声视觉性刺激联合多普勒超声在重度ED患者诊断中的价值

目的 采用自身前后对照探讨声视觉性刺激联合多普勒超声在重度勃起功能障碍(ED)患者诊断中的价值。方法 自2015年6月至2016年7月,在中南大学湘雅三医院泌尿外科门诊对以ED为主诉的患者进行筛选,采用国际勃起功能评分量表-5(IIEF-5)初筛,IIEF-5评分小于8分的重度ED患者纳入研究,共筛选出139例患者。采用自身对照方式,研究对象先后接受两次阴茎彩色多普勒超声检查。第一次检查仅阴茎海绵体注射前列腺素E1(A组),7 d后的第二次检查予以声视觉性刺激(AVSS)联合阴茎海绵体注射前列腺素E1(B组)。采集注射后第5、10、20 min的收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、血流阻力指数(RI)。结果 在第一期检测中(A组),共有117例患者被检测为血管性ED,包括54例动脉性ED、40例静脉性ED、23例混合性ED。在第二期检测中(B组),共有91例患者被检测为血管性ED,包括34例动脉性ED、30例静脉性ED、27例混合性ED。B组患者加入AVSS后需要的血管活性药物注射剂量与次数明显低于A组,同时发现AVSS联合ICI可以提高非血管性ED检出率,26例患者...     

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。     

超声造影技术在静脉性勃起功能障碍诊断中的应用

目的:探讨超声造影技术用于静脉性ED诊断的有效性及安全性。方法:2015年6月至2016年3月在南京鼓楼医院泌尿男科通过阴茎海绵体造影确诊为阴茎海绵体静脉漏患者23例、无阴茎海绵体静脉漏患者20例,43例患者行阴茎海绵体活性药物注射+超声造影检查。结果:23例阴茎海绵体静脉漏患者中21例在超声造影过程中显示明显静脉漏,准确率为91.3%;其中双静脉漏型12例,单静脉漏型2例,阴茎脚静脉漏型5例,海绵体混合型静脉漏2例。2例超声造影未见静脉漏,与阴茎海绵体造影结果不相符。20例无阴茎海绵体静脉漏患者2例超声造影见静脉漏,与阴茎海绵体造影结果不相符。结论:超声造影技术诊断静脉性ED具有一定准确性;超声造影技术用于静脉性ED的诊断具有创伤小,安全性高等优点。     

宝石CT阴茎海绵体造影及三维重建在静脉性勃起功能障碍中的诊疗价值

目的探讨宝石CT阴茎海绵体造影在静脉性勃起功能障碍中的诊疗价值。方法通过阴茎彩色多普勒(CDDU)初步检查怀疑静脉性勃起功能障碍的126例患者,行CT下阴茎海绵体造影明确是否为静脉性ED,评估阴茎海绵体静脉漏的位置及范围。结果通过CT阴茎海绵体造影图像显示:105例患者均有不同程度的阴茎海绵体静脉漏,根据每个患者不同的静脉漏类型,制定个性化治疗方案,82例采取保守治疗患者,治疗前和治疗后1～6个月随访勃起硬度均有不同程度提升。23例保守治疗无效患者采取手术治疗,10例行阴茎海绵体静脉漏介入栓塞术,13例阴茎背深静脉结扎术。术后3个月随访,行阴茎海绵体静脉漏介入栓塞术10例患者,7例患者阴茎勃起充分,2例勃起硬度稍差,1例治疗无效。13例行阴茎背深静脉结扎术患者,8例勃起硬度较前有明显改善,5例勃起硬度无明显改变。结论宝石CT阴茎海绵体造影可更清楚的显示阴茎海绵体静脉漏病变区域及范围,既能为静脉性ED的诊断提供提供解剖学依据,还可以对静脉行ED治疗方式选择提供重要的帮助作用。     

