尿道外伤患者勃起功能障碍相关因素的临床研究

目的研究尿道外伤患者勃起功能障碍相关因素。方法对40例外伤所致尿道损伤患者采用IIEF-5量表、夜间阴茎勃起监测、血管活性药物注射下阴茎血流彩超检查并进行统计学分析。结果40例中,11例存在明显勃起障碍,3例有血管病变依据。所有患者受伤前后IIEF-5评分有显著性差异(P<0．05);耻骨联合有分离病人较不分离者在IIEF-5评分变化上幅度更大(P<0．05);两组患者在背深动脉收缩期流速上显示出统计学差异(P<0．05)。后尿道损伤患者在阴茎勃起长度变化、周径变化以及勃起持续时间上较前尿道损伤患者明显变小,且ED概率更高。背深静脉流速>5 cm／s患者的比率在两组人群中有显著性差异(P<0．05)。而静脉流速>5cm／s人群主要集中在30-40岁。结论尿道外伤患者发生勃起功能障碍与损伤部位尤其是耻骨联合分离与否、前后尿道损伤位置、神经受损受伤年龄相关,与心理因素也有一定关系。     

骨盆骨折所致后尿道损伤患者勃起功能障碍的治疗进展

随着城市建设进程的不断加快,因交通事故或者外伤引起的骨盆骨折尿道损伤所导致的后尿道狭窄或闭锁的患者数量逐年递增。受伤的患者中绝大多数为中青年男性,他们面临的最主要的问题是尿道梗阻,而其次就是阴茎勃起功能障碍(ED)。尿道狭窄患者常存在器质性改变,外伤本身或者尿道修复重建手术损伤支配勃起相应的血管及神经,进而出现ED。目前尿道外伤后男性器质性ED的治疗随着技术的发展也不断在进步,本文就其治疗研究进展进行综述。     

直视下尿道内切开术后的勃起障碍

作者对104名20～90岁因尿道狭窄作直视下尿道内切开术的病人,通过问卷对切开术前后性能力作回顾性研究,11名(10.6％)在术后有部分或全部勃起障碍,其中大多数为远侧长段狭窄。8名进行阳萎系列诊断包括详细病史、体检、阴茎多普勒测定及罂粟硷试验,结果3名在阴茎海绵体与尿道海绵体之间可能有异常交通,其中2名作了海绵体造影,1名见阴茎海绵体完全不透光,但不能示出漏的正确部位,因而难以手术。作者认为尿道内切开才后发生阳萎的原因可能是:1.在近端尿道球部水平海绵体神经位于尿道海绵体的1及11点处,勃起     

人工促勃起状态下对后尿道血管瘤诊治的临床观察

目的初步探讨人工促勃起状态下,经尿道内窥镜在后尿道血管瘤的诊治过程中的实用性及安全性。方法回顾性分析东南大学医学院附属江阴医院泌尿外科2015年1月至2018年9月收治的6例后尿道血管瘤患者的诊治过程。所有患者均以勃起或者性生活过程中无痛性肉眼血尿为第一主诉。患者术前均行泌尿系MRI或者CT扫描等检查,以排除泌尿系肿瘤或者结核。患者全身麻醉后以罂粟碱局部注射阴茎海绵体后制造人工促勃起状态,通过内窥镜对所有患者的后尿道进行手术诊治。术后对所有患者进行密切随访,以观察患者的远期疗效及手术并发症。结果全身麻醉后人工促勃起状态下,所有患者在内窥镜下均证实为后尿道血管瘤,患者行经尿道血管瘤电切术,术后留置尿管1周。患者术后2个月开始行性生活。平均随访12.7(10～18)个月,随访过程中未见血管瘤复发及尿道狭窄等远期并发症。结论后尿道血管瘤是一种较为少见的临床疾病,常规检查方法对其诊治具有一定的局限性,人工促勃起状态下通过内窥镜操作可有效提高其临床诊治效果。     

西地那非对骨盆骨折尿道断裂后ED的治疗作用

勃起功能障碍(ED)是骨盆骨折尿道断裂(PFUD)的一个常见后遗症。在修补尿道损伤后,ED可能是最困扰患者的一个远期问题。Shenfeld,OZ等人前瞻性的研究了由于骨盆骨折导致ED患者的勃起功能和对西地     

