外伤后高流量性阴茎异常勃起1例

动脉性、高流量性阴茎异常勃起较少见,多发生于会阴部或阴茎钝性损伤后,以非缺血和无疼痛的阴茎持续勃起为特征。我院近期收治1例,结合文献,对其临床特点、发病机制、诊断和治疗体会进行讨论。1病例报告患者,40岁,已婚。主诉会阴部外伤后,阴茎持续勃起2周于2004年4月入院。发病     

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。     

高流量阴茎异常勃起一例报告

阴茎异常勃起是一种病理状态 ,可分为低流量 (缺血性 )和高流量 (非缺血性 )阴茎异常勃起。高流量阴茎异常勃起临床较少见。我们 2 0 0 1年 6月收治 1例 ,报告如下。患者 ,男 ,36岁。阴茎持续勃起 2 5ｄ入院。患者于 2 7ｄ前骑跨伤 ,当时会阴部疼痛 ,轻度肿胀 ,排尿正常 ,无血尿。第 3天性生活后持续性阴茎勃起 ,伴轻度疼痛。曾于外院应用间羟胺等阴茎海绵体注射治疗 ,无效。查体 :阴茎呈完全勃起状态 ,阴茎皮肤无青紫、紫斑 ,触之较硬 ,无明显触痛 ,会阴部无肿胀 ,无结节 ,排尿正常。辅助检查 :血尿常规正常 ,海绵体穿刺抽血呈鲜红色。血气…     

选择性阴部内动脉栓塞术对高流量阴茎异常勃起的治疗(附4例报告)

目的: 探讨选择性阴部内动脉栓塞术治疗高流量阴茎异常勃起 (HFP)的疗效。　方法: 对 4例外伤后阴茎异常勃起病例进行彩色多谱勒检查,其中 1例为双侧动脉 海绵体瘘,另 3例为单侧。2例 (双侧及单侧各 1例 )接受了高选择性阴部内动脉造影术及可吸收性明胶海绵选择性阴部内动脉栓塞术;另 2例接受了保守治疗。　结果: 前 2例患者术后阴茎硬度明显减低, 2个月及 1年后随访性功能基本恢复正常,性交满意;后 2例患者阴茎勃起分别持续到就诊后 19d及 21d;随访其性功能均有不同程度的减退,性交不满意。　结论: 选择性阴部内动脉造影及栓塞术是治疗HFP比较有效、安全、可选择的方法。     

老年自发性高流量阴茎异常勃起(附1例报告及文献复习)

目的 :探讨高流量阴茎异常勃起的病因与发病机制 ,提高对高流量阴茎异常勃起的诊断和治疗的认识。　方法 :报告 1例老年自发性高流量阴茎异常勃起病人的临床资料。　结果 :动脉血管造影提示右侧阴茎海绵体动脉破裂 ,海绵体血气分析结果正常。行明胶海绵体栓塞术 ,术后阴茎很快转入疲软状态。　结论 :老年自发性高流量阴茎异常勃起 (非缺血性 )较少见 ,保守治疗无效时需采用血气分析和动脉造影确定出血部位后行栓塞或海绵体动脉结扎术。     

外伤性高流量阴茎异常勃起三例报告

阴茎异常勃起分为高流量和低流量性两类.2001-2003年我们收治外伤性高流量阴茎异常勃起患者3例,现报告如下.     

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。     

高流入性、动脉性阴茎异常勃起(附二例报告)

报告２例高流入性、动脉性阴茎异常勃起病例，并较详细地阐述了其发病机理，诊断和治疗。２例均为外伤后所致及延迟性发作，经选择性阴部内动脉造影证实，海绵体动脉窦状隙瘘是诊断的主要依据。２例均经超选择性海绵体动脉栓塞治疗，术后勃起功能恢复正常。结果认为超选择性海绵体动脉栓塞术是治疗动脉性阴茎异常勃起的安全有效方法。     

Successful superselective arterial embolization for post-traumatic high-flow priapism

We report a case of high-flow priapism treated successfully with superselective embolization of the cavernous artery. An 18-year-old man presented to our hospital 12 days after having been struck in the perineum by the corner of a skateboard. Immediately after the injury, he suffered painless sustained incomplete erection. High-flow priapism was diagnosed on the basis of cavernosal blood gas analysis and color Doppler ultrasonography findings. Right internal pudendal arteriography showed blood pooling in the cavernosum as a result of a broken artery. We identified the precise position of the arterial-venous fistula and embolized it superselectively with gelatin sponge particles. The fistula disappeared completely. One year later, the patient's erectile function was completely restored, and there had been no recurrence of the priapism. According to the American Urological Association guidelines, conservative treatment should be attempted first for high-flow priapism. In our review of the literature, superselective arterial embolization could be an alternative treatment after more than 3 weeks of conservative treatment.     

Post-surgical high-flow priapism treated by embolization

Perineal and penile traumas are the commonest cause of high-flow priapism. The clinical symptom of this disease is generally a prolonged, painless, and semirigid penile erection without any other urogenital symptoms. In contrast, high-flow priapism is a quite uncommon condition after transurethral surgery and it may be presented with an unusual clinical manifestation. Herein, we report the first case of priapism associated with massive urethral hemorrhage requiring blood transfusion after internal urethrotomy. High-flow priapism was successfully treated by autologous clot embolization and the priapism associated with massive urethral hemorrhage resolved.     

