阴茎折断的诊治(附9例报告)

目的对阴茎折断病人的临床表现和治疗方法进行总结,分析手术治疗后的效果,提高该病的诊疗水平。方法1997年2月～2004年11月共诊治阴茎折断患者9例,伤后2～7h接受外科手术8例,36h手术1例。分别采用阴茎脱套式切口(7/9)和阴茎背侧正中切口(2/9)。术中阴茎海绵体白膜裂口缝合用4- 0号可吸收缝线(8/9)或0号丝线(1/9)。结果采用阴茎背侧正中切口者,寻找海绵体白膜裂口较困难,其中1例术中改为脱套式切口,7例脱套式切口均在20min内完成手术。1例用丝线缝合裂口者,性交伴有局部不适感:1例伤后36h接受手术的患者出现阴茎海绵体硬结伴痛性勃起;其余7例患者勃起功能均恢复,IIEF- 5评分为20.1分,未发现阴茎弯曲或粗大畸形。结论阴茎折断的外科手术宜采用阴茎脱套式切口,海绵体白膜裂口应选择可吸收缝线,早期手术是防治并发症的根本措施。     

阴茎白膜破裂修补术切口选择的探讨

目的:探讨阴茎折断的诊断和治疗。方法:1993年6月至2017年5月,我院共收治阴茎折断46例,平均年龄33.5岁(25~42岁),病程平均3.45 h(1~10h)。性交时发生41例,手淫4例,俯卧睡觉时发生1例。均无排尿困难及尿道口出血,4例发生了血尿,血肿局限于阴茎。45例在腰麻下行急诊手术治疗,1例局部麻醉下手术,16例采用冠状沟近侧环行切口,30例根据B超显示的破裂位置采用局部纵形纵切口。术中发现白膜破口平均1.31 cm(0.5~2.5 cm),6例采用丝线"8"字缝合白膜裂口,18例改用3-0可吸收线缝合白膜。常规放置皮片或负压引流管,留置导尿,早期使用纱布加压包扎,近年使用弹力绷带加压包扎3~5d,应用抗生素预防感染。术后1周拆线并拔除导尿管。结果:46例均行急诊手术修补,术后环形脱套切口的16例患者中,14例短期内发生了包皮水肿,而采取局部切口的患者则没有任何并发症,远期随访到的28例阴茎勃起功能均保持良好,无痛性勃起,能维持满意性交。结论:大多数阴茎折断局部纵行的小切口足以保证手术顺利完成,损伤小,不破坏血供和淋巴回流,不易发生手术并发症,相比环形脱套切口,优势明显,但如需探查尿道海绵体,应采用冠状沟下方的环形脱套式切口。     

阴茎折断8例诊治分析

目的探讨阴茎折断患者的手术治疗效果，提高其诊疗水平。方法1991年10月～2008年6月共收治阴茎折断患者8例，均在采用阴茎脱套式切口行阴茎自膜修补术，白膜裂口缝合用5-0号可吸收缝线。结果8例切口均Ⅰ期愈合，随访4个月～3年，无并发症发生。结论阴茎折断应早期手术治疗，确保良好疗效。     

阴茎折断8例报告

目的：总结阴茎折断的手术治疗策略和技巧，评价临床效果。方法：回顾2000年2月~2010年4月8例阴茎折断病例资料，均手术治疗。结果：8例均于术后第7天拆线出院。随访1～3年，无勃起不坚、勃起弯曲、勃起疼痛及皮下硬结等并发症，性交满意。结论：阴茎折断可行海绵体造影、B超可以明确破裂部位，帮助判断是否有对侧海绵体或尿道的损伤。可取局部适宜的切口，同时修补双侧阴茎海绵体及尿道海绵体。用可吸收线缝合海绵体白膜及Buck筋膜，可减少术后硬结的发生。     

阴茎折断的诊断和治疗

目的 :探讨阴茎折断的病因和临床特征 ,比较手术或保守治疗的临床效果。　方法 :4例闭合性阴茎折断病人 ,3例急诊开放手术清除血凝块 ,修补白膜裂口 ,1例保守治疗。　结果 :手术病人探查白膜裂口 1.0～ 1.5cm ,经 2～ 5年随访 ,阴茎勃起坚硬 ,无弯曲或畸形 ,性生活满意 ,保守治疗者伤后 1.5年后阴茎局部可扪及硬结 ,性功能基本正常。　结论 :阴茎折断临床特征明显 ,容易诊断 ,应用超声影像或海绵体造影则可准确定位白膜损伤部位与伤口大小 ,指导手术或作保守治疗。手术治疗效果佳 ,创伤小 ,应作首选治疗手段。     

