尿道、阴茎

阴茎两侧肉膜蒂组织双层覆盖在Snodgrass尿道下裂修复中的应用,不同年龄包茎和包皮过长患者包皮组织中触觉小体的观察,腔内手术治疗后尿道狭窄与闭锁（附46例报告）,后尿道狭窄外科治疗191例临床分析,阴茎起勃器植入手术治疗阴茎硬结症合并重度S型弯曲（1例并文献复习）[编者按]     

斑块磨削和改良Nesbit技术治疗阴茎硬结症患者的护理

目的总结阴茎硬结斑块磨削和改良Nesbit技术治疗阴茎硬结症患者的护理经验。方法对10例阴茎硬结症患者行阴茎硬结斑块磨削和改良Nesbit技术治疗,充分做好术前准备、心理护理及疾病知识宣教,术后做好伤口护理、保持引流通畅、预防阴茎勃起等护理。结果10例手术顺利,术中及术后均未发生并发症。术后1例仍有轻微阴茎弯曲,余9例阴茎弯曲得以矫正。10例患者出院随访6个月至2年,均无阴茎硬结复发。结论做好围术期护理是保证手术成功的关键措施之一。     

低能量体外冲击波治疗阴茎硬结症初步探讨(附32例报告)

目的:探讨低能量体外冲击波治疗阴茎硬结症的临床效果。方法:自2016年10月至2017年10月对32例阴茎硬结症患者应用低能量体外冲击波进行治疗,治疗参数为0.09 mJ/mm2、脉冲频率120次/分,每个硬结从两个角度治疗,每个角度冲击波输出900次,较大的硬结分3个点打,每点600次,另外再于硬结的远端及近端各打300次。每周治疗2个疗程,最初6个疗程连续进行,之后休息3周再治疗6个疗程。疗程结束后观察硬结大小、阴茎弯曲度、VAS评分、IIEF-5评分及不良反应等。结果:在32例患者中,9例患者阴茎硬结不同程度的变软或变小;阴茎勃起疼痛的患者中,15例疼痛减轻;阴茎勃起后明显弯曲的患者治疗后改善不明显;合并不同程度勃起功能障碍患者中,18例IIEF-5评分有所提高;所有治疗患者均未见明显并发症。结论:低能量体外冲击波可以缓解阴茎硬结症导致的疼痛,改善勃起功能,提高患者生活质量,对阴茎硬结症有一定的疗效。     

颊粘膜替代斑块治疗阴茎硬结症(附27例报告)

目的:评价使用颊粘膜替代阴茎斑块治疗阴茎硬结症的临床效果。方法:27例阴茎硬结症患者,年龄24～72岁,平均53岁,病程1～13年,勃起时阴茎弯曲的角度为30～80度。阴茎硬结位于阴茎背侧根部15例,阴茎背侧中部6例,阴茎冠状沟下3例,阴茎腹侧中部3例。硬结数目:1枚24例,2枚2例,3枚1例。硬结大小:0.7cm×0.7cm～1.6cm×1.0cm,采用手术切除阴茎海绵体白膜斑块,自体颊粘膜移植物替代治疗,并进行随访。结果:本组27例患者矫形满意,口腔疼痛多在1周内消失。3例面颊部水肿明显,5～7d后消失。无血肿、感染、口腔麻木及张口紧缩感。24例获得随访,随访6个月～7年,平均31个月,21例患者阴茎伸直,3例稍有弯曲,弯曲角度<15度,不影响阴茎有效勃起及正常性生活,无阴茎缩窄及凹痕感,无局部阴茎白膜膨出,2例阴茎长度术后有缩短(<1cm),3例仍有阴茎勃起疼痛。结论:颊粘膜弹性好,不挛缩,可在男科治疗阴茎硬结症中广泛使用。     

