去氧肾上腺素治疗TURP术中阴茎勃起(附14例报告)

自2002年11月至2005年1月,我院采用经尿道前列腺电汽化切除术(transurethral resection of prostate,TURP)治疗前列腺增生症419例。术中出现阴茎勃起14例。行阴茎海绵体内注射去氧肾上腺素(新福林),取得良好效果,现总结、报告如下。1资料与方法1.1临床资料本组14例患者,年龄57~     

阴茎海绵体注射在勃起功能障碍诊治中的应用

正阴茎海绵体注射或阴茎海绵体内注射(intracavernous injection,ICI)是泌尿外科/男科常见的临床操作技术,上世纪80年代即已用于男性勃起功能障碍的治疗。本文将对阴茎海绵体注射在勃起功能障碍诊治中的应用进展进行综述。一、阴茎海绵体血管活性药物注射(一)注射方式ICI的目的是将药物注入阴茎海绵体腔内,诱导阴茎勃起以完成对疾病的诊断或治疗。注射部位选择     

处理阴茎勃起障碍的新进展

近20年来，阴茎勃起障碍发病原因已日渐清楚，物理（有机）因素占主要地位。基础和临床研究专注于更好地了解其病因机制，并开发有效的诊治方法。本文将介绍这方面的现况，作者从事处理阴茎勃起障碍已达10年。诊断步骤包括详细病史和体检、性心理评价、激素测定、勃起监护、海绵体内注射试验、阴茎多普勒、动态海绵体灌注试验、海绵体图、海绵体肌电图和阴茎动脉造影等。治疗方法包括性心理咨询和治疗、药物治疗、海绵体注射、尿道内治疗、显微血管（动脉及静脉）外科、阴茎假体植入、海绵体硬结病及其他阴茎异常的外科矫正治疗、真空治疗等…     

罂粟碱阴茎海绵体注射治疗神经性阳萎（附32例报告）

罂粟碱阴茎海绵体注射治疗神经性阳萎（附３２例报告）郭丰富，金光庭，顾润国，宋伟，张淑建关键词罂粟碱；阴茎海绵体；阳萎阴茎勃起是受中枢和周围神经调控的，故神经系统疾患会影响阴茎勃起功能。罂粟碱是一种平滑肌松弛剂，直接注射到阴茎海绵体内可扩张血管，增加动...     

海绵体注射尿激酶治疗阴茎异常勃起

阴茎异常勃起是指无任何性欲要求状态下所呈现的阴茎疼痛性持续性勃起。此症常需要紧急处理 ,延误治疗会导致永久性阴茎勃起功能障碍。现将我院近两年来收治 5例资料报告如下。1　一般资料本组 5例 ,2 4～ 3 3岁 ,平均 2 8岁。 5例中有 4例均为心理性阴茎勃起功能障碍 ,用罂粟碱与酚妥拉明注射于阴茎海绵体内 ,1例为自发性夜间勃起。发病后均于 6ｈ内就诊。2 　 方法与结果采用海绵体注射尿激酶法 ,将国产尿激酶1万Ｕ溶于生理盐水 6ｍｌ,注射于阴茎海绵体的两侧。注射后 2 0ｍｉｎ全部阴茎开始变软 ,勃起消失 ,无任何不适。随访半年无并发症…     

罂粟碱在阳萎诊断及治疗中的应用

1982年Virag首次报告在阴茎海绵体内注射血管扩张剂罂粟碱可引起阴茎勃起。动物实验表明,阴茎海绵体内注射罂粟碱可产生与正常阴茎勃起同样的血液动力学效果。近年来,罂粟碱已广泛用于阳萎的诊断和治疗,获得了较为满意的效果。现综述如下。诊断一.罂粟碱试验方法:用橡皮条扎紧阴茎根部,局部皮肤消毒,将罂粟碱注射在任何一侧阴茎海绵体内,局部压迫2分钟,解除橡皮条,病人站立,以增加盆腔内静脉压力,减少罂粟碱回流至体循环,观察阴茎勃起情况。     