阴茎折断诊断及手术疗效长期观察(附9例报告并文献复习)

目的:探讨阴茎折断的诊断及手术治疗的长期效果.方法:回顾1993～2006年间9例行手术治疗的阴茎折断病例,患者年龄20～40岁,平均32.5岁;术后随访6～132个月,平均53个月.另选取5例健康已婚男性作对照.通过国际勃起功能指数(IIEF-5)问卷调查,探讨手术对勃起功能的长期影响.结果:9例患者皆通过临床表现确诊.8例(88.8%)阴茎外观正常且勃起功能未受任何影响,1例(11.1%)发生阴茎轻度弯曲,所有患者皆未发生勃起功能障碍.9例患者的IIEF-5平均评分为(21.3±2.5)分,对照组IIEF-5平均评分为(22.4±2.2)分,二者比较差异无统计学意义(P>0.05).实验组阴茎的勃起硬度和勃起能力方面的IIEF评分较高(P<0.05).结论:手术疗法对阴茎折断后勃起功能的恢复疗效确切且安全可靠,在阴茎折断的治疗中值得推荐.     

阴茎背侧纵行带蒂包皮瓣在尿道下裂修复中的应用

目的:评价阴茎背侧纵行带蒂包皮瓣尿道成形术在尿道下裂修复中的应用及疗效;方法:采用改进的阴茎背侧纵形带蒂包皮瓣尿道下裂修复术治疗26例有阴茎弯曲,背侧包皮丰富的中、近段尿道下裂。结果:随访3个月～1年,26例患者手术后全部一次成功。术后排尿顺利,尿线正常,外形接近正常。一次手术成功率达100%。结论:阴茎背侧纵行带蒂包皮瓣尿道下裂修复术是有阴茎弯曲,背侧包皮丰富的中、近段尿道下裂理想的手术方式。     

M形阴囊切口及其改良式的临床应用回顾与评价

目的探讨各型M形阴囊切口的手术方法：提高阴囊、阴茎有关疾患的手术疗效。方法对阴囊阴茎等有关疾病,选用相应的各式M形阴囊切口,作手术治疗,评价术后疗效。结果手术治疗59例,采用：(1)Ⅰ型M形阴囊切口矫治完全性阴茎阴囊转位6例。(2)Ⅱ型M形切口,矫治部分性阴茎阴囊转位并尿道下裂45例。(3)Ⅲ型M形切口,矫治阴茎切除术后,尿道成形术3例。(4)Ⅳ型M形切口,矫治先天性小阴囊合并隐睾5例。全部59例,术后无重大并发症,均达到治疗目的;能改善生理功能、解剖形态及提高患者生活质量,明显提高手术疗效。结论M形阴囊系列切口,用于阴囊、阴茎等相应疾患,其设计合理,疗效确实,是可选用的新术式之一。     

阴茎折断伤的诊断和急诊治疗（附23例报告）

目的探讨阴茎折断伤的诊断和急诊处理方法。方法回顾性分析14年来收治的23例阴茎折断伤病人的临床资料。结果23例患者均有典型的临床表现,依据病史和体格检查确诊,进行急诊手术修补。单侧阴茎海绵体破裂20例,右侧阴茎海绵体破裂伴尿道海绵体被膜撕裂2例,双侧阴茎海绵体破裂伴尿道断裂1例。19例随访4月～6年,阴茎无勃起不坚、勃起弯曲、勃起疼痛及皮下结节,无纤维疤痕化,性交满意,无尿道狭窄。结论阴茎折断伤的诊断主要依据典型的病史和临床表现,辅助检查可选择使用。急诊手术治疗可减少并发症的发生。     

阴茎折断伤4例报告

例1　55岁,维吾尔族。因紧急刹车,使勃起的阴茎撞在车前板上折断,于1982年11月21日(伤后2d)入院。检查:阴茎肿胀似紫茄状,阴茎头皮下淤血向下弯曲,尿道口外露,排尿正常。在阴茎背部纵形切开清除积血,双侧阴茎海绵体0.4cm和0.6cm斜形破裂口分别给予修补。例2　35岁,汉族。?..     

New surgical approach for operative management of penile fracture and penetrating trauma.

We have seen 2 cases of penile fracture and 2 of penetrating penile trauma without urethral injury surgically managed with an incision originally described for the operative treatment of venogenic impotence. This incision afforded excellent exposure of all three corporeal bodies and facilitated operative repair. Postoperative results were excellent with return of normal erectile function, minimal edema, and a well-healed, barely visible scar. This incision represents another operative approach for the surgical management of penile fracture and penetrating trauma when urethral injury is not present.     