益肾壮阳膏对勃起功能障碍阴茎血流动力学的影响

目的:观察益肾壮阳膏对ED患者阴茎海绵体动脉血流动力学参数的影响,探讨其作用机制。方法:选取门诊92例ED患者,随机分为观察组(n=60)和对照组(n=32),分别予益肾壮阳膏和安慰剂治疗,疗程4周,比较治疗前后IIEF-5评分、阴茎勃起硬度评分(EHS)及阴茎海绵体动脉血流动力学参数。结果:治疗后观察组IIEF-5、EHS较治疗前显著升高[(19.18±3.56)分vs(12.63±3.78)分,(3.58±0.50)分vs(3.21±0.62)分,P均0.01],且显著高于对照组治疗后评分[(19.18±3.56)分vs(13.72±2.85)分,(3.58±0.50)分vs(3.28±0.58)分,P均0.01)];但两组间及组内治疗前后阴茎海绵体动脉收缩期峰值流速、舒张末期流速、阻力指数变化均无统计学意义(P均0.05)。观察组治疗有效率为73.33%,优于对照组的21.88%(Z=-4.665,P0.01)。结论:益肾壮阳膏对ED患者有较好的改善作用,可以提高阴茎勃起硬度及改善IIEF-5评分。但阴茎血流动力学无明显改变,其作用机制需进一步研究。     

阴茎异常勃起诊治21例报告

目的探讨阴茎异常勃起的诊治方法、病理及预后。方法阴茎异常勃起患者21例，经彩色多普勒超声海绵体血流成像、血气分析及穿刺活检术确诊后采用保守治疗、分流术及阴茎切除术等。结果低流量型阴茎异常勃起19例。勃起时间≤12h者8例。病理示海绵体间质轻度水肿，保守治疗后阴茎疲软，随访勃起功能正常；勃起时间13～24h者4例，其中轻度间质水肿1例、中重度3倒，行阴茎头-阴茎海绵体分流术后症状消失，随访3例勃起功能正常,1例发生轻度勃起功能障碍（ED）；勃起时间25～48h者2例。病理镜下示海绵体平滑肌局灶性坏死及纤维样细胞,术后2侧均复发。其中1例扩大内瘘口后勃起消失，随访性功能无减退。另1例白血病引起者综合化疗后症状缓解，随访发生中度ED；勃起时间49～72h者3例。病理镜下示海绵体平滑肌广泛坏死、大量纤维样细胞及血栓形成。行大隐静脉－海绵体分流术后勃起消失。随访2例发生重度ED，1例术后2周因肺、脑梗死死亡；2例阴茎转移癌分别于术后12、18个月死亡。高流量型阴茎异常勃起2例，术后随访性功能正常。结论海绵体损伤程度与异常勃起时间紧密相关。应尽早采取治疗措施。同时治疗愿发病有助于提高疗效、改善预后。     

服用小剂量他达那非对动脉性勃起功能障碍患者临床疗效的观察

目的:观察服用小剂量磷酸二酯酶-5(PDE5)抑制剂他达那非对动脉性勃起功能障碍(ED)患者的疗效。方法:对43例动脉性ED患者采用了疗程为4周的隔日小剂量(5 mg)晚餐后口服他达那非的用药方案,在治疗前后进行IIEF-5评分同时用彩色多普勒超声联合阴茎血管活性药物前列腺素(PGE-1)注射实验,检测阴茎双侧海绵体动脉的收缩期最大流速(PSV)。结果:经统计学分析,IIEF-5评分以及阴茎双侧海绵体动脉的PSV在治疗4周后有显著提高(P<0.05)。结论:口服小剂量他达那非能有效提高动脉性ED患者阴茎海绵体动脉的收缩期最大流速,改善患者的勃起质量。     