Pediatric high-flow priapism and super-selective angiography--an Australian perspective

High-flow priapism is an uncommon entity in the pediatric and adolescent population. It is usually caused by perineal trauma. Here we describe the experience of our institution in this condition over the past 10 years, the various treatment options available, and the successful application of super-selective angiographic embolization as our treatment modality of choice. Included here is the case of a 4-year-old boy (case 3) who, to our knowledge, is the youngest patient described with this condition in the literature.     

Insights of priapism mechanism and rationale treatment for recurrent priapism

Priapism is defined as abnormal prolonged penile erection occurring beyond or unrelated to sexual interest. The disorder is enigmatic yet devastating because of its elusive etiology, irreversible erectile tissue damage, and resultant erectile dysfunction （ED）. Current management strategies suffer from a poor understanding of the pathophysiology, especially at the molecular level. The traditional treatments are based more on empirical rather than evidence-based knowledge. The outcomes for restoration of normal erectile function are poor, especially for stuttering priapism. Therefore, it is critical to understand priapism from a molecular level, to formulate treatment strategies and to establish rational prevention strategies for high-risk populations, such as sickle cell disease （SCD） patients and cases of the stuttering variant. This review focuses on the recent advances at the molecular level in priapism and penile erection, and applies the recent knowledge to the treatment of stuttering priapism.     

高流量性阴茎异常勃起的诊治(附3例报告)

目的 探讨高流量性阴茎异常勃起的诊断和治疗方法。方法 复习3例高流量性阴茎异常勃起，2例会阴部外伤所致，1例原因不明。行体检、血气分析、阴茎彩色超声、阴部内动脉血管造影等检查，并分别行阿拉明注射、穿刺放血、阴茎头．阴茎海绵体分流、明胶海绵动脉瘘栓塞等治疗。结果 2例明确诊断为高流量性阴茎异常勃起，右侧动脉瘘栓塞后勃起完全消失，随访短期内勃起功能恢复。1例诊断模糊，行分流手术后勃起不完全消退，随访2年内发生勃起功能障碍。结论 选择性阴部内动脉造影和栓塞治疗是高流量性阴茎异常勃起有效的诊治方法。     

9例阴茎异常勃起诊治体会

目的 探讨阴茎异常勃起的诊断和治疗方法.方法 回顾性分析9例阴茎异常勃起患者的诊治过程.结果 9例患者均通过病史、体检、海绵体抽吸血气分析及多普勒超声检查确诊.经镇静、局部冷敷、海绵体抽吸血液、海绵体内注射药物及手术等不同方法治疗后,8例缺血性阴茎异常勃起患者中5例完全消退,3例部分消退;1例非缺血性阴茎异常勃起患者部分消退.5例随访6个月,其中4例出现ED.结论 阴茎海绵体血气分析、海绵体彩色多普勒检查对阴茎异常勃起有重要诊断价值,早期及正确应用海绵体注射药物和阴茎海绵体尿道海绵体分流术加术中冲洗是治疗缺血性阴茎异常勃起的可靠方法,但是由于大多数病人持续勃起时间较长,ED的发生率偏高.     

阴茎异常勃起的诊断和治疗(附12例报告)

目的提高阴茎异常勃起的诊治水平。方法统计临床所见12例阴茎异常勃起患者，年龄20-62岁，平均44岁。持续勃起时间13-162h，平均25．4h。其中血管活性药物所致5例，膀胱癌转移至阴茎异常勃起1例，白血病1例，有外伤史者3例，不明诱因者2例。对异常勃起分型，治疗及预后进行分析。结果12例患者中9例为低流量型，3例为高流量型。随访2—26个月，9例低流量型患者中，5例经阴茎海绵体根部注射间羟胺2—6mg，必要时在阴茎头及阴茎海绵体根部置9号针头灌注肝素化生理盐水对冲治愈，其中2例发生勃起功能障碍（ED）；2例行阴茎海绵体与阴茎头血管分流术治愈，其中一例术后出现ED；因白血病引起的阴茎异常勃起1例，膀胱癌转移至阴茎1例，预后均不佳。3例高流量型患者中1例行选择性阴部内动脉栓塞后治愈，无ED；2例行保守治疗出院，均有ED发生。结论详细的病史、海绵体血气分析和彩色双功能超声等检查有助于阴茎异常勃起准确及时的诊断。阴茎异常勃起如保守治疗无效，应立刻进行手术治疗。关键词阴茎异常勃起，诊断，治疗     

New aspects in the treatment of priapism

Recent advances in the understanding of erectile physiology have improved the prompt diagnosis and treatment of priapism. During initial assessment, the physician must distinguish between veno-occlusive low flow (ischemic) and arterial high flow (nonischemic) in order to choose the correct treatment option for each type of priapism. Patient history, physical examination, penile haemodynamics and corporeal metabolic blood quality assist the distinction between static and dynamic priapism. Normally, priapism is effectively treated with intracavernous vasoconstrictive agents or surgical shunting. However, when these two methods fail, subsequent treatment procedures are a matter for debate. Alternative options, such as intracavernous injection of methylene blue or selective penile arterial embolization, for the management of high and low flow priapism are described and a survey of current treatment modalities is presented.