西地那非对骨盆骨折尿道断裂患者勃起功能障碍的治疗作用

勃起功能障碍(ED)是骨盆骨折尿道断裂(PFUD)的常见后果。修复尿道损伤后，ED可能对患者起最大的长期破坏性影响。一些患者可能恢复正常的勃起功能。作者对PFUD造成的ED患者进行了西地那非疗效和勃起功能的前瞻性研究。对因PFuD需进行尿道成形手术的患者在术前前瞻性地评价勃起功能，进行夜间阴茎胀大试验，如结果异常，则进行海绵体内注射药物的阴茎双相超声和动脉造影以诊断ED的病因。手术后每3个月随访患者勃起功能情况，     

骨盆骨折后勃起功能障碍的发生率和病因

骨盆骨折的最常见的后果是勃起功能障碍,尤其是后尿道损伤的患者,他们常常是神经源性和动脉源性。为了客观了解骨盆骨折导致尿道损伤后勃起功能障碍的发生率和发生的原因,作者对骨盆骨折后致后尿道损伤的患者进行了勃起功能的研究,所有的患者均行夜间勃起检测,如果夜间勃起异常就进行彩色双功能多普勒超声检测,经过超声检测正常的患者就认为是神经异常,超声显示动脉功能     

输尿管镜尿道置管治疗尿道损伤及狭窄

采用输尿管镜尿道置管方法 ,治疗尿道球部撕裂、前列腺切除术后尿道内口狭窄、外伤后尿道狭窄以及医源性尿道损伤 ,方法简单 ,效果满意 ,现报告如下。1　临床资料本组 2 1例均为男性 ,年龄 2 1～ 74岁。外伤性尿道球部撕裂伤 4例 ,前列腺切除术后尿道内口狭窄7例 ,外伤后尿道狭窄 2例 ,医源性尿道损伤 8例(其中导尿损伤 4例 ,膀胱镜检及尿道扩张损伤各 2例 )。2　方法与结果在腰麻或骶管麻醉下 ,取截石位。F14 号输尿管镜 (硬镜 )自尿道口直视下插至损伤或梗阻部位 ,沿正常粘膜 (梗阻时为细小通道 )插入 F4～ 5号输尿管导管 ,有尿液滴出 ,…     

骨盆骨折尿道损伤后狭窄患者阴茎勃起功能障碍相关性因素的临床研究

目的 研究男性骨盆骨折尿道损伤导致的尿道狭窄与阴茎勃起功能障碍(ED)的相关因素.方法对41例骨盆骨折尿道损伤导致尿道狭窄患者进行IIEF-5量表调查,所有患者接受血管活性药物注射下阴茎血流彩超(PPUD)等检测,并进行统计学分析.结果 所有41例患者在受伤后均发生了ED,所有患者受伤前后的IIEF-5评分差异有统计学意义,P＜0.001.不同年龄段患者受伤前后IIEF-5评分比较,P≤0.001;而不同年龄段患者受伤后IIEF-5评分组间比较,P＞0.05.不同部位损伤患者受伤前后IIEF-5评分比较,P＜ 0.001;而不同部位损伤患者受伤后的IIEF-5评分组间比较,P＞0.05.尿道狭窄段长度不同的患者组间比较,差异具有统计学意义;狭窄段较长的患者比狭窄段较短的患者,发生ED概率更高.根据患者PPUD检查结果,约一半患者的ED属于动脉性,部分患者属于静脉性,其他的可能原因为神经性,心理性,混合性或者原因不明.结论 骨盆骨折尿道损伤导致尿道狭窄可使患者勃起功能明显受损,其勃起功能与尿道狭窄长度密切相关,与年龄,尿道狭窄部位等相关性不强.     

