无创性动态阴茎海绵体测压的临床应用

目的　初步评价应用VISER软件行无创性动态阴茎海绵体测压在阳萎 (ED)诊断中的作用。　方法　采用AquariusXLT型尿动力学仪配置的VISER软件 ,辅助眼镜式影像仪听觉视觉性刺激 (AVSS)或阴茎海绵体内血管活性药物注射 (ICI)进行无创性动态海绵体测压 39例 ,其中ED患者 32例 ,正常对照 7例。　结果　正常对照 7例均可通过AVSS诱发勃起 ;32例ED患者中 ,13例单纯AVSS可诱发勃起 ,占 4 0 % ;19例单纯AVSS无效者 ,给予罂粟碱 10mg海绵体内注射 ,其中 13例出现勃起 ,占 6 8%。结果除ED罂粟碱组勃起平均时间延长外 ,勃起数据和峰值数据中的其他多项指标ED各组均低于对照组 ,尤以勃起和峰值总能量降低明显。　结论　VISER具有精确的动态阴茎海绵体测压功能 ;辅助眼镜式影像仪有助于增强AVSS效果和减少阴茎海绵体血管活性药物注射剂量 ;VISER检查具有无创、准确、便捷等优点 ,有望成为ED诊断的首选方法     

无创性动态阴茎海绵体测压诊断阴茎勃起功能障碍

目的　探讨应用无创性动态阴茎海绵体测压 (VISER)在勃起功能障碍 (ED)诊断中的价值。　方法　对 5 3例ED患者的PGE1阴茎海绵体内注射试验、VISER及彩色双功能超声检查结果进行对比分析。　结果　PorstⅢ级者 4 3例 ,平均海绵体压力和压力指数分别为 14 4 .2 9mmHg(1mmHg=0 .133kPa)和 1.2 4。 4 2例血管功能正常 ,1例为静脉性ED ;PorstⅡ级者 10例 ,平均海绵体压力和压力指数为 87.76mmHg和 0 .81,两组间比较差别有显著性意义 (P <0 .0 5 ) ;PorstⅡ级者中动脉性ED2例 ,静脉性ED8例 ,两组间海绵体压力比较差别有显著性意义 (P <0 .0 5 )。　结论　VIS ER是一种有效的无创性诊断ED的方法 ,对动脉性及静脉性ED的鉴别亦有一定价值。     

声视觉性刺激联合多普勒超声在重度ED患者诊断中的价值

目的 采用自身前后对照探讨声视觉性刺激联合多普勒超声在重度勃起功能障碍(ED)患者诊断中的价值。方法 自2015年6月至2016年7月,在中南大学湘雅三医院泌尿外科门诊对以ED为主诉的患者进行筛选,采用国际勃起功能评分量表-5(IIEF-5)初筛,IIEF-5评分小于8分的重度ED患者纳入研究,共筛选出139例患者。采用自身对照方式,研究对象先后接受两次阴茎彩色多普勒超声检查。第一次检查仅阴茎海绵体注射前列腺素E1(A组),7 d后的第二次检查予以声视觉性刺激(AVSS)联合阴茎海绵体注射前列腺素E1(B组)。采集注射后第5、10、20 min的收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、血流阻力指数(RI)。结果 在第一期检测中(A组),共有117例患者被检测为血管性ED,包括54例动脉性ED、40例静脉性ED、23例混合性ED。在第二期检测中(B组),共有91例患者被检测为血管性ED,包括34例动脉性ED、30例静脉性ED、27例混合性ED。B组患者加入AVSS后需要的血管活性药物注射剂量与次数明显低于A组,同时发现AVSS联合ICI可以提高非血管性ED检出率,26例患者...     