斑块切除加自体睾丸鞘膜移植术治疗阴茎硬结症

目的:探讨斑块切除+自体睾丸鞘膜移植术治疗阴茎硬结症的临床疗效。方法:选取2013年1月至2015年12月收治的10例经药物保守治疗12个月以上无效、处于稳定期6个月以上、阴茎弯曲60°、不能完成性交的阴茎硬结症患者,行阴茎硬结切除+自体睾丸鞘膜移植修补缺损。结果:10例患者术后随访期6~24个月,所有患者术后阴茎均能正常勃起,无手术侧睾丸萎缩、扭转或坏死。患者对阴茎外形满意,未觉阴茎有明显缩短。结论:斑块切除+自体睾丸鞘膜移植术是治疗阴茎硬结症造成的阴茎勃起畸形的一种安全、简便、经济和有效的手术方式。     

自体睾丸鞘膜移植治疗阴茎硬结症

目的:探讨自体睾丸鞘膜移植治疗阴茎硬结症的手术效果。方法:10例阴茎硬结症患者,采用自体睾丸鞘膜移植阴茎成形术进行治疗,并在术前以及术后1年和5年接受IIEF-5问卷评分。结果:10例患者术后阴茎均能恢复正常勃起形态,阴茎勃起疼痛症状消失,阴茎弯曲明显减轻,无复发性ED,能进行满意的性生活,IIEF-5评分在术后1年和5年分别为(22.40±1.08)、(22.80±1.14)分,均显著高于术前[(19.20±2.28)分,P均0.05]。结论:自体睾丸鞘膜移植术治疗阴茎阴茎硬结症造成的勃起畸形是一种安全、简便、经济、有效的手术方式,然而需要进一步大样本的研究来证实。     

三件套可控性阴茎假体植入术治疗器质性勃起障碍

目的观察三件套可控性阴茎假体植入术治疗器质性阴茎勃起障碍(ED)的疗效、安全性及可靠性。方法我科自1999年3月~2003年10月起使用国产/进口可控性阴茎假体对7例器质性ED患者进行假体植入治疗,并对其进行随访观察。结果7例器质性ED假体植入患者术后1周内均有不同程度的阴茎疼痛,其中1例因长期焦虑症状和阴茎勃起疼痛取出假体;其余假体目前使用情况良好。结论可控性阴茎假体植入术治疗器质性ED有效、安全、疗效可靠。良好的医患沟通,严格掌握手术适应证,正确仔细术中操作,正确及时假体使用指导是手术成功有效的保证。     

大隐静脉补片治疗阴茎硬结症

目的探讨大隐静脉补片治疗阴茎硬结症的应用。方法对3例患者将阴茎硬结斑块“H”型切开，伸直阴茎，大隐静脉补片修补白膜缺损。结果随访6月以上，全部患者术后阴茎勃起良好。结论斑块切开结合大隐静脉移植可作为治疗阴茎硬结症的理想手术方法。     

阴茎修复和功能重建(附62例报道)

目的:探讨严重阴茎病变(畸形)的外科治疗方法。方法:62例患者年龄19～63岁(平均35岁),其中阴茎部分缺失4例,分别行阴茎缺损修复、阴茎延长术、尿道成形术;阴茎完全缺失3例,行阴茎再造术;阴茎严重弯曲22例,行"16点"弯曲矫正术;阴茎折断15例,1例保守治疗,14例分别修补阴茎海绵体、尿道海绵体,阴茎背深静脉结扎;假体植入术后并发症5例,包括假体从尿道穿出、水泵失灵、连接管断裂,勃起角度<60°和海绵体无法扩张,分别行假体取出、修补尿道裂口,更换新的假体,切除纤维化的瘢痕再次植入假体;阴茎完全离断4例,行阴茎再植术;撕脱伤3例,行皮瓣回植和游离植皮;阴茎Paget病6例,行病灶切除、游离植皮和阴茎埋入阴囊。结果:该组随访3个月至4年,平均9个月,4例阴茎部分缺失患者,2例术后阴茎外形满意,性功能恢复,较满意和不满意各1例。阴茎完全缺失3例术后外形满意,排尿好,1例不满意。22例阴茎严重弯曲均被矫正,1例复发。阴茎折断15例,失访1例,14例获得随访,性功能均恢复,术后并发症5例,分别为轻度弯曲、性交痛、皮下硬结、硬度差、性快感差,未作进一步处理。假体植入术后并发症5例,再次手术均成功,术后均能进行性生活,4例配偶满意,仅1例配偶不满意。阴茎完全离断4例,2例再植成功,2例坏死。撕脱伤3例植皮均获得成功。6例阴茎Paget病患者术后皮瓣均成活,随访2～4年,1例死于脑转移,5例无瘤存活至今。结论:该类病例需在泌尿男科手术的基础上,配合显微外科技术、皮瓣或皮肤移植技术等,设计个性化手术方案,能解决大多数患者的阴茎形态和勃起功能障碍,但部分患者仍不能达到理想的外形或功能,有待于寻求新的治疗方法。     