膀胱镜下尿道会师术治疗尿道损伤的临床分析

目的探讨膀胱镜下尿道会师术治疗尿道损伤的临床疗效。方法回顾性分析自2006年以来行膀胱镜下尿道会师术的12例尿道损伤患者的临床资料。结果 9例前尿道断裂行膀胱镜下尿道会师术成功,3例后尿道断裂会师失败后改开放手术治疗,术后均留置导尿管2～6周。随访6～30个月,均出现尿道狭窄,经尿道扩张后治愈。3例出现勃起功能障碍,其中2例经膀胱镜手术者半年后好转。结论膀胱镜下尿道会师术是急诊治疗尿道损伤的有效手段,创伤小、恢复快、效果满意。     

Isolated posterior urethral injury： an unusual complication and presentation following male coital trauma

We describe an unusual complication of coital trauma in a 29-year-old man who presented with a 3-year history of hematospermia and post-coital gross hematuria. Using urethroscopy under a semi-tumescent penis, an isolated urethral injury with active bleeding was detected at the prostatic urethra. The patient was successfully treated with transurethral fulguration. We suggest that isolated posterior urethral injury is one of the causes of male coital trauma, which might be asymptomatic when the penis is flaccid but show symptomatic bleeding when the penis is erect.     

Management of urethral lesions in penile blunt trauma

BACKGROUND: Traumatic lesions to the penis may extend into the corpus spongiosum, causing laceration or complete transection of the urethra. Blunt penile trauma is usually related to sexual intercourse or manipulation. The aim of this paper was to report the authors experience with the management of urethral injuries in patients with penile blunt trauma. METHODS: The charts from 77 patients with penile blunt trauma were retrospectively reviewed, and the cases associated with urethral injuries associated were selected. Patient age ranged from 18 to 63 years (mean 33 years). RESULTS: From 77 cases assessed, 11 (14.2%) patients had urethral injury, 62 (80.5%) had injury of the corpora cavernosa and four (5.2%) had injury of the dorsal vein. The etiology of urethral injuries was sexual intercourse in 10 patients (91%) and direct trauma to the flaccid penis in one patient (9%). A partial urethral disruption was presented in eight patients (72.8%) and a total disruption in three patients (27.2%). Preoperative urethrogram was performed in seven patients with a suspicion of urethral trauma. When a partial injury was present the urethra was closed over the catheter, and in the presence of a total injury an end-to-end anastomosis was performed. CONCLUSION: The data support the reported incidence of urethral injury associated with blunt penile trauma. No clinically apparent urethral structures were appreciated with primary urethral repair after a follow up of more than 6 months.     

Penile fracture associated with complete urethra and bilateral corpora cavernosa transection

Penile fracture is a rare urological emergency caused by blunt trauma to the erect penis. It occurs due to the forcible bending of the turgid erect penis against resistance leading to tunica albuginea tear. The rupture of tunica albuginea surrounding the corpora cavernosa leads to hematoma formation and classical ‘aubergine’ deformity. Timely intervention is essential to improve sexual function. Urethral injury may occur concomitantly in case of severe trauma. Blood at the meatus, inability to void and haematuria are distinctive features. We describe a case of 36-year-old man who presented to the emergency department with penile fracture during sexual intercourse associated with blood at the meatus and voiding difficulty. On surgical exploration, complete bilateral corpora cavernosa tear and penile urethral transection was noted. The patient was successfully managed with timely repair. This case highlights the need for suspicion of an associated urethral injury in patients of penile fracture with blood at the meatus.     

Traumatic penile injuries--mechanisms and treatment

Injuries of the penis are uncommon but represent urological emergencies. We report 3 cases of penile trauma illustrating the diversity of penile injury presentation. Radiological investigations are only mandatory if there is any suspicion of a urethral injury. Primary surgical approach is recommended in cases of penile fracture or local wound infection. An immediate operative exploration with removal of hematoma and primary defect closure should be done in every case. Surgical management should not be delayed to avoid late complications.     

Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma

PURPOSE: Precise definition of pelvic fracture location may enable prediction of which subjects are at risk for urethral injury and understanding of the pathophysiological mechanism of injury. We determined the specific anterior pelvic injury locations associated with urethral injury. MATERIALS AND METHODS: We completed a retrospective, nested case-control study of 119 male patients evaluated at a single large level 1 trauma center between January 1, 1997 and July 15, 2003. We performed detailed measurements of the location, displacement and direction of force of each anterior pelvic fracture from computerized tomography and pelvic radiographs. Multiple logistic regression was used to determine associations between specific fracture locations and urethral injury after controlling for age, injury mechanism, injury severity and direction of force. RESULTS: Urethral injury was present in 25 patients and all had anterior pelvic fracture (inclusive of pubic symphysis diastasis). There were no urethral injuries in patients with fractures isolated to the acetabulum. Pelvic fractures that were independently associated with urethral injury from multiple regression analysis included displaced fractures of the inferomedial pubic bone, OR 6.4 (95% CI 1.6 to 24.9), and symphysis pubis diastasis, OR 11.8 (95% CI 4.0 to 34.5). Each millimeter of symphysis pubis diastasis or inferomedial pubic bone fracture displacement was associated with an approximately 10% increased risk of urethral injury. CONCLUSIONS: The location and displacement of anterior pelvic fractures in males predict risk of urethral injury and may be valuable in determining when evaluation of the urethra is appropriate.     