The management of penile fracture based on clinical and magnetic resonance imaging findings

OBJECTIVE: To present our experience with repairing penile fracture, based on clinical and magnetic resonance imaging (MRI) findings. PATIENTS AND METHODS: Between December 2002 and October 2004, 14 men (19-64 years old) presented to our centre with a penile fracture. Two patients had urethral bleeding. MRI was used before surgery in all patients, and the repair comprised a localized longitudinal penile incision in 13 men. This incision was designed according to the tunical tear site and size already depicted by MRI. One case was managed conservatively, as MRI confirmed an intercavernosal haematoma with no tunical tear. The follow-up was 4-21 months. RESULTS: The tear involved one corpus cavernosum in 11 patients; two were associated with urethral injury. The course after repair was uneventful in all men; the follow-up showed no erectile dysfunction in any. The patients reported neither pain nor penile curvature during erection. CONCLUSION: MRI is a simple and informative investigation for evaluating and documenting a penile fracture, and it improves the management plan.     

阴茎折断的临床分析

目的分析阴茎折断的临床特点和治疗经验。方法回顾性分析我院2003年10月至2016年6月收治的19例阴茎折断患者的临床资料,并复习近年相关文献。19例患者致伤原因为性交失误17例,粗暴性交2例。除1例保守治疗外,均急诊行阴茎血肿清除、白膜修补术。结果术后随访6~12个月,1例术后短期自感勃起时硬度较前有所下降,其余未发生阴茎畸形、勃起疼痛、勃起功能障碍等并发症。结论病史及查体是确诊阴茎折断的重要依据,尽早手术是阴茎折断的恰当治疗方法。     

Penile fracture in Kermanshah, Iran: report of 172 cases

PURPOSE: Experience with 172 cases of penile fracture, in Kermanshah, Iran is reviewed. MATERIALS AND METHODS: Records of penile fracture cases were reviewed from April 1990 to October 1999. RESULTS: Diagnosis was made clinically and there was no need to perform cavernosography in any case. The most common mechanism of fracture was referred to by patients as "taghaandan" (to click or snap when forcibly pushing the erect penis down to achieve detumescence). All but 2 cases were treated surgically and 2 cases had concomitant urethral injury diagnosed by selective urethrography. Repair consisted of a circumferential degloving incision to evaluate the corpora. Because of unavailability of synthetic absorbables, inverted knot nylon sutures were used successfully for repair. Delay in operation did not increase difficulty in dissection or early postoperative morbidity. Preoperative and postoperative use of antibiotics was effective in eliminating risk of infection. There were no significant intraoperative or immediate postoperative complications and most patients were discharged home on postoperative day 1. CONCLUSIONS: Patient misinformation about penile tissue properties is the main explanation for the high incidence of penile fracture. Cavernosography, and urethrography and intraoperative urethral catheterization are not routinely needed, as diagnosis can be made clinically. Preoperative and postoperative use of antibiotics, and a uniform surgical plan regardless of delay in presentation are recommended.     

No evidence of depression, anxiety, and sexual dysfunction following penile fracture

There is a gap in the literature about psychological status of patients following penile fracture surgery. We aimed to assess the long-term psychological status of penile fracture patients who have been treated by immediate surgical repair. A total of 32 patients with penile fracture have been treated surgically at our center. These 32 patients and 30 healthy control subjects were included in the study. All participants have completed the Hospital Anxiety and Depression Scale (HADS), Glombok-Rust Inventory of Satisfaction Scale (GRISS), and the premature ejaculation diagnostic tool (PEDT). The mean age of patients was 30.4 years and the mean body mass index was 27.3?kg?m(-2). Sexual intercourse was the most common cause of the fracture. Immediate surgical repair was performed in all cases using a circumferential subcoronal incision and none of the patients had urethral injury intraoperatively. All tears were unilateral with a mean size of 1.5?cm. Only two patients had superficial dorsal vein rupture. At the day of assessment, the mean time elapsed after penile trauma was 15.9±6.3 months (range: 6-23). Only three patients had complications due to penile fracture including minimal penile curvature, penile nodule, and penile pain during intercourse. The mean scores obtained from PEDT, HADS, and GRISS did not show any statistically significant difference between groups. Anxiety, depression, premature ejaculation, and sexual dyssatisfaction levels were similar in both penile fracture patients who underwent immediate surgical repair and healthy control subjects. Immediate surgical repair of corporal ruptures have not shown any harmful psychogenic sequelae on patients with penile fracture.     

