闭合性阴茎海绵体破裂6例

闭合性阴茎海绵体破裂临床少见，占住院患者的１７．５万分之一［１］。国内自１９６３年蒋鼎新等［２］报道第１例至今，笔者共检索到３６例报道。本文报告６例并分析如下。１ 资料与方法１．１一般资料 本组６例，年龄２６～５２岁，平均３８岁。左侧阴茎海绵体破裂４例，右侧２例。受伤至就诊时间４～２４ｈ。致伤原因：性交失误（性交时阴茎滑出阴道，顶撞于女方耻骨联合或会阴部）５例，手淫弯曲阴茎１例。均有典型表现：听到阴茎折断之响声，局部疼痛，阴茎迅速疲软继之淤血肿胀，远端弯向健侧，皮肤青紫，１例淤血范围达阴囊及会阴部…     

闭合性阴茎海绵体破裂的诊断与治疗

闭合性阴茎海绵体破裂临床少见.本院1996年至2004年收治8例,结合文献对其发病机制、诊断、治疗和预后作一分析,现报告如下.     

阴茎闭合性白膜及海绵体破裂一例报告

患者 ,2 7岁。已婚。阴茎勃起时手握阴茎猛向左折 ,突闻断裂声 ,并感阴茎剧痛 ,随之松软 ,继之迅速肿大 ,青紫变色 ,进行性加重。伤后 6ｈ急诊入院。查体 :阴茎肿大增粗并向左侧呈直角弯曲 ,松软状 ,长约 12 .5ｃｍ ,最大周径 18.0ｃｍ。除阴茎头及阴茎根部左侧 1.5ｃｍ×1.5ｃ     

阴茎海绵体破裂7例报告

当阴茎勃起时遭受暴力可导致一侧或双侧的阴茎海绵体以及尿道海绵体的破裂。我院于 1989～1999年收治阴茎海绵体破裂 7例 ,报告如下。1　资料和方法1.1　临床资料　本文 7例病人 ,年龄 2 3～ 4 7岁 ,平均31.5岁。除 2例意外碰撞损伤 ,其余 5例均因性交不慎所致 ,并闻及破裂声 ,继之阴茎剧烈疼痛 ,肿胀松软。 7例伤后都无排尿困难及肉眼血尿。就诊时间为 6～ 2 6ｈ ,平均 11.3ｈ。 7例均有阴茎弯曲畸形 ,皮下瘀血肿胀 ,其中 2例阴囊皮肤呈紫红色伴肿胀。1.2　处理方法　 1例用粗针穿刺血肿 ,负压抽吸积血 ,留置导尿管 ,加压包扎并以硬纸板做…     

闭合性阴茎海绵体破裂的诊断与治疗

目的探讨闭合性阴茎海绵体破裂的临床特征和诊治效果。方珐8例闭合性阴茎海绵体破裂患者，1例保守治疗，7例早期急诊手术治疗。结果8例患者随访12—36个月。1例保守治疗者发生痛性勃起，但不影响性交；7例手术治疗者均未发生海绵体纤维化、阴茎弯曲或畸形、痛性勃起、阴茎硬结等并发症，性功能均正常。结论闭合性阴茎海绵体破裂的临床特征明显；容易诊断，B超检查能较好地定位白膜破裂的部位和创口大小，早期急诊手术治疗效果好，并发症少，可以使患者阴茎功能早日恢复。     

闭合性阴茎海绵体破裂的早期手术修复及疗效观察

目的 探讨闭合性阴茎海绵体破裂的诊断与早期手术修复的疗效.方法 回顾分析15例闭合性阴茎海绵体破裂病例资料.选取30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,观察手术治疗对勃起功能的长期影响.结果 15例患者依靠典型临床表现确诊,彩色超声可助定位.15例均早期手术修复海绵体破口,术后14 例(93.3%)阴茎外观正常,1 例(6.7%)阴茎轻度弯曲,均未发生勃起功能障碍.IIEF-5评分:治疗组平均(22.6±3.1)分,对照组平均(21.7±2.5)分,二者比较差异无统计学意义(P>0.05).结论 早期手术修复是治疗闭合性阴茎海绵体破裂的金标准,疗效确切,安全可靠,术后勃起功能恢复良好.     

闭合性阴茎海绵体损伤12例报告

闭合性阴茎海绵体损伤较少见,严重病例需行急诊手术修复。我院自1990～2000年共收冶12例,现结合文献对其致病原因、诊断、治疗及预后进行讨论。     

Bilateral disruption of corpus cavernosum with complete urethral rupture

Penile fracture is a relatively rare condition. We report an unusual case of the bilateral disruption of the corpus cavernosum with complete urethral rupture resulting from blunt trauma during sexual intercourse. The subject underwent emergency surgery with preservation of erectile and voiding functions in the follow-up.     