单纯缝扎法治疗阴茎弯曲2例并文献复习

阴茎弯曲(penile curvature)是临床上较为少见的男性生殖系统畸形,可先天发生,也可继发于阴茎外伤、感染、阴茎硬结症等疾病。阴茎弯曲可产生性交困难、疼痛等症状,同时还造成性伴侣的性交痛等不适,严重影响患者生殖健康,因此在保守治疗困难的情况下,常常需手术矫形。目前阴茎弯曲矫形手术有多种术式,现报告本中心完成的2例单纯缝扎法治疗阴茎弯曲病例,在此基础上进行文献回顾,总结相关经验。     

Critical analysis of surgery for Peyronie's disease

PURPOSE OF REVIEW: This review focuses on the surgical management of Peyronie's disease in the light of recent published reports from 2003 and 2004. RECENT FINDINGS: Although there have been a number of non-surgical innovations in this field, the surgical treatment of Peyronie's disease still remains the only alternative for patients not responding to other therapies. Various surgical modalities have recently been promulgated, however the ideal surgical procedure is still not perfected, particularly in cases of severe and complex penile curvature. The recent results of various surgical approaches have engendered concern about their long term benefits. SUMMARY: The initial management of the acute presentation of Peyronie's disease is conservative and non-surgical. Surgery for Peyronie's disease is contemplated only after stabilization of the fibrotic process, and is generally reserved for men with severe penile deformities that impede satisfactory sexual intercourse. If there is ample penile length and the deformity is mild to moderate in severity, a variety of plication techniques may be considered to provide a straight and functional penis. In patients with larger plaques, severe curvature, complete or hourglass deformities, then incision or excision of the plaque and the placement of a graft are recommended. Most authorities currently favor non-synthetic graft materials whose properties resemble the anatomy and functionality of the tunica albuginea. The implantation of a penile prosthesis, with or without excision/incision of the diseased tunica albuginea, is reserved for patients with erectile dysfunction who have not responded to medical therapies. Manual modeling of the deformed penis over a penile prosthesis may prevent some patients from needing more complex surgical grafting procedures.     

Surgical treatment of Peyronie's disease: a critical analysis

OBJECTIVE: The present paper reviews surgical treatment alternatives for patients with Peyronie's disease using knowledge obtained from the contemporary literature. METHODS: : All aspects of surgical treatment for Peyronie's disease were examined on the basis of MEDLINE database researches. RESULTS: Surgical treatment should be delayed until the acute inflammatory phase has resolved and should be considered in patients with deformity that impairs sexual function. Currently, surgical treatment alternatives are reconstructive surgery by either lengthening the concave side (incision and grafting) or shortening the convex side (Nesbit procedure or plication) of the penis, and implantation of penile prosthesis with or without incision of the plaque. PD patients with good erectile capacity are candidates for reconstructive surgery. Meanwhile, implantation of penile prosthesis with or without remodeling should be considered for patients without adequate erectile capacity. CONCLUSIONS: The aim of the surgical treatment in Peyronie's disease is to correct the deformity while preserving or improving erectile capacity of the penis. Appropriate treatment options should be individualized according to the patients' expectations and erectile capacity.     

Surgical therapy of penis shaft induration in congenital penis deviation and induratio penis plastica]

The therapy of Peyronie's disease is an operative one primarily. Indication for the operative treatment is the penile deviation which prevents the patient from intercourse. The method of choice is plaque excision and subsequent corporoplasty with dermal graft. Good long-term results can also be achieved with a sole straightening of the penile shaft without plaque excision. However, this procedure (Nesbit's operation) results in a shortening of the length. In patients who are suffering from an additional erectile dysfunction an implantation of a penile prosthesis is done accompanied by plaque excision and a corporoplasty with alloplastic material (Dacron, Goretex). In 80% of all cases good postoperative results can be achieved with the operative treatment of Peyronie's disease. Patient's satisfaction is very good with all procedures described above. The exact diagnosis of the erectile quality seems to have a prognostic value for the postoperative result.     