药物所致阴茎持续勃起的诊断及治疗

1977年有人在行阴茎血管手术时偶然发现在阴茎海绵体内注入罂粟碱,阴茎勃起可持续2小时之久。1983年Brindly报告,海绵体内注入酚苄明勃起可达30小时。其后Virag及Zorgnitti几乎同时单用罂粟碱或合用酚妥拉明于阴茎根部注射治疗阳萎。近几年来,阳萎治疗的重要进展就是血管活性药物罂粟碱及α-肾上腺素能阻滞剂的使用。目前国内也有人用以上两种药物治疗阳萎。这样就增加了药物所致阴茎持续勃起(pharmacologically induced prolonged erection,PIPE)的发生机会。一、血管活性药物的作用机理阴茎勃起是由神经冲动引起的,神经冲动是由盆神经(含副交感神经纤维)及腰交感     

勃起功能障碍病人阴茎海绵体血浆中降钙素基因相关肽含量的研究

目的　了解阴茎勃起前后 ,阴茎海绵体内血浆中降钙素基因相关肽 (CGRP)含量。方法　对不同组受检者行海绵体内注射生理盐水、盐酸罂粟碱、盐酸罂粟碱和酚妥拉明混合液。每次注药间隔时间超过 3 0分钟 ,注药前后取海绵体内血液测定CGRP含量。结果　正常人及各类ED在海绵体内注射血管活性药物后阴茎均发生勃起。在阴茎勃起过程中海绵体内血浆CGRP含量升高 (P <0 .0 5 )。周围静脉注射罂粟碱和酚妥拉明混合液的受检者 ,注药后周围静脉血浆CGRP含量无变化 (P >0 .0 5 )。结论　CGRP是参与人类阴茎勃起的重要神经递质     

胰岛素治疗糖尿病大鼠阴茎勃起功能障碍的研究

目的 观察糖尿病(diabetes mellitus,DM)大鼠胰岛素治疗后阴茎勃起功能的情况及阴茎海绵体细胞凋亡、Bcl-2和Bax的基因表达.方法 成年雄性Wistar大鼠50只.腹腔内注射链尿佐菌素(STZ)建立糖尿病动物模型,成模后8周根据阴茎勃起功能的情况,随机分成未行胰岛素治疗组(DM组)和胰岛素治疗组.胰岛素治疗组大鼠治疗16周后,处死并取阴茎海绵体,测血糖及糖化血红蛋白,用原位末端标记法(TUNEL)检测细胞凋亡,western blot方法检测阴茎组织Bcl-2、Bax蛋白的表达.结果 DM组大鼠阴茎勃起功能明显低于胰岛素组.胰岛素组血糖及糖化血红蛋白下降(P＜0.001),DM组大鼠较胰岛素治疗组大鼠阴茎海绵体凋亡细胞数明显增多,Bax表达增强,Bcl-2表达减弱.结论 DM大鼠胰岛素治疗后,阴茎海绵体细胞凋亡率减少,阴茎勃起功能改善,Bcl-2和Bax可能参与了DM大鼠阴茎海绵体细胞凋亡的基因调控.     

阴茎异常勃起的诊疗体会(附14例报告)

目的探讨阴茎异常勃起的诊断及治疗。方法回顾性分析14例阴茎异常勃起患者的诊治经过。结果通过体查、海绵体抽吸血气分析及多普勒超声扫描等方法,低流量型阴茎异常勃起13例,高流量型1例。经保守、海绵体抽吸、肾上腺素海绵体内注射治疗及手术处理,患者勃起均消退。随访3～16个月,5例出现勃起功能丧失。结论准确判断阴茎异常勃起的类型有助于治疗方式的选择,阴茎海绵体血气分析结合多普勒超声扫描有助于分类的判断；阴茎海绵体穿刺抽吸结合肾上腺素反复灌洗,是一种简单、有效和副作用较少的治疗异常勃起的方式。     

