory effects of simultaneous stimulation of the sympathetic chain. Furthermore, the mean ED₅₀ value for contraction to phenylephrine of isolated strips of erectile tissue from the corpus cavernosum was not significantly different between groups. This suggests that the mechanism of penile erection is not affected by reducing the levels of testosterone.     

外用罂粟碱抑制植皮片术后挛缩的实验研究

目的探讨外用罂粟碱霜对自体游离植皮片术后晚期挛缩的影响。方法在每头小型猪背部两侧皮肤制备10个2cm×2cm创面,从动物腹部正中取2cm×2cm的断层皮片并植于背部创面上,术后2周拆线,取同一动物身上100%成活且位置恰好左右侧相对的植皮片共12对,按左右侧分成A(罂粟碱治疗组)、B(空白霜剂对照组)2组,自拆线之日起,A组每日在植皮片表面外涂2%罂粟碱霜2次,B组仅涂抹空白对照霜剂,最后观察两组植皮片成活后1、2、3、4、5、6个月收缩率及植皮片成活后6个月时的组织学差异。结果A组植皮片收缩率较B组明显降低,两组之间差异有显著性意义(P<005)。组织切片显示A组植皮片成纤维细胞较B组明显减少,微血管数量较B组数量多,两组之间差异有显著性意义(P<005)。结论外用罂粟碱霜剂能够抑制自体游离植皮片术后挛缩,提高植皮效率。     

扩张器囊壁对罂粟碱渗透性的体外实验研究

目的研究抗收缩剂罂粟碱能否通过扩张器的囊壁有效渗出对周围组织发挥药理作用。方法通过在体外测定注入到扩张器内的罂粟碱的渗出率实验。结果在常量扩张（１００％）和超量扩张（２００％）状态下平均每天的渗出量分别为２．１％和２．９％。结论扩张器的硅胶囊壁不能使罂粟碱有效渗出。     

血管活性药物诱发阴茎持续勃起的原因分析及治疗体会

对５３例婴粟碱及酚妥拉明阴茎海绵体内注射诱发的阴茎持续勃起进行了分析，认为其发生原因与药物剂量、阳萎类型、注射后性交频度、年龄、病程及勃起障碍的程度等有关。体会该类持续勃起均可通过非手术治疗，特别是阿拉明的局部应用来消除；就诊越早，治疗越简单；根据持续勃起的时间不同，可分别采取单用阿拉明，或阴茎海绵体内抽血、冲洗加阿拉明注射；阿拉明最大剂量勿超过１０ｍｇ，１次勿超过５ｍｇ，注意防治其副作用。     

Effect of local alpha-adrenergic blockade on human penile erection

Recent data suggest that selective local blockade of the alpha-adrenergic receptors of the sympathetic innervation within the corpora cavernosa of the penis will result in erection in normal and impotent subjects. To examine this hypothesis we studied in a randomized, double-blinded fashion 8 impotent patients and 2 normal controls. The organic nature of the impotence was documented with nocturnal penile tumescence testing, sacral latency examination, Doppler penile blood flow measurements, hormonal evaluation and psychological testing. The 2 normal controls had full erections for 5 to 7 minutes after the intracorporeal injection of 5 mg. phentolamine. All of the impotent subjects had tumescence without full erection after a similar injection. The tumescence was augmented by standing upright and diminished by assuming a supine posture, and lasted for several hours. Possible mechanisms, and diagnostic and therapeutic implications are discussed.     

Synchronous penile urethra onlay patch and scrotal reconstruction after Fournier's gangrene using medial thigh flaps

Massive penoscrotal skin loss, frequently a sequela of Fournier's gangrene, can sometimes be successfully treated using skin grafts alone. If the urological debridement has been extensive with a concomitant disruption of the urethra, a regional vascularized flap must be introduced. A superiorly based fasciocutaneous flap can be constructed on the medial thigh to provide scrotal reconstruction. The underlying gracilis muscle is an ideal onlay patch for ventral penile defects. Simultaneous use of independent, multiple flaps from a single medial thigh donor site allows coverage of separate penile and scrotal deformities, and leaves only a linear scar.     