Peyronie's disease: advancements in recent surgical techniques

PURPOSE OF REVIEW: The aim of this review is to discuss the recent advances in surgical techniques for the correction of Peyronie's disease. A review of the literature published in 2002 and 2003 regarding surgical treatment was performed in preparation for this article. RECENT FINDINGS: The surgical treatment of Peyronie's disease remains a debated topic. Generally, surgical therapy for Peyronie's disease can be divided into three main categories: wedge resection/plication surgeries; plaque excision/incision with grafting procedures; and the placement of a penile prosthesis. New reports have investigated suture selection, graft acceptability, and new surgical approaches. These new surgical enhancements will give urologists a greater choice in the surgical management of Peyronie's disease. This will aid the ability of the urologist to tailor the therapy necessary for each individual patient. SUMMARY: The correction of acquired penile deformity seen in Peyronie's disease patients can be a challenge for the practising urologist. Newer advancements in surgical techniques and materials will allow the urologist greater treatment options. The degree of curvature, the type of deformity, erectile dysfunction, and penile length are all characteristics that are assessed in choosing the best surgical intervention in Peyronie's disease. Surgical therapy can be quite beneficial for patients who suffer from penile deformity and can greatly improve their quality of life.     

Peyronie's disease: etiology, medical, and surgical therapy

Peyronie's disease remains an enigma. With the recent introduction of an animal model for Peyronie's disease, the entry of a number of double-blind placebo-controlled clinical trials, and the application of new molecular diagnostic methods, the investigation of this wound-healing disorder of the penile tunica albuginea should illuminate many of the unknowns. Investigators need to be open to innovations in other fields of medicine involving idiopathic fibrosing conditions in other organ systems, eg, Dupuytren's contracture, keloids, hypertrophic scarring, etc. Applications from these other disciplines will undoubtedly widen our scope about Peyronie's disease. While a minority of patients respond with observation alone, most authorities recommend at least a trial of medical therapy with a safe, inexpensive, and well-tolerated agent, as early-stage disease is reputedly more likely to respond better than patients with established, longstanding Peyronie's plaques. The reintroduction of intralesional therapies (verapamil and interferon alpha-2b) provides the clinician with an alternative minimally invasive intervention that has promising possibilities. In severe fibrotic or calcified plaques or with major structural abnormalities, the judicious use of surgery with or without grafting materials and a penile prosthesis can restore many men back to their previous level of high esteem and provide both partners an excellent quality of life.     

Risk factors for penile prosthetic infection

OBJECTIVES: To determine the risk factors for penile prosthesis infection. METHODS: The records of 135 penile prosthesis implantation in 127 patients were reviewed. Of the 135 prothesis, 115 were malleable, 12 were self-contained and 8 were inflatable. Of these procedures, 111 were primary, 9 were primary with reconstructions and 15 were secondary. Mean follow-up was 47 months (minimum 6 months). All of the reconstructions were penile plications or plaque excisions for Peyronie's disease. RESULTS: The ratio of penile prosthesis infection was 8.89%. Secondary implantation, paraplegia, non-controlled diabetes mellitus (p < 0.001) and surgeon's inexperience (p < 0.05) were detected as the risk factors for penile prosthesis infection. But age, smoking, alcohol consumption, obesity, atherosclerosis, presence of diabetes mellitus (DM), history of penile surgery, simple penile reconstruction, type of the erectile dysfunction (ED), type of the penile prostheses and incision and were not found as the risk factors (p > 0.05). CONCLUSIONS: Paraplegie, non-controlled diabetes mellitus, secondary implantation and surgeon's inexperience appear to be the risk factors for penile prosthesis infection. In secondary implantation, longer operation time is detected as a factor increasing the risk of penile prosthesis infection. For these patients, careful preoperative preparation, more attention to perioperative antisepsis and postoperative follow-up are required. Since it has been determined that surgical experiences decrease the complication rate, these patients should be operated by experienced surgeons.     