阴茎勃起机制的实验研究

为了进一步了解阴茎勃起机制，以３１条犬为对象，对阴茎海绵体的特征进行了研究。以２～１０Ｖ，１０～３０Ｈｚ的正方波刺激盆神经（ＰＮＳ），观察阴茎海绵体内压（ＩＣＰ）、动脉血流（Ａｆ）和静脉血流（Ｖｆ）的变化，以及阻断腹主动脉后ＰＮＳ时ＩＣＰ、Ａｆ和Ｖｆ的变化。结果发现ＩＣＰ在ＰＮＳ结束后的变化趋势是阴茎海绵体的本身特征。证明了阴茎海绵体是阴茎勃起的功能主体，并首次提出，在勃起过程中可能存在着动脉抗返流机制     

The hemodynamics of erection at the level of the penis and its local deterioration

We have studied penile structure in 300 specimens from cadavers, 3,000 patients undergoing general physical examination and more than 700 patients operated on for organic impotence. Special attention has been focused on the closure mechanism of the corpora cavernosa during erection. Venous outlets of the corpora cavernosa normally are situated only on the distal third of the ventral penile surface. A firm, lasting erection requires a tight albuginea of the corpora cavernosa, with perfect closure of the venous outlets. During life use of the penis or, eventually, misuse by repeated long-lasting, firm erections (high pressure in the corpora cavernosa) results in deterioration of the tightness of the albuginea, especially when the albuginea is thin (25 per cent of the cases). We have found that a leakage factor of the corpora cavernosa is the most frequent cause of organic impotence in aging men.     

Cavernospongious shunts: anatomical study of intrapenile vascular pathways.

OBJECTIVES: The reality of cavernospongious shunts has never been confirmed and their role in penile erection remains undetermined. We aim to describe the intrapenile vascular anatomy as the precise nature of the connections between the corpus spongiosum, the glans and the corpora cavernosa remains unknown. METHODS: Ten human penises were removed from adult male cadavers 8 days after arterial casting with latex. In four specimens coloured latex was injected into the corpus spongiosum. Ex situ microdissection was performed to analyse the origin and distribution of the penile arteries. The anastomotic arterial pathways were dissected. RESULTS: In all the specimens, 6-10 anastomoses were found between the cavernous arteries (a. profundae penis) and the spongious arterial network. These arteries arose at regular intervals from the cavernous arteries and perforated the tunica albuginea vertically to anastomose with urethral arteries (a. urethralis). No arteriovenous shunts were found between the corpus spongiosum and the corpora cavernosa, nor was there any venous drainage from the corpus spongiosum entering the corpora cavernosa. CONCLUSION: These shunts are arteries connecting the urethral and cavernous arteries. Cavernospongious arterial anastomoses were found in all the cadavers dissected. Further studies are needed to determine their role in penile erection.     

Hemodynamics of erection in the monkey

Being able to induce controlled erection in dogs and monkeys, we investigated the hemodynamics and mechanism of penile erection. 'Chronic' monkey models, having had electrodes implanted around the cavernous nerves for electroerection, were studied to evaluate the details of the hemodynamic changes. The studies included: 1) arterial blood flow, 2) corporeal pressure, 3) blood gases, 4) venous flow and 5) radiography. Tumescence of the corpora cavernosa was found to be a result of: 1) active relaxation of the sinusoidal spaces, 2) active arteriolar dilatation and 3) active venous outflow constriction. At full erection there is adequate but reduced blood flow into and out of the corpora cavernosa for metabolic exchange.     

Mechanisms of venous occlusion during canine penile erection: an anatomic demonstration

Hemodynamic studies have clearly demonstrated that intracorporeal injection of papaverine causes an increase of venous outflow resistance, and we therefore undertook a study of the venous drainage of the canine penis to delineate the anatomic changes in the venular structure during papaverine-induced erection. In 11 dogs, the corpora cavernosa were examined by corrosion casting in six and serial trichrome staining and histologic sectioning in five. Low-power scanning electron microscopy of the corrosion casts demonstrated the existence of a venular plexus interposed between the tunica albuginea and the sinusoidal spaces. After papaverine injection, this subalbugineal venular plexus is compressed between the dilated sinusoids from below and the tunica albuginea from above, such that venous drainage is effectively impeded. Examination of two cadaveric human penile corrosion casts by low-power scanning electron microscopy revealed evidence of a similar subalbugineal venular plexus draining into the emissary veins along the shaft of the penis. Based on the above, a model for the anatomic basis of venous occlusion during penile erection is outlined. Along with arteriolar and sinusoidal smooth-muscle relaxation, this can account for the three basic hemodynamic changes necessary for erection: increased arterial inflow, increased intracorporeal pressure, and increased venous outflow resistance.     