大鼠阴茎海绵体肌源性干细胞的分离与表型鉴定

目的 探讨阴茎海绵体中肌源性干细胞(MDSCs)的分离与表型鉴定的方法.方法 取2个月龄SD大鼠阴茎海绵体组织,用0.5％Ⅰ型胶原酶、0.1％胰蛋白酶进行酶消化初步分离.应用改良的Preplate差速贴壁法进一步行细胞纯化,细胞培养1h,贴壁细胞为PP1;未贴壁细胞转瓶培养2h,贴壁细胞为PP2;未贴壁细胞再次转瓶培养18h,贴壁细胞为PP3;此后,每次间隔24h转瓶培养依次获得的贴壁细胞为PP4、PP5、PP6,观察细胞形态变化.流式细胞仪检测PP3、PP6细胞中干细胞抗原l (Sca-l)和结蛋白(Desmin)的阳性表达量;Western blot检测PP1 ～ PP6细胞中Sca-1和Desmin的阳性表达;免疫荧光细胞化学法检测Sca-1、Desmin、Sca-1/Desmin在PP6细胞中的表达.结果 PP1～ PP6细胞贴壁能力逐渐减慢,PP6细胞贴壁最慢,2～3d后才开始贴壁成圆形或短梭形.流式细胞仪检测结果显示,PP3细胞中Sca-1阳性表达量为(0.3±0.2)％,与同型对照组比较差异无统计学意义(P＞0.05),Desmin阳性表达量为(15.3±1.5)％,与同型对照组比较差异有统计学意义(P＜0.05);PP6细胞中Sca-1、Desmin阳性表达量分别为(5.7±0.7)％、(41.1±1.6)％,与PP3比较差异均有统计学意义(P＜0.05).Western blot显示PP1 ～ PP5细胞中未检测到Sca-1蛋白明显表达,但在PP6细胞中则检测到Sca-1蛋白的表达,Desmin蛋白在PP1 ～ PP6细胞中表达逐渐增强.免疫荧光细胞化学显示在PP6细胞中有少量细胞表达Sca-1、散在分布、以胞质表达为主;表达Desmin细胞聚集、数量较多、主要表达于胞质;亦发现有极少量双阳性标记细胞(Sca-1/Desmin),共同表达于同一细胞的胞质.结论 在大鼠阴茎海绵体中分离出既有于细胞表型又有肌源性表型的细胞,提示此类细胞为MDSCs.     

Leiomyoma of the corpus cavernosum of the penis

While soft tissue tumors can occur in the penis, corpus cavernous tumors are rare. Reported cases of corpus cavernous tumors are from metastases of advanced malignancy, such as cancers of the bladder, prostate, rectosigmoid colon, kidney, pancreas, liver, testis and nasopharynx. Primary corpus cavernous tumors are extremely rare and have possibly never been reported before. Herein, we report a case of leiomyoma of the corpus cavernosum. After the diagnosis of leiomyoma was established, total excision of the tumor was not attempted and the tumor remained unchanged in size and shape over a follow-up period of 15 months.     

Electrical activity of the corpus cavernosum in denervated rats

BACKGROUND: We evaluated the electrical activity of the corpus cavernosum after intracavernous papaverine injection in rats that had been denervated experimentally. METHODS: Twenty-four male adult Sprague Dawley rats were divided into three groups: (i) controls (n=8) (ii) unilateral cavernous nerve resection on the right side (n=8); and (iii) bilateral cavernous nerve resection (n=8). Through a suprapubic incision, the urinary bladder was retracted laterally to locate the major pelvic plexus on the lateral surface of the prostate. The major branch of the cavernous nerve, running caudally from the pelvic plexus, was isolated and excised using an operating microscope. Three weeks later, recording of the electrical activity of the corpus cavernosum (EACC) was performed by using a Neuropack-2 EMG unit (Nihon Kohden, Tokyo, Japan) and coencentric needle electrode. Changes in amplitude were evaluated before and after intracavernosal papaverine injection. The results in the flaccid state and after papaverine injection were compared by using the Mann Whitney U-test in all three groups and paired t-test between groups. RESULTS: In the flaccid penis, the mean (+/- SD) amplitude of electrical activity of the corpus cavernosum was 17.42+/-2.05, 12.42+/-1.88, 9.71+/-1.59 and 5.85+/-0.96 microV in control rats, in unilaterally denervated rats (in which the cavernous nerve was intact on the left side), in unilaterally denervated rats in which the cavernous nerve was resected on the right side and in bilaterally denervated rats, respectively. In the flaccid state, EACC is lower in the bilaterally denervated group than in the control and unilaterally nerve-resected groups (P < or = 0.05). The recording of electrical activity of the corpus cavernosum was continued for 20 min after papaverine injection. In the control group and in both groups of unilaterally denervated rats, we observed a significant decrease in the electrical activity of the corpus cavernosum in the first 5 min after papaverine injection (P < or = 0.05). However, no difference was observed in bilaterally denervated rats after injection (P > or = 0.05). CONCLUSIONS: We conclude that electrical activity of the corpus cavernosum continues after unilateral nerve injury in rats. Cross-innervation may play a role in penile innervation and corpus cavernosum electromyography shows electrical activity in denervated rats.     

