以阴茎异常勃起为首发症状的白血病5例并文献复习

目的 :探讨阴茎异常勃起为首发症状的白血病的诊断和治疗原则。方法 :回顾性分析了 5例首诊入住泌尿外科 ,以阴茎异常勃起为首发症状的白血病患者的临床资料。结果 :5例阴茎异常勃起均为慢性粒细胞白血病所致 ,均伴有不同程度的脾肿大和血象异常。1例阴茎尿道海绵体分流 ,1例阴茎海绵体切开 ,3例行海绵体抽吸冲洗术。1例海绵体部分纤维化 ,勃起功能障碍 ,余 4例均取得了较好疗效。结论 :以阴茎异常勃起为首发症状的白血病误诊率高。对白血病性阴茎异常勃起应采用综合方法治疗 ,化疗是主要的治疗措施 ,阴茎持续勃起时间长者应尽早行外科处理。     

外伤后高流量性阴茎异常勃起的介入治疗

阴茎异常勃起是一种与性刺激或性欲无关的阴茎持续性勃起，勃起持续时间超过4～6h。根据病理可分为高血流量和低血流量异常勃起。低流量称为缺血性异常勃起，临床上常见，与海绵体静脉回流受阻有关。高流量性称充血性异常勃起（High flow priapism，HFP），临床少见，它是由于外伤等因素造成阴茎动脉损伤，使动脉血直接流入海绵体窦状间隙，引起阴茎海绵体内血流高灌注和低流出而形成。本文总结近年来我院和中山大学附属第一医院6例HFP患者，分析其临床特点和诊断及治疗方法，现报告如下。     

手术治疗阴茎异常勃起6例分析

目的 :探讨阴茎异常勃起的诊断和手术治疗效果。方法 :回顾性分析 6例阴茎异常勃起患者的临床资料。 6例患者分别经阴茎头阴茎海绵体分流术 ,阴茎海绵体抽吸冲洗术 ,阴茎海绵体股静脉分流术 ,阴茎海绵体大隐静脉分流术 ,阴部内动脉栓塞术 ,阴茎海绵体白膜修补术等手术治疗。结果 :除 2例行大隐静脉阴茎海绵体分流术患者外 ,其余 4例全部恢复了性功能。结论 :阴茎异常勃起早期可行阴茎海绵体抽吸冲洗后 ,局部注入阿拉明 ,如超过 2 4h后应积极手术治疗 ,如延迟治疗 ,将增加阳萎发生的风险。     

彩色多普勒超声在阴茎异常勃起诊断中的价值

目的探讨彩色多普勒超声在阴茎异常勃起诊断中的价值。方法回顾性分析经超声检查的16例阴茎异常勃起患者声像图表现。结果阴茎异常勃起分缺血性和非缺血性2种,非缺血性阴茎异常勃起多由外伤所致,患者阴茎海绵体内可见血肿或假性动脉瘤及海绵体动脉-海绵体窦状隙漏,一侧海绵体动脉血流速度明显增快,峰值流速(PSV)>40cm/s,阴茎背深静脉增宽,血流速增快,流速(V)>20cm/s;缺血性阴茎异常勃起患者阴茎海绵体回声随时间延长,内回声逐渐不均匀,海绵体动脉血流速减低,PSV<18cm/s,阴茎背静脉增宽,可有血栓形成,内无血流显示或呈星点状血流信号,V<10cm/s。结论阴茎异常勃起具有较特征性的声像图表现,彩色多普勒超声在该病的诊断中有重要价值。     

缺血性阴茎异常勃起的护理

总结17例缺血性阴茎异常勃起患者的护理。缺血性阴茎异常勃起的主要治疗方法有保守治疗、阴茎海绵体穿刺放血、阴茎头阴茎海绵体分流术。做好患者的心理护理、用药护理,加强阴茎海绵体穿刺冲洗的观察及护理,阴茎头阴茎海绵体分流术前做好患者准备、术后密切病情观察,可提高缺血性阴茎异常勃起的治愈率。     