A new technique for augmentation phalloplasty: albugineal surgery with bilateral saphenous grafts--three years of experience

OBJECTIVES: Penile augmentation surgery is a highly controversial issue due to the low level of standardisation of surgical techniques. The aim of the study is to illustrate a new technique to solve the problem of enlarging the penis by means of additive surgery on the albuginea of the corpora cavernosa, guaranteeing a real increase in size of the erect penis. METHODS: Between 1995 and 1997, 39 patients who requested an increase in the diameter of their penises underwent augmentation phalloplasty with bilateral saphena grafts. The patients considered eligible for surgery were patients with either hypoplasia of the penis or functional penile dysmorphophobia. All the patients included in our study presented normal erection at screening. The average penis diameter in a flaccid state and during erection was found to be 2.1cm (1.6-2.7 cm) and 2.9 cm (2.2-3.7 cm), respectively.Before surgery the patients were informed of the experimental nature of the surgical procedure. The increase in volume of the corpora cavernosa was achieved by applying saphena grafts to longitudinal openings made bilaterally in the albuginea along the whole length of the penis. RESULTS: No major complications and specifically no losses of sensitivity of the penis or erection deficiencies occurred during the post-operative follow-up period. All the patients resumed their sexual activity in 4 months. A measurement of the penile dimensions was carried out 9 months after surgery. No clinical meaningful increases in the diameter of the flaccid penis were documented. The average penis diameter during erection was found to be 4.2 cm (3.4-4.9) with post-surgery increases in diameter varying from 1.1 to 2.1cm (p<0.01). CONCLUSIONS: The penile enlargement phalloplasty technique with albuginea surgery suggested by the authors definitely is indicated for increasing the volume of the corpora cavernosa during erection. Albuginea surgery with saphena grafts has been found to be free from aesthetic and functional complications with excellent patient satisfaction.     

Anatomy of the human penis: the relationship of the architecture between skeletal and smooth muscles

To investigate the anatomy of the ischiocavernosus muscle, bulbospongiosus muscle, and tunica albuginea and to determine their relationships to smooth muscle, which is a key element of penile sinusoids, we performed cadaveric dissection and histologic examinations of 35 adult human male cadavers. The tunica of the corpora cavernosa is a bilayered structure that can be divided into an inner circular layer and an outer longitudinal layer. The outer longitudinal layer is an incomplete coat that is absent between the 5-o'clock and 7-o'clock positions where 2 triangular ligamentous structures form. These structures, termed the ventral thickening, are a continuation of the anterior fibers of the left and right bulbospongiosus muscles. On the dorsal aspect, between the 1-o'clock and 11-o'clock positions, is a region called the dorsal thickening, a radiating aspect of the bilateral ischiocavernosus muscles. In the corpora cavernosa, skeletal muscle contains and supports smooth muscle, which is an essential element in the sinusoids. This relationship plays an important part in the blood vessels' ability to supply the blood to meet the requirements for erection, whereas in the corpus spongiosum, skeletal muscle partially entraps the smooth muscle to allow ejaculation when erect. In the glans penis, however, the distal ligament, a continuation of the outer longitudinal layer of the tunica, is arranged centrally and acts as a trunk of the glans penis. Without this strong ligament, the glans would be too weak to bear the buckling pressure generated during coitus. A significant difference exists in the thickness of the dorsal thickening, the ventral thickening, and the distal ligament between the potent and impotent groups (P < or =.01). Together, the anatomic relationships between skeletal muscle and smooth muscle within the human penis explain many physiologic phenomena, such as erection, ejaculation, the intracavernous pressure surge during ejaculation, and the pull-back force against the glans penis during anal constriction. This improvement in the modeling of the anatomic-physiologic relationship between these structures has clinical implications for penile surgeries.     