Application of correlation techniques in the analysis of corpus cavernosum electromyographic signals

Aim： To establish an objective, easy-to-use and comprehensive method to analyze corpus cavernosum electromyo- graphic signals （CC-potentials）. Methods： CC-potentials were recorded during flaccidity in 23 young healthy volunteers, with surface electrodes placed on the penile shaft bilaterally. Based on the correlation function of Matlab software, an application program for the analysis of CC-potentials was developed. Individual CC-potentials and their autocorrelation function were evaluated, yielding parameters amplitude （A）, duration （D）, and dominant frequency （DF）. The crosscorrelation function of both longitudinal and bilateral pairs of adjacent electrodes was calculated to assess the similar- ity and mutual delay of CC-potentials recorded simultaneously from different parts of the CC. The parameters derived were squared maximum cross-correlation coefficient （Rmax） and delay （τ）. Based on the absolute value of τ and the corresponding inter-electrode distance, propagation velocity （PV） was calculated. Results. The values of the parameters were determined automatically. No significant difference related to the locations of the electrodes for parameters A, D, and DF was detected. The cross-correlation showed that both longitudinal and bilateral CC-potential pairs had highly similar waveforms （the absolute values of Rmax were 0.80 ± 0.05 and 0.87 ± 0.06, respectively）. PV of longitudinal pairs was estimated as 6.15 ± 3.98 cm/s. Conclusion： The application program for correlation analysis of CC-potentials is a comprehensive and versatile method to analyze corpus cavernosum electromyographic recordings. Its objectiveness makes multi-center application possible.     

创伤性膈肌破裂86例诊治体会

目的探讨创伤性膈肌破裂的早期诊断和治疗方法。方法对收治的86例创伤性膈肌破裂患者的临床资料进行回顾性分析。结果 86例创伤性膈肌破裂患者中治愈80例,死亡6例。结论对创伤性膈肌破裂患者必须早期诊断,及时手术。     

Relaxation mechanisms of neferine on the rabbit corpus cavernosum tissue in vitro

Aim： To investigate the relaxation mechanisms of neferine （Nef） on the rabbit corpus cavemosum tissue in vitro. Methods： Strips of rabbit corpus cavemosum were mounted in organ chambers. The effects of Nef were examined on isolated muscle strips precontracted with phenylephrine （PE） alone, in the presence of NW-nitro-L-arginine （LNNA, a nitric oxide synthase inhibitor）, 1-H-[ 1,2,4]oxadiazolo[4,3-tx]quinoxalin- 1-one （ODQ, a guanylyl cyclase inhibitor）, indomethacin （cyclooxygenase inhibitor）, tetraethylammonium （Ca^2＋ -activated K^＋ channel blocker）, 4-aminopiridine （4-AP ,voltage dependent K^＋ channel blocker） and glibenclamide （ATP sensitive K^＋channel blocker）. The effects of Nef on KCl-induced contraction of isolated muscle strips were also investigated. The procedure of calcium absencecalcium addition was designed to observe the effect of Nef on two components of the contractile responses to PE based on the source of Ca^2＋ （extracellular vs. intracellular）. Results： Corpus cavemosum strips relaxed in response to Nef （10-9-10-4 mol/L） in a concentration-dependent manner with an IC50 of 4.60 × 10^-6 mol/L. However, they were not affected by LNNA, ODQ, indomethacin or K^＋-channel blockers. Nef （10^-6 mol/L, 10^-5 mol/L） concentration dependently reduced the maximal contraction response of isolated strips induced by KC1 to 79.3% ± 5.5% and 61.5% ±3.2%, respectively （P 〈 0.01）. In the calcium absence-calcium addition procedure, Nef 10.5 mol/L inhibited both intracellular calcium-dependent and extracellular calcium-dependent contraction induced by PE （2 × 10^5 mol/L） （P 〈 0.05）. The inhibition ratios were 26.2% ± 5.4% and 48.3% ±7.6%, respectively. Conclusion： The results of the present study suggest that Nef possesses a relaxant effect on rabbit corpus cavemosum tissues, which is attributable to the inhibition of extracellular Ca^2＋ influx and the inhibition of release of intracellular stored Ca^2＋, but not mediated by the     