高流量性阴茎异常勃起的彩色多普勒与实时超声造影表现

目的通过研究高流量性阴茎异常勃起的彩色多普勒与实时超声造影表现,探讨其血流动力学变化和发病机制。方法观察6例高流量阴茎异常勃起患者的海绵体、窦状隙及海绵体动脉的超声表现,寻找假性动脉瘤部位。实时超声造影检查动脉瘘口,确定血液的高流入方式,分析阴茎海绵体的血流动力学变化。结果高流量性阴茎异常勃起的表现为：阴茎海绵体肿大,回声减低;窦状隙扩张,彩色血流信号增多;海绵体动脉呈高速低阻型血流频谱;假性动脉瘤形成,内可见涡流及喷射状血流信号。实时超声造影可直观显示瘘口处的喷射状血流,以及造影微泡流入阴茎海绵体的顺序,治疗后再次行超声造影可直观显示动静脉瘘和侧支循环形成。结论彩色多普勒超声和实时超声造影可明确高流量性阴茎异常勃起的诊断。     

藻酸双酯钠致阴茎异常勃起2例报告并文献复习

【目的】探讨藻酸双酯钠（PSS）致阴茎异常勃起的治疗方法与效果。【方法】报告2例PSS致异常勃起的患者诊治过程并复习文献。【结果】1例经行阴茎海绵体冲洗3日后,症状完全改善;另1例在外院经3次阴茎海绵体冲洗及行阴茎头体分流术后症状无改善,给予再次行阴茎海绵体头体分流术＋阴茎海绵体隧道术,术后次日阴茎勃起完全消失。【结论】对PSS致阴茎异常勃起时间在6～8h内给予保守治疗,若PSS致阴茎异常勃起超过24h,应行阴茎头体分流术＋阴茎海绵体隧道术,以防止海绵体坏死纤维化,最大限度地保护患者的勃起功能。     

1例阴茎异常勃起症病人的护理

阴茎异常勃起症是一种与性刺激和性欲无关的阴茎持续性痛性勃起[1]。临床较少见,大部分原因不清,少部分与阴茎或会阴部外伤、白血病、服用抗精神病药、镰状细胞贫血、阴茎背静脉栓塞等有关[2]。2005年9月我科收治1例阴茎异常勃起症病人行阴茎头、阴茎海绵体分流术,效果满意。现报告如下。1病例简介病人,男,36岁,因阴茎无性欲持续勃起10余天入院。查体:阴茎极度勃起,表面暗红,明显触痛,呈持续性,病人感阴茎胀痛伴排尿困难。病人10年前患精神分裂症,长期服用氯丙嗪等抗精神病药物,诊断为阴茎异常勃起症。立即给予阴茎海绵体冲洗法治疗,效果不…     

2例以阴茎异常勃起为首发症状的慢性粒细胞白血病患者的护理

目的总结以阴茎异常勃起为首发症状的慢性粒细胞性白血病患者的治疗及护理。方法采用COM-TEC血细胞分离机进行白细胞分离去除术,同时联合羟基脲等药物化疗;对阴茎异常勃起长时间不能缓解者,行阴茎海绵体分流术;护理上加强心理护理。结果2例患者经过心理护理,白细胞去除术及阴茎海绵体分流术伤口的护理,阴茎异常勃起症状完全消失,疴隋稳定。结论以阴茎异常勃起为首发症状的慢性粒细胞性白血病患者的治疗选择白细胞去除术联合化疗,效果明显;对阴茎异常勃起长时间不能缓解者行阴茎海绵体分流术,可最大限度地保留患者的勃起功能,避免阴茎海绵体纤维化。     

阴茎海绵体内注射罂粟硷并发异常勃起9例报告

阴茎海绵体内注射罂粟硷并发异常勃起９例报告周惠耕３１５０１０浙江省宁波市妇女儿童医院近数年来，应用阴茎海绵体内注射罂粟硷诊断、治疗阳萎和不射精颇有效果，但也有发生阴茎异常勃起等并发症，如不及时处理可导致海绵体硬结和纤维化。总结我院自１９８６年６月～１...     

Safety and efficacy of blood exchange transfusion for priapism complicating sickle cell disease

Background : Priapism is unwanted painful penile erection that affects about 36% of boys and men with sickle cell disease (SCD) most of whom have sickle cell anemia. Clinically, priapism could be stuttering, minor, or major. The first two types are mild, last < 4 h, are usually treated at home, have good prognosis with normal sexual function. The major type of priapism lasts >4 h, associated with severe pain, requires hospitalization; often does not respond to medical treatment and may require shunt surgery. Untreated major priapism and surgical intervention often cause impotence. In this study, we report our 15‐year experience in treating adult patients with SCD and major priapism with blood exchange transfusion after being refractory to other medical therapies. Methods : Adult male African Americans patients with SCD and major priapism were enrolled in this study and followed for 15 years. A Haemonitics V‐50 machine was initially used for whole blood exchange and was later replaced with Cobe Spectra machine for RBC exchange. Results : We used 239 blood exchanges requiring 1,136 RBC units. We maintained a post‐exchange hemoglobin level of about 10 g/dL and hemoglobin S level < 30%. None of the patients had any neurological complications such as headache, seizures, neurological deficits, or obtundation post‐exchange. Conclusion : Together, the data indicate that blood exchange transfusion for the treatment of patients with SCD and major priapism is efficacious and safe. J. Clin. Apheresis 31:5–10, 2016. © 2015 Wiley Periodicals, Inc.     