Microneurovascular reimplantation in a case of total penile amputation

Amputation of the penis is a rare condition reported from various parts of the world as isolated cases or small series of patients; the common aetiology is self-mutilating sharp amputation or an avulsion or crush injury in an industrial accident. A complete reconstruction of all penile structures should be attempted in one stage which provides the best chance for full rehabilitation of the patient. We report here a single case of total amputation of the penis, which was successfully reattached by using a microsurgical technique. After surgery, near-normal appearance and function including a good urine flow and absence of urethral stricture, capabilities of erection and near normal sensitivity were observed.     

Complete urethral injury in the penile fracture: a case report and literature review

Penile fracture is described as a traumatic rupture of the tunica albuginea caused by blunt injury to the erect penis. It usually occurs as a single rupture of the tunica albuginea in one of two corpora cavernosa; a rupture with urethral injury is an extremely rare condition. Although its diagnosis is usually clinical, ultrasound plays an important role in confirming diagnosis and identifying the site of the injury. Here, we presented a case of penile fracture with complete urethral injury. A 43-year-old male was admitted to the hospital because of trauma to the genital and dysuria following sexual intercourse. After admission, the patient was diagnosed with double penile fracture and complete urethral injury after the physical and B-ultrasound examinations. Emergency surgery to remove the hematoma and repair the urethra was performed. The patient recovered smoothly and was discharged on the third day after operation. After two months’ follow-up, the patient urinated smoothly and achieved an adequate erection without other complications. In this case, consistent with previous studies, emergency surgery for penile fracture is necessary and can preserve the urethral function and sexual function. In addition, there are two lesions in tunica albuginea in this case, so careful search for the penile shaft during the surgery is important to avoid the missed injuries. This report provides evidence of an uncommon and underreported clinical case.     

Fracture of the penis

BACKGROUND: Sporadic reports of penile fracture give the impression of a rare trauma. The value of diagnostic investigations is doubtful and treatment options are controversial.METHODS: A Medline search from January 1966 to July 2001 using the terms 'fracture of penis', 'penile trauma' and 'coital injuries' was used to identify full texts of publications on fracture of the penis. Full texts of relevant references from these publications were also identified. Data extracted for review included authors, country and year of publication, number of cases in each report, aetiology, clinical features, investigations, treatment and outcome.RESULTS: In 183 publications 1331 cases were reported between January 1935 and July 2001. Most reports were from the Mediterranean region. The commonest causes were coitus and penile manipulations, especially masturbation. Most patients were in their fourth decade. Clinical features included sudden penile pain, detumescence, voiding difficulties, and penile swelling and deviation. Diagnosis was made mainly on clinical grounds. Associated injuries included urethral rupture. Predisposing factors included excessive force at coitus or manipulation, fibrosclerosis of the tunica albuginea and chronic urethritis. Most authors advocated early surgical repair using absorbable sutures. Complications of the injury included coital difficulty, urethral fistula, penile plaque and erectile dysfunction.CONCLUSION: Penile fracture is not rare. Radiological investigations are expensive and may delay treatment. Current management favours early surgical exploration to prevent complications.     

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.     

Urethral catheter induced pseudoaneurysm of the bulbar artery

Injuries of the urethra due to urethral catheter have been well recognised. We report a case of pseudoaneurysm of the artery to the bulb of the penis which formed due to necrosis of the arterial wall secondary to prolonged pressure due to a wrongly placed urethral catheter. The catheter was inflated in the bulbar urethra and left during surgery for 4 hours. The patient developed intermittent severe urethral bleeding. An angiogram of internal iliac artery showed a pseudo aneurysm involving the bulbar artery with arteriovenous communication. Super selective embolization of the feeding vessel was performed with cessation of the blood fl ow immediately. To our knowledge, pseudoaneurysm of the bulbar artery of penis has not previously been described.