Comparative studies on intracellular calcium and nadh fluorescence of the rabbit corpus cavernosum

Erectile function (erection and detumescence) involves the complex interaction of direct neuronal stimulation of corporal smooth muscle, neurohumoral release of specific endothelial contractile and relaxant factors, and secondary modulation by a variety of putative neuropeptides and vasoactive modulators. Using surface spectrofluorometry, we have correlated spontaneous contractile activity and the contractile response to field and pharmacological agents with intracellular calcium and NADH metabolism. The results demonstrate that the corpus cavernosal tissue has very unusual properties. Spontaneous contractile activity is correlated with a phasic increase in intracellular calcium. However, spontaneous contractile activity is most often correlated with a bi-phasic effect on the ratio of NADH/NAD. At the start of the spontaneous contraction, there is a sharp phasic increase in NADH/NAD; peak contractile force occurs simultaneous with a phasic decrease in this ratio showing that at peak force generation, there is a decrease in the level of intracellular energy. Phenylephrine stimulation results in an increase in intracellular calcium in proportion to the increase in tension; however, phenylephrine stimulation at low concentrations results in a net increase in the NADH/NAD ratio whereas high concentrations of phenylephrine result in a net decrease in the NADH/NAD ratio. In general, field stimulation results in a decrease in tension at low frequencies, a biphasic response at midfrequencies, and a contraction at high frequencies. These contractile responses are directly related to alterations in the intracellular concentration of calcium. That is, a decrease in tension is preceded by a decrease in intracellular calcium while an increase in tension is preceded by an increase in intracellular free calcium. Field stimulation results in a rapid and phasic alteration in the NADH/NAD ratio; however, the NADH/NAD response can be either an increase, decrease, or biphasic response. There does not appear to be a consistent relationship between the contractile/relaxant response to field stimulation and altered NADH/NAD ratio. Finally, ATP, bethanechol, and nitroprusside induce a decrease in the basal tension of the corpus cavernosal strips which corresponds with a decrease in the NADH/NAD ratio. However, whereas nitroprusside relaxation is correlated with a decreased intracellular calcium level, both ATP and bethanechol stimulate an increase in intracellular free calcium. These studies indicate that the response of the corpus cavernosal tissue to both field stimulation and pharmacological agents is complex and may involve both direct and indirect actions of a variety of cellular mediators on the corporal smooth muscle. © 1994 Wiley-Liss, Inc.     

Relaxation effects of adrenomedullin in isolated rabbit corpus cavernosum smooth muscle

OBJECTIVES: To clarify the pharmacological effects of adrenomedullin, a potent vasodilator and hypotensive peptide isolated from human phaeochromocytoma cells, on corpus cavernosal smooth muscle in vitro, as the intracavernosal injection of adrenomedullin induces penile erection in the anaesthetized cat. MATERIALS AND METHODS: The effects of adrenomedullin were investigated in isolated muscle strips from New Zealand rabbit corpus cavernosum smooth muscle pre-contracted with phenylephrine alone, in the presence of indomethacin (cyclooxygenase inhibitor), Nomega-nitro l-arginine methyl ester (L-NAME, a nitric oxide synthase inhibitor), and K+-channel blockers. RESULTS: Adrenomedullin caused relaxation of isolated pre-contracted rabbit corpus cavernosum strips in a concentration-dependent manner. The response of corpus cavernosum was unaffected L-NAME, indomethacin and K+-channel blockers. CONCLUSION: The relaxation exerted by adrenomedullin in rabbit corporal tissue may arise from the effect of the drug on its specific receptors and/or calcitonin gene-related peptide-1 receptors. The relaxant effect of adrenomedullin might lead to novel clinical applications for erectile dysfunction.     

阴茎包埋对海绵体形态结构的影响

目的:探讨阴茎包埋对大鼠阴茎海绵体形态结构的影响。方法:通过建立隐匿阴茎大鼠模型获得实验标本,分2月组、4月组进行观测,每组25只大鼠。各阶段又分包埋组(15只)、正常组(10只),光镜和电镜下观察海绵体形态结构的改变。结果:阴茎包埋2月组海绵体形态结构无明显变化,4月组病理改变较为明显,光镜下见大鼠阴茎海绵体平滑肌细胞,内皮细胞分布杂乱,细胞间大量间质组织增生,海绵窦狭窄;电镜下见阴茎海绵体平滑肌细胞及内皮细胞萎缩、线粒体退变、内质网扩张,致密体及收缩纤维减少,脂滴增加,空泡形成。包埋组与正常组阴茎海绵体在外观和重量上无明显差异(P>0.05)。结论:阴茎包埋对海绵体外观和重量无明显影响,但随着包埋时间的延长,海绵体组织发生超微结构上的病理改变。