In pursuit of the best candidates and procedures for penile revascularization

Coronary bypass surgery to provide better blood flow to deficient areas of the heart is commonplace; the arteries of the heart in which blockage occurs are relatively large, and rerouting of blood is readily accomplished. In the penis, the internal pudendal system that provides arterial inflow can be easily bypassed when injury to a large vessel is the cause of erectile dysfunction. In the great majority of cases of penile arterial disruption, however, large-vessel disease cannot be demonstrated; the problem of low arterial flow originates within the corpora cavernosa, in the so-called helicine arteries. These arteries are very small, and are inaccessible unless the spongy erectile tissue of the corpora cavernosa is violated. In recent years, modest success has been reported in revascularizing the smaller arteries of the penis. The expert panelists in this symposium discuss the indications for such revascularization procedures, compare their techniques, and review the success rate in their work.     

Dynamic cavernosography: venous outflow studies of cavernous bodies

Based on dynamic cavernosography studies in 15 patients, including 8 with simultaneous passive erection, we present more precise details of the venous drainage of the penis. The venous drainage is comprised of 3 different systems. The superficial dorsal vein drains mainly the penile skin and prepuce, and empties via the external pudendal veins into the femoral vein. The deep dorsal vein, located between the tunica albuginea and Buck's fascia, drains the glans and all 3 corpora. The venae profundae penis emerge from each crus of the corpora cavernosa and drain only the corpora themselves. Considerable individual differences were found regarding further drainage via the pelvic venous system, including the prostatovesical plexus and internal pudendal veins. Passive erection was tried in 11 patients and was successful immediately after cavernosography in 8. The flow rates to induce an erection averaged 111 ml. per minute (range 55 to 160 ml. per minute), while the rate to maintain the erection was 48 ml. per minute (range 12 to 90 ml. per minute).     

Erectile dysfunction: anatomical parameters, etiology, diagnosis, and therapy

Functional anatomy of the human penis involves various parameters: cavernous tissue, covering integument, prepuce foreskin, corpora cavernosa, corpus spongiosum, glans, facia, arterial supply, venous drainage, lymph drainage, musculature, and nerve supply. Several factors affect the expression/degree of erectile dysfunction (ED) endocrine profile, aging/senescence, demyelinating diseases, and surgery. Risk factors of ED are: age, vascular factors, metabolic diseases (diabetes mellitus), neurologic diseases, and HIV/AIDS. Several drugs are associated with ED: antiandrogenic, anticholinergic, antidepressants, antihypertensive, major tranquilizers, anxiolytics, and certain medicines/metabolites. The International Index of Erectile Function (IIEF) is a multidimensional scale for assessment of erectile dysfunction. The main structures mediating erection are the corpora cavernosa or "erectile bodies," which are fused distally for approximately three-quarters of their length. They separate proximally to fuse with each ischial tuberosity of the pelvis. On their ventral surface lies the corpus spongiosum, which surrounds the urethra. Coital dysfunction is classified into "erectile dysfunction" (psychosexual and endocrine/neuro-endocrine) and "ejaculatory dysfunction" (psychosexual, and genitourinary surgery). Vasculogenic impotence was evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Cavernosal, alpha-blockade is a technique used to evaluate and treat ED. Another diagnostic procedure for ED involves color floro and spectural Doppler imaging after papaverine-induced erection in impotent men. Color Doppler and duplex ultrasonography are used to evaluate Peyronie's disease. Sildenafil cilrate (Viagra) is an effective therapy of ED in men. Vardenavil is a highly selective phosphodiesterase 5 (PDE5) inhibitor which improved ED. Prostagland E1, vasoactive intestinal polypeptide (VIP), and phentolamine mesylate (administered by autoinjectors) have been applied to treat ED in patients resistant to other intracavernosal agents. Clinical trials were conducted on self-injection of vasoactive drugs, apomorphine SL, and tadalafil in diabetic men. Medical therapy of ED includes: medicated urethral system for erection (MUSE), intravenous pharmacotherapy, arterial revascularization, vacuum devices, two- and three-component inflatable penile prosthesis, semi-rigid penile prosthesis in situ, and inflatable one-piece penile prosthesis. Surgical therapy include procedures to correct Peyronie's penile deformity and penile deformity, procedures to avoid inevitable shortening accompanying Nesbit's disease, and for penile lengthening.