异常勃起的局部注射治疗及其治愈后勃起功能的探讨(附31例报道)

目的:探讨去甲肾上腺素阴茎海绵体注射治疗异常勃起的效果及长时间异常勃起经治疗后对其勃起功能的影响。对象与方法:应用去甲肾上腺素0.5mg 海绵体注射治疗31例36次异常勃起。异常勃起发生时间为 7～120小时,平均 23.7小时,并对 27例作了随访。结果:全部治愈,近期内无明显不良后果。除 4例失访外,其余 27例作了 8个月～11年(平均 5.4年)的随访。患者短期内勃起功能与发病前无显著差别。但在6个月后,异常勃起超过36小时的11例中有9例发生勃起功能障碍(82％)和4例发生海绵体纤维化(36％)。而在36小时以内的16例中只有5例有勃起功能障碍(36.25％,x~2=4.78,P<0.05)。结论:海绵体内注射去甲肾上腺素是治疗异常勃起有效而安全的方法。超过36小时的异常勃起可能导致勃起功能障碍。其原因与海绵体的纤维化可能有一定的关系。     

Stuttering priapism--a review of the therapeutic options

Introduction: Priapism is a urological emergency which is commonly classified into low‐flow and high‐flow priapism. Immediate intervention is required for low‐flow cases as the development of ischaemia ultimately leads to long‐term erectile dysfunction. Stuttering or recurrent priapism is less well understood. This subtype is characterised by short‐lived painful erections and is commonly encountered in patients with sickle cell disease. Methods: A systematic review of the treatment options available for stuttering priapism is presented combined with our own experience in managing this condition over a period of 25 years. Results: Although numerous medical treatment options have been reported, the majority are through small trials or anecdotal reports. Conclusions: Stuttering priapism is a condition which is still not well understood and there is no standardised algorithm for the management of this condition. A multicentre randomised trial is required to evaluate the treatment options.     

Propofol-induced priapism, a case confirmed with rechallenge

OBJECTIVE: To report a case of propofol-induced priapism. CASE SUMMARY: A 17-year-old male receiving propofol for induction of anesthesia during a cardiac ablation procedure developed priapism that required medical intervention and discontinuation of propofol. The priapism developed after a total propofol dose of 550 mg, lasted for 2 hours, and resolved immediately following medical intervention. The following day, the patient underwent a transesophageal echocardiogram and received a total propofol dose of 40 mg throughout the procedure. He again developed priapism, which resolved within one hour without medical intervention. DISCUSSION: Priapism experienced by this patient is considered to be drug-induced because of the temporal relationship, recurrence with rechallenge, and dose-response relationship. Using the Naranjo probability scale, we determined that propofol was a highly probable causative agent of priapism in this patient. CONCLUSIONS: Although, as of April 4, 2006, this adverse effect has not been previously reported, there is a strong correlation of propofol to priapism in this patient. Clinicians should be aware of this adverse effect.     

PRIAPISM INDUCED BY CHLORPROMAZINE

Priapism is a pathologically prolonged and painful penile erection, usually unassociated with sexual desire or intercourse. Causes include certain oral medications, although the mechanism for drug-induced priapism is unknown. We describe two cases of priapism attributed to chlorpromazine who have presented within the past two years.     

Priapism associated with zuclopenthixol

OBJECTIVE: To present a single case of zuclopenthixol-induced priapism and a literature review. CASE SUMMARY: We report the case of a 31-year-old patient hospitalized due to behavioral alterations and treated with oral zuclopenthixol, an antipsychotic from the thioxanthene family, who developed an acute, painful erection. DISCUSSION: The occurrence of priapism in our patient was related to zuclopenthixol. This adverse reaction is reported for the first time in a patient not concomitantly treated with other drugs associated with the appearance of priapism. The capacity of zuclopenthixol to induce priapism is thought to be due to its antagonist activity on alpha-adrenergic receptors. CONCLUSIONS: Priapism is an uncommon but potentially serious adverse effect of zuclopenthixol that practitioners, as with many other antipsychotics, should be aware of.