多普勒超声技术动态观察血管性勃起功能障碍患者阴茎血流动力学的变化

目的动态观察多普勒超声技术配合阴茎海绵体注射在血管性勃起功能障碍患者诊断中的价值。方法120例疑血管性ED患者在阴茎注射PGE1后5min、10min和20min应用多普勒超声技术测量阴茎血流动力学变化,指标包括:收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、血流阻力指数(RI)。另100例心因性ED设为对照组。第一次注射后勃起不佳的患者3d后增加PGE1剂量重新检测。结果120例患者可以观察到明显的血流动力学变化,其中有动脉性ED者34例,静脉性ED 55例,混合血管性31例。ICI后不同时间的多普勒测量其血流动力学变化有一定差异。结论多普勒超声技术诊断血管性勃起功能障碍有一定意义。阴茎海绵体注射药物后须动态观察阴茎血流动力学的变化。     

两组药物海绵体内注射治疗勃起功能障碍效果比较

目的 :为临床勃起功能障碍 (ED)治疗时海绵体内注射 (ICI)选药提供临床资料。　方法 :5 6例ED病人 ,随机分 2组 ,每组 2 8例。第 1组用酚妥拉明 2～ 10mg +罂粟碱 10～ 3 0mg ,第 2组用酚妥拉明 2～ 5mg +罂粟碱 10～15mg +川芎嗪 40mg注射液治疗。 　结果 :第 2组勃起时间、勃起硬度足以完成性交例数均优于第 1组 (P <0 .0 5 )。　结论 :ICI合用川芎嗪可延长勃起时间 ,增强勃起硬度 ,减少海绵体内结节发生 ,为一种低价安全的ICI用药     

阴茎海绵体注射结合声视觉性刺激在实时超声诊断血管性勃起功能障碍中的意义

目的探讨阴茎海绵体注射(ICI)结合声视觉性刺激(AVSS)在实时超声诊断血管性勃起功能障碍中的应用价值.方法200名门诊诊断勃起功能障碍(ED)患者.每位患者均先后接受A、B两次实时超声阴茎检查.A即在单独ICI下完成,B即在ICI结合AVSS下完成.检查间隔时间为一周.检查指标包括检测ICI后第5、10、20min的收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、血流阻力指数(RI).结果 A测试中,静脉性ED患者,EDV指标在检测ICI后的第10min明显高于其他时间段,差异有统计学意义(P<0.05).B测试中,动脉性ED患者,PSV 指标各时间段差异均有统计学意义(P<0.05),且动静脉混合型ED患者,EDV指标在ICI后第5min明显高于其他时间段,差异有统计学意义(P<0.05).通过超声检查诊断,A测试中动脉性、静脉性、动静脉混合型以及非血管性ED的情况是34例(17%)、35例(17.5%)、31例(15.5%)和100例(50%);而在B测试中各组情况是27例(13.5%)、44例(22%)、7例(3.5%)和122例(60.7%).两次检测比较发现,A测试中,动静脉混合型ED显著高于B测试,而B测试中非血管性ED显著高于A测试(P<0.05).结论实时超声检测中联合应用ICI和AVSS可提高阴茎勃起反应,这种方法有助于提高超声评估阴茎海绵体血管功能的准确性.     

多普勒超声在静脉性勃起功能障碍诊断中的应用价值研究

目的：探讨Doppler超声在静脉性勃起功能障碍（ED）诊断中的应用价值。方法：10例静脉性ED者在阴茎海绵体内血管活性药物注射（ICI）后，行Doppler超声检查，并同时海绵体内灌注生理盐水，动态观察不同勃起状态海绵体动脉舒张期血流变化，30例心理性ED者仅ICI后行Doppler超声检查作对照。结果：静脉性ED者在勃起硬度差时，海绵体动脉舒张期表现为前向血流（正值表示），随着海绵体内生理盐水灌注后，勃起硬度逐渐增加，舒张末期血流消失；达正常勃起时，舒张期表现逆向血清（负值表示）。心理性ED者在阴茎膨胀期、海绵体动脉舒张期表现前向血流，正常勃起时，舒张期表现逆向血流。结论：在海绵体动脉供血正常情况下，静脉关闭障碍导致海绵体内压受损，舒张期出现血流动力学异常，前向血流为一特征性表现，因此Doppler超声在静脉性勃起功能障百的诊断中具有一定价值。     