彩色多普勒超声在血管性阴茎勃起功能障碍诊断中的应用

目的评估阴茎海绵体注射后彩色多普勒超声对男性血管性阴茎勃起功能障碍（ED）患者诊断作用。方法47例ED患者经阴茎海绵体注射PGE1 30μg诱导勃起后行彩色超声多普勒检查左、右海绵体动脉血流指标,包括收缩期最大流速（PSV）,动脉舒张末期血流速度（EDV）,阻力指数（RI）。结果非血管性ED组41例（87.2%）,其中左、右海绵体动脉PSV分别〉25 cm/s者33例,左右海绵体动脉PSV相加〉50 cm/s者8例。动脉性ED组2例（4.25%）,左右海绵体动脉PSV均〈25 cm/s,背深静脉未见血流。静脉性ED组4例（8.51%）。结论阴茎海绵体注射血管活性药物后多普勒彩色超声对男性血管性ED检查是一种微创而准确的方法。     

选择不同剂量他达拉非治疗ED的临床标准初步探索

目的:本文通过观察不同剂量他达拉非(希爱力)对于勃起功能障碍(ED)患者的治疗效果,探索他达拉非剂量与阴茎血流彩色多普勒参数之间的关系。方法:对136例ED患者在治疗前后进行IIEF-5评分同时用彩色多普勒超声联合阴茎血管活性药物前列腺素(PGE1)注射试验,检测阴茎双侧海绵体动脉的收缩期最大流速(PSV)。根据治疗前不同的PSV值,随机分为4组,采用了疗程为4周的隔日晚餐后口服不同剂量他达那非的用药方案。A组:PSV>15 cm/s,选择10 mg剂量;B组:PSV>15 cm/s,选择5 mg剂量;C组:PSV<15 cm/s,选择10 mg剂量;D组:PSV<15 cm/s,选择5 mg剂量。结果:治疗4周后,经统计学分析,4组IIEF-5评分以及阴茎双侧海绵体动脉的PSV与治疗前相比均有显著提高(P<0.01)。而且治疗4周后,A组与B组IIEF-5评分以及阴茎双侧海绵体动脉的PSV之间没有明显差异;C组却显著高于D组(P<0.01)。结论:隔日口服不同剂量的他达那非均能有效提高ED患者阴茎海绵体动脉的收缩期最大流速,改善患者的勃起质量。PSV>15 cm/s的ED患者可选择小剂量5 mg隔日;PSV<15 cm/s的ED患者尽量选择较大剂量10 mg隔日,以取得更好的疗效。     

闭合性阴茎海绵体破裂的早期急诊手术治疗

目的:探讨闭合性阴茎海绵体破裂的处理办法。方法:对9例闭合性阴茎海绵体破裂患者先经B超定位,后行急诊手术治疗。结果:9例患者术后随访6~18个月,无一例发生海绵体纤维化、阴茎畸形、痛性结节及尿道狭窄等并发症,性功能均正常。结论:B超检查可以对海绵体破裂的部位进行术前定位;早期急诊手术不仅可以降低损伤后并发症的发生,而且可以使患者阴茎功能早日恢复。     

Opacification of the glans penis during cavernosography

Cavernosography and cavernometry were performed in 150 impotent patients and 10 normal potent volunteers. Opacification of the glans penis was noted in 5 normal volunteers, while among the impotent patients it was noted in 53 per cent of those with venous leakage and in 36 per cent of those without leakage. We believe that opacification of the glans during cavernosography must be regarded as a normal variant rather than as a sign of pathological shunts between the glans and the corpora cavernosa.     