Lengthening shortened penis caused by Peyronie's disease using circular venous grafting and daily stretching with a vacuum erection device

PURPOSE: We evaluated the results of chronic intermittent stretching with a vacuum erection device after circumferential tunical incision and circular venous grafting in 4 patients with penile shortening from severe Peyronie's disease. MATERIALS AND METHODS: We performed complete circumferential tunical incision and covered the defect with a circular venous graft in 4 patients with shortened penis as a result of Peyronie's disease. Preoperative evaluation included determination of patient and partner expectations, potency status, measurement of penile length after intracavernous injection and color duplex ultrasonography to determine possible vascular communication. Lower saphenous, upper saphenous and deep dorsal veins served as graft materials. We advised patients to use a vacuum device on a daily basis for 6 months starting 1 month after surgery. Postoperative evaluations were done at 6 and 18 months postoperatively. RESULTS: At 6-month followup 1 patient who did not use the vacuum device gained 1 inch in penile length and was not available for further followup. The other 3 patients each gained 2 inches but had decreased erectile rigidity due to narrowing in the grafted area (hourglass deformity). One patient who wanted a more natural erection elected penile prosthesis implantation about 1 year after grafting. The remaining 2 patients gained 3 inches at 18-month followup and regained partial penile rigidity similar to preoperative erections when the hourglass deformity improved. All patients were satisfied and indicated that surgery improved psychological well-being as well as relationships with partners. CONCLUSIONS: The results in this small group are satisfactory. Our technique offers a reasonable solution for correction of penile shortening in patients with Peyronie's disease.     

Treatment of organic impotence by implantation of Jonas prosthesis

We carried out operative insertion of Jonas penile prosthesis in 10 cases with organic impotence. Erection had been incomplete due to radical surgery for bladder or rectal cancer in 5, pelvic fracture in 1, diabetes in 1, Peyronie's disease in 1 and unknown in 2 of the operated cases. Nine of the 10 cases were able to have sexual intercourse at 5-16 weeks after the operation, but the prosthesis was taken off in the remaining one due to long-lasting pain in the penile and perineal region. We have confirmed that the implantation of Jonas prosthesis is a safe and useful procedure for organic impotence.     

Prospective analysis of 16S rDNA as a highly sensitive marker for bacterial presence in Peyronie's disease plaques

PURPOSE: Previous studies have implicated an infectious agent induced pathogenesis in Peyronie's disease. To our knowledge an association with venereal diseases or other infectious diseases has not been demonstrated to date, although Peyronie's disease is an inflammatory disorder. In case of an infectious origin of the disorder bacteria or at least their fragments should occur in the plaque. We investigated prospectively the occurrence of 16S rDNA as a highly sensitive marker for the presence of bacteria in inflammatory processes. MATERIALS AND METHODS: In 19 patients with idiopathic Peyronie's disease biopsy of the tunica albuginea was sampled. A total of 16 men with no evidence of Peyronie's disease served as the control group. In these men tissue from the tunica albuginea was obtained during penile prosthesis implantation for erectile dysfunction or during a Nesbit procedure for congenital penile curvature. Screening for bacterial DNA was performed prospectively using a polymerase chain reaction targeting bacterial 16S rDNA. RESULTS: In the tunica albuginea specimen 16S rDNA was not detectable in patients with Peyronie's disease or in the control group. CONCLUSIONS: The results of this study do not indicate an association between Peyronie's disease and bacterial infection.     

Surgical correction of Peyronie's disease: the Nesbit procedure

Surgical therapy for the correction of Peyronie's disease is indicated in patients with severe and chronic penile curvature that does not respond to conservative therapy and that is severe enough to prevent sexual intercourse. The penile prosthesis has been shown to be an effective treatment in patients with associated erectile impotence. However, there is disagreement regarding the procedure of choice in patients with Peyronie's disease and adequate erectile function. Because of the inconsistent results reported for grafting techniques, we used the Nesbit procedure in 12 patients with adequate erectile capacity distal to the plaque. Eleven patients reported satisfactory intercourse postoperatively with excellent anatomical results.