阴茎肱动脉压力指数(PBI)测定的临床意义

目的　探讨阴茎肱动脉压力指数 (PBI)对勃起功能障碍 (ED)筛诊的临床意义。方法　①采用DT 2 10 0型多谱勒血流探测仪测定 4 2例主诉ED患者的阴茎背动脉收缩压 ,采用水银血压计测量肱动脉收缩压 ,求得PBI值 ;②阴茎海绵体内注射罂粟碱针30mg(ICI)试验后再次测量PBI值 ;③对 7例PBI<0 .75和 16例PBI>0 .75的患者进行了彩色双功能多谱勒超声检查。结果　①阴茎疲软状态下 4 2例患者的PBI值为 0 .5 9～ 0 .93,其中有 7例PBI<0 .75 ,平均为 0 .83;②在ICI试验后有 35例患者能诱发勃起 ,其PBI值为 0 .83～ 1.5 4 ,平均为 1.0 3;③ICI试验勃起欠佳的 7例 ,PBI<0 .75 ,经彩色双功能多谱勒超声检查诊断为血管混合性ED。其中有 1例PBI<0 .6 ,以动脉性ED为主。结论　PBI的测定对血管性ED的诊断具有筛诊意义 ,它是一种无创、简便、经济、实用的一种诊断手段     

中药振阳煎对动脉性勃起功能障碍患者阴茎血流动力学的影响

目的:通过中药振阳煎对动脉性勃起功能障碍(ED)患者阴茎血流动力学的临床观察,探索对动脉性ED 患者有效的治疗方法。　方法:47例(40～49岁)动脉性ED患者,用中药振阳煎口服治疗1个月,治疗前后均采 用罂粟碱30mg+酚妥拉明1mg进行阴茎海绵体内注射(ICI),并运用双功能彩色多普勒超声检查治疗前后阴茎 左右海绵体动脉收缩期最大血流流率(PSV)。　结果:47例患者经中药振阳煎治疗后,左右两侧海绵体动脉PSV 明显改善(P<0.05)。　结论:中药振阳煎能明显改善动脉性ED患者的阴茎海绵体动脉血流,有效促进阴茎勃起。     

海绵体内注射亚甲蓝治疗阴茎异常勃起

20 0 1年 3月～ 2 0 0 2年 6月 ,我们采用海绵体内注射亚甲蓝治疗因注射罂粟碱等血管活性药物而导致的阴茎异常勃起病人 5例 ,疗效满意 ,报告如下。1　资料和方法1.1　临床资料　本组病人 5例 ,年龄 2 9～ 4 8岁 ,平均 4 2 .5岁 ,均因治疗勃起功能障碍 (erectiledisfunc tion ,ED)行阴茎海绵体注射罂粟碱 +酚妥拉明导致阴茎长时间勃起。发病至就诊时间 4～ 9h ,平均 6.4h。其中 2例就诊前于外院行阿拉明海绵体内注射、海绵体穿刺抽吸等无效后转来我院。1.2　治疗方法　先行海绵体穿刺抽吸 ,抽出瘀血30～ 5 0ml,然后将 1%亚甲蓝注射液 (江苏…     

VISER检查鉴别心理性与器质性勃起功能障碍(附320例报告)

目的应用VISER鉴别心理性与器质性ED并利用该方法对心理性ED严重性进行客观分级。方法320例ED患者接受了VISER检查。首先海绵体内注射罂粟硷10mg；未诱发勃起，药物剂量增至30mg。将药物试验阳性者定义为心理性ED，并根据海绵体压力、波幅形态以及药物剂量将心理性ED分为轻、中、重二度。两次检查均失败者，行阴茎彩色多普勒超声和海绵体造影检查。结果本组中，心理性ED占81．9％，其中轻度、中度和重度者分别占19．8％，60．7％和19．5％。在部分病例中，检查结果与Zung氏抑郁量表评分具有一定相关性。33例接受阴茎多普勒超声或海绵体造影检查提示，正常13例，动脉性ED5例，静脉性ED9例，动脉静脉混合性ED6例。结论VISER有助于签别心理性与器质性ED，依据其结果对心理性ED严重程度进行客观分级，便于对患者选择有针对性的治疗。     

Pharmaco-induced erections for penile color-duplex ultrasound: oral PDE5 inhibitors or intracavernosal injection?