Comparative analysis of the penis corpora cavernosa in controls and patients with erectile dysfunction

OBJECTIVE: To evaluate the presence of structural disorders of the corpora cavernosa in patients with erectile dysfunction (ED), as despite new drugs being effective in many men with ED, some aspects of structural disorders of the corpora cavernosa remain unknown. MATERIALS AND METHODS: Biopsy specimens were taken from the corpora cavernosa of seven patients (mean age 57.8 years, range 51-72) with severe ED who had a penile prosthesis implanted. The controls tissues were fragments of corpora cavernosa obtained from autopsies of six men (mean age 52.3 years, range 40-66) who died from causes unrelated to the urogenital system. For light microscopy, the specimens were processed routinely to paraffin wax, and by immunohistochemistry to evaluate elastic fibres, and by Masson's trichrome to analyse collagen and smooth muscle fibres. Stereological methods were used to quantitatively evaluate the different elements (as a percentage). RESULTS: The percentages of the different elements in the human penis of controls and men with ED, respectively, were: elastic fibres 13.2% and 9.1%; collagen fibres 40.8% and 41.6%; and smooth muscle, 40.4% and 42%. CONCLUSIONS: In patients with ED there was a statistically significant reduction in the percentage of elastic fibres, but no statistically significant difference in collagen and smooth muscle fibres, and no appreciable differences in collagen distribution between the groups.     

疏肝理气活血法对肝郁气滞大鼠阴茎海绵体NOS活性影响的实验研究

目的 探求肝郁气滞男性阴茎海绵体组织中NOS活性及疏肝理气活血中药对其影响。方法 采用与人类精神性应激十分相似的非损伤性应激刺激法,制造肝郁气滞型大鼠动物模型,以免疫组化与计算机图象分析技术测定海绵体组织中NOS活性。结果 证明肝郁气滞动物模型组阴茎海绵体组织中nNOS活性与空白对照组有显著性差异(P<0.01),疏肝理气活血中药高剂量组阴茎海绵体组织中nNOS活性与模型组有显著性差异(P<0.05)。结论 肝郁气滞可导致阴茎海绵体组织中nNOS活性下降,而疏肝理气活血中药有增强阴茎海绵体组织中nNOS活性的作用。 这可能是形成心因性ED病理基础的一个重要环节。     

海绵体神经在前列腺尖部及远端的行程与分布

目的 观察海绵体神经在前列腺尖部及其远端的行程和分布,探讨海绵体神经与周围 组织的关系.方法 3具成年男性尸体尿道和阴茎标本,自前列腺尖部至阴茎头连续切片行HE染色和神经纤维嗜银染色,观察海绵体神经在前列腺尖部及其远端尿道膜部阴茎的行程与分布.结果 海绵体神经纤维束行于前列腺尖部和尿道膜部约3点到9点处,距离尿道腔约3～5 mm,向远端进入阴茎海绵体近段.自尿道膜部向前走行与海绵体静脉丛并行进入海绵体中隔.结论 海绵体神经在前列腺尖部以及阴茎近段与尿道及海绵体静脉关系密切,该部位尿道和海绵体静脉相关手术容易损伤海绵体神经.     

疏肝理气活血法对肝郁气滞大鼠阴茎海绵体PDE5活性影响的实验研究

目的 :探求肝郁气滞阴茎海绵体组织中Ⅴ型磷酸二酯酶 (PDE5 )活性及疏肝理气活血中药对其影响。　方法 :采用与人类精神性应激十分相似的非损伤性应激刺激法 ,制造肝郁气滞型SD大鼠动物模型 4 0只 ,随机法将大鼠分为 :空白组 ;肝郁证造模组 (简称模型组 ) ;萎康凝胶高剂量给药组 (高剂量组 )和低剂量给药组 (低剂量组 ) 4组 ,每组 10只。以免疫组化与计算机图像分析技术测定海绵体组织中PDE5活性。　结果 :高剂量组阴茎海绵体组织中PDE5活性与模型组差异有显著性 (P <0 .0 1)。　结论 :肝郁气滞可导致阴茎海绵体组织中PDE5活性增强 ,而疏肝理气活血中药有抑制PDE5活性的作用     

Penile fracture involving cavernous bodies and urethra

Reports on fracture of the penis are scarce in the spanish urological literature and in most cases injury appear limited to the corpora cavernosa. In this report a case of rupture of both corpora cavernosa and the urethra during sexual intercourse is presented. Early surgical treatment rendered good results. A literature review on currently recommended diagnostic and treatment practices is presented.     