Effect of sildenafil citrate on penile erection of rhesus macaques

Aim: To examine the effect of sildenafil citrate on penile erection of male rhesus macaque. Methods:Twenty Macaca mulatta were divided into the sildenafil treated and the control groups of l0 animals each. The penile size, the corpus cavernosal electromyogram (EMG) and the intra-corpus cavernosal pressure (ICP) were determined. Results: The diameter of penis and the ICP were significantly increased and the corpus cavernosal EMG significantly reduced in the sildenafil group. Conclusion: Sildenafil citrate increases the penile size and ICP and reduces the corpus cavernosal EMG in male rhesus macaque. (Asian J Androl 2004 Sep; 6: 233-235)     

Neurophysiology of penile erection

Summary In 6 dogs and 6 monkeys electrical stimulation of the cavernous, pudendal and hypogastric nerve was performed to gain better understanding of the erectile neurophysiology. Arterial flow, intracorporeal pressure and venous restriction studies during single and combined neurostimulation demonstrated that initiation and maintenance of erection is a parasympathetic phenomenon. Penile rigidity however, could only be achieved with additional pudendal nerve stimulation resulting in muscular compression of the blood distended cavernous bodies. Detumescence or subsidence of erection is primarily under sympathetic control, due to inhibition of sinusoidal smooth muscle relaxation. On the basis of our observations we conclude that penile erection is dependent upon three neurophysiological mechanisms: 1. the parasympathetic vascular mechanism, the somatomotor muscular mechanism and the sympathetic inhibitory mechanism.Part of this paper was presented at the 9th Symposium of the Association for Experimental Urology of the German Urological society, June 17–18, 1988, Aachen, Federal Republic of Germany     

麻醉对泌尿外科术中阴茎勃起的影响

背景 术中阴茎勃起是泌尿外科手术中发生率较低的一种并发症,一旦发生可使手术操作困难.虽然至今对于术中阴茎勃起的机制仍然不完全清楚,但是已有的研究表明麻醉方法和麻醉药可影响术中阴茎勃起的发生和发展. 目的 旨在增加临床医生关于麻醉对术中阴茎勃起影响的认识. 内容 系统阐述了术中阴茎勃起的机制,麻醉方法和麻醉药对术中阴茎勃起的可能影响. 趋向 使用恰当的麻醉方法和麻醉药可有效阻止术中阴茎勃起的发生和发展.     

罂粟碱作用下扩张器周围纤维包膜超微结构的变化

为了探讨罂粟碱通过带导药系统的双囊扩张器加速组织扩张的机理，作者采用透射电镜观察在罂粟碱作用下纤维包膜中的成肌纤维细胞（ＭＦ）的变化。结果表明：ＭＦ的核膜变得平滑，皱褶减少。胞浆中微丝减少，细胞间的桥粒和缝管连接减少，成肌纤维细胞固定线，（ＭＡＳ）减少。另有部分成肌纤维细胞表现为退行性变的征象，胞浆中的线粒体减少，部分发生肿胀变性，基粒脱落，嵴间隙和周边间隙扩张，腔内有空泡。部分线粒体呈萎缩征，膜增厚皱缩呈波浪状，嵴变短甚至消失，粗面内织网减少，网膜上的多核蛋白体脱落散离，高尔基复合体减少，部分萎缩。说明罂粟碱是通过降低细胞活性和破坏部分细胞的结构抑制扩张器周围纤维包膜的挛缩。     

尿道延伸术治疗小儿单纯性阴茎下弯

目的:探讨尿道延伸术治疗小儿单纯性阴茎下弯的疗效.方法:总结1999年1月～2004年10月采用尿道延伸术治疗18例单纯性阴茎下弯患儿的临床资料,通过随访观察其疗效.结果:全部患儿排尿通畅,顺利出院.随访3年,1例发生尿道外口狭窄,经1个月尿道扩张后排尿通畅;1例患儿阴茎勃起时仍有阴茎下弯,下曲角度＜15°,行阴茎海绵体背侧折叠横缝矫正.结论:尿道延伸术是一种治疗小儿单纯性阴茎下弯的理想手术方式,手术方法简单,成功率高.     

Topical application of a Rho-kinase inhibitor in rats causes penile erection

Studies from this laboratory have demonstrated that RhoA/Rho-kinase signaling mediates vasoconstriction in the penile circulation of the rat and that erection results from inhibition of this activity with Y-27632. In prior animal studies, Y-27632 was administered to the rats by intracavernous injection. To determine if topical application of the Rho-kinase inhibitor is an effective mode of delivery, Y-27632 was applied to the surface of the tunica albuginea or to the glans penis and surrounding skin in intact or castrated rats. Both sites of drug administration resulted in a marked increase in the erectile response both with and without stimulation of the autonomic innervation of the penile vasculature. Although high doses of the drug were found to reduce systemic blood pressure, topical administration of the Rho-kinase inhibitor, in appropriate doses, may have clinical value for the treatment erectile dysfunction.