To prospectively compare the clinical responses and penile color-duplex ultrasound (PCDU) results of oral PDE5 inhibitors (PDE5-Is) with papaverine intracavernosal injection (ICI) and to evaluate whether PDE5-Is could be used as alternatives to vasoactive agent injections, 25 ED patients underwent PCDU three times with an interval of at least 1 week, using different pharmacological induction: ICI mode (30-60?mg papaverine), sildenafil mode (100?mg sildenafil) and tadalafil mode (20?mg tadalafil). The preference of the patients was collected when all tests were completed. No significant differences were found in peak systolic velocity and acceleration time among all three modes. However for the ICI mode, end diastolic velocity of the right cavernosal artery was significantly higher than those of the sildenafil and tadalafil modes 5?min after erection induction, and at 15?min it became lower than those of two PDE5-I modes. Consequently, resistance index of the right cavernosal artery in ICI mode was reversed at 5 and 15?min. In all, 60.0 and 56.0% patients managed to reach full erection in PDE5-Is modes, which was significantly lower than in ICI mode (80.0%). Therefore, although PDE5-Is and papaverine ICI showed similar effects on PCDU parameters in detecting arterial ED, more patients had better clinical responses to ICI, and oral PDE5-Is administration still showed some pitfalls in practical use.     

Clinical and sonographic assessment of the side effects of intracavernous injection of vasoactive substances

The objective of this study is to evaluate the side effects of intracavernous vasoactive agents on clinical and sonographic basis. Two groups of patients were included, group I included 168 ED patients trained on self-injection therapy using one of the three protocols. Protocol A: papaverine; protocol B: PGE1; and protocol C: trimix (papaverine, phentolamine and PGE1). Patients were followed up clinically, sonographically and by laboratory investigations for 6 months to evaluate the occurrence of side effects. Group II included 21 patients presenting to our department for the first time with a complication of intracavernous injection pharmacotherapy (ICI) initiated elsewhere. In all, 168 patients of group I completed the study. Patients on papaverine had the highest incidence of complications concerning prolonged erection, subcutaneous hematoma and penile fibrosis. Postinjection penile pain was observed more with groups B and C than group A. No systemic side effects were reported. Duplex ultrasound was beneficial in detecting mild clinically impalpable fibrosis. In total, 10 patients of group II presented with prolonged erection, seven with penile fibrosis, three with cavernositis and one with intracavernous needle breakage. We conclude that although ICI therapy is an effective second-line treatment option, patients on a self-injection program should be followed up both clinically and sonographically both at the initiation phase and on regular follow-up visits.     

Usefulness of power Doppler ultrasonography in evaluating erectile dysfunction

OBJECTIVE: To evaluate deep penile arterial flow after an intracavernosal injection with papaverine in patients with erectile dysfunction (ED). PATIENTS AND METHODS: Twenty patients with ED were evaluated using power Doppler ultrasonography with a linear probe (8 MHz). Diagnostic tests were undertaken after an intracavernosal injection with 40 mg papaverine. The peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) were analysed. RESULTS: After injecting papaverine, seven patients had a normal erection and appropriate waveform patterns; their mean PSV was 30.7 cm/s, the EDV 4.42 cm/s and the RI 0.85. There was tumescence and elongation of the penis with no rigidity in eight patients; their mean PSV was 23.9 cm/s, the EDV 7.34 cm/s and the RI 0.72. There was no erection in five patients. The abnormal flow values showed insufficient arterial vessels in a quarter of the men, venous leakage in 15% and mixed ED in 20%. CONCLUSION: The power Doppler technique allows the accurate location and evaluation of deep penile arteries. Vascular pathology may be differentiated after an intracavernosal injection with a vasomotor agent. Recognising the pathological pattern assists in choosing the best method of treatment.     

Duplex scanning in suspected vasculogenic impotence: a worthwhile exercise?

The value of duplex scanning in the assessment of impotence was evaluated in 146 impotent men. Scanning was by means of a Diasonics DRF 400 and penile artery measurements were taken before and after the intracorporeal injection of papaverine hydrochloride. The penile/brachial index was measured in 82 patients and its predictive value compared with the results of duplex scanning and papaverine-induced erection. On scanning evidence of good arterial inflow but poor erections, indirect evidence of venous leakage was assumed. The results showed that the deep artery responses best characterised the erectile response, with the dorsal artery being less helpful. All 37 patients with full erections following papaverine exhibited bilateral deep artery peak velocities of greater than or equal to 25 cm/s. Of the remaining 109 sub-optimal responders, 17 also has this finding; all had undergone dynamic cavernosography, with 16 exhibiting venous leakage. The penile/brachial index was found to classify 13 patients incorrectly. A critical value of deep artery response to attain erection is postulated, enabling more logical use of cavernosography. The penile/brachial index was shown to be suspect and it was concluded that duplex scanning is a useful, non-invasive method in the assessment of impotence.     