The hemodynamics of erection at the level of the penis and its local deterioration

We have studied penile structure in 300 specimens from cadavers, 3,000 patients undergoing general physical examination and more than 700 patients operated on for organic impotence. Special attention has been focused on the closure mechanism of the corpora cavernosa during erection. Venous outlets of the corpora cavernosa normally are situated only on the distal third of the ventral penile surface. A firm, lasting erection requires a tight albuginea of the corpora cavernosa, with perfect closure of the venous outlets. During life use of the penis or, eventually, misuse by repeated long-lasting, firm erections (high pressure in the corpora cavernosa) results in deterioration of the tightness of the albuginea, especially when the albuginea is thin (25 per cent of the cases). We have found that a leakage factor of the corpora cavernosa is the most frequent cause of organic impotence in aging men.     

Transplantation of endothelial progenitor cells transfected with VEGF165 to restore erectile function in diabetic rats

The present study investigated the effect of transplanting endothelial progenitor cells (EPCs) transfected with the vascular endothelial growth factor gene (VEGF165) into the corpora cavernosa of rats with diabetic erectile dysfunction (ED). A rat model of diabetic ED was constructed via intraperitoneal injection of streptozotocin. After streptozotocin treatment, pre-treated EPCs from each of three groups of rats were transplanted into their corpora cavernosa. Our results, following intracavernosal pressure (ICP) monitoring, showed that ICP increased significantly among rats in the trial group when compared to the results from rats in the blank-plasmid and control groups during basal conditions and electrical stimulation (P<0.01 for both comparisons). Histological examination revealed extensive neovascularisation in the corpora cavernosa of rats in the trial group. Fluorescence microscopy indicated that many of the transplanted EPCs in the trial group survived, differentiated into endothelial cells and integrated into the sites of neovascularisation. Based on the results of this study, we conclude that transplantation of VEGF165-transfected EPCs into the corpora cavernosa of rats with diabetic ED restores erectile function.     

Longitudinal changes in erectile function after thulium:YAG prostatectomy for the treatment of benign prostatic obstruction: a 1-year follow-up study

This study aimed to evaluate the impact of thulium:yttrium-aluminum-garnet (Tm:YAG) (RevoLix®) laser prostatectomy for the treatment of benign prostatic obstructions on erectile function (EF). A total of 208 patients who underwent Tm:YAG laser prostatectomies participated in this study. All cases were evaluated preoperatively and at 3, 6, and 12 months postoperatively using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, and the International Index of Erectile Function (IIEF-5) questionnaires. Patients were divided into groups A (severe erectile dysfunction [ED]), B (moderate ED), and C (mild-to-normal ED), according to their IIEF-5 scores. The median patient ages were 69, 65, and 62 years in groups A, B, and C, respectively. Significant improvements occurred in the IPSS and QoL score within the groups during the 12-month follow-up period. The IIEF-5 scores at 3 months postoperatively were lower than the preoperative scores in groups B and C. The IIEF-5 scores subsequently improved during the 12-month follow-up period. The slope of the relationship between the IIEF-5 score and the time since Tm:YAG laser prostatectomy had a ß value of 0.2210 (95% confidence interval 0.103 to 0.338, p = 0.0003); hence, each postoperative month was associated with an increase of 0.2210 in the IIEF-5 score. The IIEF-5 scores gradually increased and reached the preoperative levels by the 12-month follow-up assessment. Although the IIEF-5 score dropped significantly during the first 3 months postoperatively, it improved over the following 12 months. Tm:YAG laser prostatectomy did not impact on EF ultimately.     

Rupture of the penis

Traumatic rupture of the penis is a rare accident. One or both corpora cavernosa may be affected. Approximately one third of the cases are associated with rupture of the urethra. In view of previous studies, and the present case reports both of which occurred during the same night, the authors propose primary surgical repair of the corpora cavernosa.