Fracture of the penis: Nine cases with evaluation of reported cases in Japan

BACKGROUND: Fracture of the penis is a relatively rare condition that is defined as a rupture of the tumescent corpora cavernosa as a result of blunt trauma, most commonly during sexual intercourse or masturbation. The fracture is easy to recognize but treatment remains controversial. We, therefore, examined the treatment methods for penile fracture. METHODS: Between December 1990 and March 2001, eight patients underwent immediate surgical repair on the first or second day after fracture of the penis, and one patient underwent surgery on the 30th day after fracture, at Kansai Rosai Hospital. Patient age at presentation ranged from 15 to 55 years. Eight patients came to the hospital 2-23 h after the fracture occurred. All patients complained of penile swelling and ecchymosis. Three patients reported hearing a snapping sound. None of the patients demonstrated macroscopic hematuria. RESULTS: We treated all of the patients surgically. All patients showed a unilateral injured corporeal rupture. We took a circumferential coronal incision under the glans and repaired with absorbable stitch. At follow-up, eight of the nine patients who were available reported the achievement of an adequate erection for intercourse without erectile or voiding dysfunction. CONCLUSION: All patients were treated surgically and recovered successfully. Therefore, immediate repair is recommended for the treatment of penile fracture.     

False penile fracture: report of 16 cases

We determined the value of diagnostic and therapeutic approaches of false penile fractures and the outcome of treatment. We retrospectively reviewed 16 cases of presumed penile fracture with a negative surgical exploration. Clinical presentation, technique of treatment and outcome were noted. The mean age was 39 years (17-64). Nine patients were injured during sexual intercourse. All the patients presented with the presumptive diagnosis of penile fracture. False penile fracture was evoked in one patient presenting a new erection. Surgical penile exploration was carried out for all the patients without any radiological explorations. It revealed nonspecific dartos bleeding in 10 cases and avulsed superficial dorsal vein in six cases requiring venous ends ligation. All the patients regained penile appearance and potency. We can hardly distinguish false penile fracture from 'true' penile fracture with certainty either clinically or radiologically, thus, surgical exploration is mostly necessary. The prognosis is excellent.     

Penile vascular abnormalities observed long-term after surgical repair of penile fractures.

AIM: To assess the penile vascular system in men long-term after surgical treatment of penile fractures. PATIENTS AND METHODS: During a 15-year period, 36 cases of penile fracture underwent immediate surgical repair at the University of Istanbul, Turkey. At least 1 year after operation, all patients were invited for penile vascular evaluation. 15 patients accepted our call and were enrolled in our study. They were evaluated with detailed medical and sexual history, a serial of serum analyses, and penile color Doppler ultrasonography. RESULTS: By history, 6 of the 36 (16.6%) patients who had undergone surgical repair had erectile dysfunction (ED). The mean interval between surgical intervention for penile fracture and penile vascular evaluation was 3.6 +/- 1.9 (range 1.5-8) years. Evaluation of the penile vascular system of 15 men (mean age 35.7 +/- 17.3, range 21-63 years) revealed normal vascular system in seven (46.7%), while cavernosal insufficiency was observed in four (26.7%) and arterial insufficiency in three (20%) men. The remaining case (6.7%) was diagnosed to have mixed arterial and cavernous insufficiency. Erectile dysfunction in two cases was considered to be in psychogenic origin and vascular in the remaining four. CONCLUSION: Although immediate repair is reported to be the treatment of choice in penile fractures, ED of either a physiological or vascular origin can be encountered as a long-term sequel and deserves to be evaluated in detail.     

Penile fractures: immediate surgical approach with a midline ventral incision

OBJECTIVES

To present our experience with immediate surgical treatment of penile fractures, using a midline ventral incision, as the choice of either immediate surgical or conservative treatment in penile fractures, as well as the type of surgical incision, remains controversial.

PATIENTS AND METHODS

In a period of 5 years (2002–2006) eight patients were treated in our department for a penile fracture. The diagnosis was established by a history and clinical examination. In six patients ultrasonography before surgery located the fracture in the right corpus cavernosum, distally from the penoscrotal junction. All patients had immediate surgery using a midline ventral incision and were followed for a mean of 1 year.

RESULTS

All patients presented with a penile haematoma, while five and two had concomitant scrotal and perineal haematomas, respectively. Penile urethral rupture was associated with corporal cavernosal rupture in one patient. In all patients a 5‐cm midline ventral incision was made at the penile raphe. There was unilateral rupture of the corpus cavernosum in seven patients and bilateral rupture with concomitant urethral rupture in one. The fascial defect was sutured in all patients and an end‐to‐end anastomosis made if there was urethral rupture. The early and late periods after surgery were uneventful. Erectile function was unaffected during the follow‐up.

CONCLUSION

Immediate intervention for penile fractures, using a midline ventral incision, achieves good early and late results. Our technique has the advantage of direct access to both corpora cavernosa and the anterior urethra, with a minimal skin incision.