Determination of erectile penile volume by ultrasonography

A total of 58 men with organic erectile dysfunction underwent penile blood flow studies with a 10 MHz. high resolution ultrasonogram and pulsed Doppler analysis after papaverine injection. The average volume increase for the entire group was 52.62 cc (445.9 per cent). No statistical differences in volume increase were noted among 3 groups separated by age. The average volume increase in 23 patients with venous insufficiency was greater than that in 20 patients with primary arterial insufficiency (p less than 0.033). Eleven patients who had erections satisfactory for vaginal penetration after papaverine injection had a statistically greater increase in penile length but no difference in volume increase than those with a poor response. The 10 MHz. high resolution sonogram provides the most accurate assessment of penile volume, which if measured at specific intervals after papaverine injection should allow an accurate assessment of penile flow. Patients with venous insufficiency may have weakness of the tunica, allowing greater volume expansion. A satisfactory erection is not associated with a significant increase in volume.     

Objective penile vascular response to intraurethral prostaglandin E2 (dinoprostone)

PURPOSE: Intraurethral prostaglandin E2 (PGE2) administration is a noninvasive treatment modality for erectile dysfunction. The purpose of this study was to evaluate the objective effects of this agent by measuring peak systolic velocities of cavernosal arteries after intraurethral PGE2 administration and comparing with the results obtained with an intraurethral placebo gel and intracavernous papaverine injection. MATERIALS AND METHODS: The study group consisted of 22 consecutive impotent volunteers with a mean age of 46 years who had normal penile arterial responses as determined by penile arterial responses on papaverine-stimulated penile duplex ultrasonography. The peak systolic velocity in cavernosal arteries was recorded after intracavernous injection of 60 mg of papaverine. All patients received 1 mg of intraurethral PGE2 gel and placebo at 15-day intervals. The peak systolic velocities were recorded after each treatment. RESULTS: Mean peak systolic velocity achieved by intraurethral administration of PGE2 gel (25 +/- 8 cm/s) was less than that achieved by intracavernous papaverine (40 +/- 6 cm/s) but higher than that obtained by placebo (15 +/- 4 cm/s). Twelve patients had erections, while 9 had partial and 1 had no erection with intraurethral PGE2. Placebo did not cause any erections. No serious side effects were observed. CONCLUSION: Intraurethral administration of PGE2 appears to be an effective and simple method for increasing penile arterial flow and can be used during penile Doppler ultrasonography to stimulate the penile arterial system.     

The value of using a facilitating dose of papaverine chlorhydrate during cavernometry

In order to establish diagnostic cavernometric criteria, we selected 63 patients who did not respond positively to visual sexual stimulation. They were subjected to the following protocol including Rigiscan monitoring of 2 or 3 nights erections for, hormonal assays, penile doppler, cavernometry and cavernography. Intracorporeal injection of 8 mg of papaverine was performed during the hemodynamic tests. Our results showed that the erection maintenance blood flow and the maintenance index are statistically reliable diagnostic criteria for venous leaks (the maintenance index is more accurate). The use of 8 mg of papaverine reduces the incidence of false positive results without significant hemodynamic changes. In order to exclude psychogenic false positive patients, it is recommended to select the candidates for cavernometry after papaverine tests and nocturnal penile tumescence and rigidity monitoring.     

Induction of an erection using papaverine

In 61 patients erectile impotency was treated with papaverine injections into penile spongy body: initially 20-30 mg/day, then followed several days of intermittence, and then the dosages were built up with regard to the optimum time of erection for each person. Dosages higher than 80-100 mg were not advisable because of the evidence of prolonged erections. Recorded in 6 patients (7 times) prolonged erections lasted from 5 to 16 hrs (in 5 cases it was stopped by intracavernous injection of dopamine but in 2 patients cavernotomy was performed). A total of 300 sessions of papaverine intracavernous injections were made in 61 patients before the copulation (out of them 16 patients injected the drug themselves). During the treatment the patients were warned against prolonged erections: when it lasted for more than 4 hrs emergency clinical treatment be required for priapism prevention. It was proved that an adequate dosage of papaverine autoinjections into a spongy body was a simple, safe and effective method to cure erectile impotency, especially in patients with nonadvanced psychoneurological or vasculogenic disorders.