电刺激阴茎海绵体神经测定大鼠勃起功能的方法探讨

目的:探讨电刺激阴茎海绵体神经(CN)测定大鼠勃起功能的方法。方法:选择4月龄雄性SD大鼠20只,体质量(425±25)g。左颈总动脉内插管,直接法持续监测大鼠平均动脉压(MAP);左侧海绵体内插管测定阴茎海绵体内压(ICP);前列腺右侧叶前外侧表面暴露右侧CN,通过电刺激CN诱发阴茎勃起。电刺激参数为:5V,2ms,25Hz,每次刺激持续1min,间隔5min重复电刺激,共刺激3次。电刺激CN前的(ICP/MAP)×100(rR)代表阴茎海绵体的静息状态;电刺激CN后的(ICP最大值/MAP)×100(bR)代表阴茎海绵体的勃起状态或大鼠的基础勃起功能;bR/rR代表阴茎勃起后ICP的增高程度。结果:电刺激CN使ICP明显升高,MAP变化不大,表明电刺激可有效诱发勃起。ICP、MAP、rR、bR、bR/rR等各项指标3次重复测定之间的差异均无统计学意义(均P>0.05),表明电刺激法结果稳定。rR、bR和bR/rR总的平均值分别为(12.00±2.62)%、(67.68±11.28)%和(5.85±1.80)。结论:电刺激阴茎CN测定大鼠勃起功能的方法稳定易重复,能够客观准确地评估阴茎的勃起程度,是研究阴茎勃起功能的重要技术,值得在国内推广。     

阴茎海绵体内注射血管活性药物排除血管性阳萎的应用

对６７０例阳萎患者采用不同血管活性药物及不同剂量进行阴茎海绵体内注射（ＩＣＩ）以排除血管性阳萎，结果９１．５％的非血管性和阳萎患者在应用罂粟碱３０ｍｇ加酚妥拉明１ｍｇ后可获充分勃起，还有２．０％的患者在罂粟碱加至６０ｍｇ时方获充分勃起；而对罂粟碱注射反应不佳的非血管性阳萎患者注射前列腺素Ｅ１（ＰＧＥ１）２５μｇ后，有０．９％的患者获充分勃起，当ＰＧＥ１加至５０μｇ时又有０．２％的患者获得勃起，提示     

阴茎海绵体药物注射治疗勃起功能障碍19年1例报告

阴茎勃起功能障碍(ED)是指阴茎不能勃起和(或)不能维持勃起以达到满意的性生活,是男性最常见的性功能障碍之一.ED的治疗方法多种多样,有第一线的口服药物和负压式辅助装置等;第二线的阴茎海绵体内药物注射(ICI)以及经尿道内给药;第三线的假体植入手术治疗等([1]).     

海绵体内注射尿激酶治疗早期阴茎异常勃起

自 198 9年 1月～ 1999年 1月共收治阴茎异常勃起 7例 ,其中 6例属早期 ,采用海绵体内注射尿激酶 ,效果满意 ,现报告如下。临床资料与方法1.一般资料　本组 6例 ,发病至就诊时间 5～2 4小时 ,年龄 2 6～ 4 7岁 ,追问病史海绵体内注射罂粟硷、酚妥拉明 3例 ,酗酒后性交 1例 ,重复性交 1例 ,不明原因 1例。2 .治疗方法　采用国产尿激酶 10 0 0 0ｕ溶于生理盐水 5ｍｌ,然后注射于海绵体一侧 ,如半小时内无效 ,则以同量尿激酶注射海绵体另一侧。结果5例患者注射尿激酶 15～ 30分钟后 ,阴茎开始变软并很快勃起消失 ,1例经两次注射后勃起消失 ,随…     

海洛因阴茎海绵体内注射致阴茎异常勃起1例

随着毒品的泛滥，海洛因静脉依赖者日益增多，由于长时间使用海洛因后，他们中大多数都伴有不同程度的阴茎勃起功能障碍，为了寻求性刺激，有人盲目地采用海洛因直接注入阴茎海绵体内，使阴茎勃起，完成性交。我院于2003年2月收治了1例因使用海洛因阴茎海绵体内注射诱发阴茎异常勃起，时间长达1周的患者，现报告如下。     

阴茎海绵体内注射川芎嗪对兔阴茎勃起效应的影响

目的 观察阴茎海绵体内注射川芎嗪对兔阴茎勃起效应的影响.方法 12只成年雄性新西兰大白兔,静脉麻醉后游离一侧颈总动脉和阴茎海绵体,颈总动脉插管与电生理记录仪连接监测平均动脉压(MBp),阴茎海绵体内置入25 G针头与电生理记录仪连接用于测定阴茎海绵体内压(ICP).通过在兔阴茎海绵体内注射不同剂量(0.5～5.0 mg/kg)川芎嗪和等体积生理盐水,分别记录ICP变化(ICP)、阴茎膨胀持续时间(DT)和MBp的变化.结果 阴茎海绵体内分别注射不同剂量的川芎嗪(0.5、1.0、2.0、5.0 mg/kg),ICP分别由基线增加至(19.1±3.7)、(24.8±2.1)、(30.2±4.8)、(39.7±6.1)mm Hg(1 mm Hg=0.133 kPa), ICP为6.5～25.8 mm Hg,最大ICP为(25.8±5.9)mm Hg,DT为(8.5±2.8)～(22.9±7.3)min.阴茎海绵体内注射川芎嗪呈剂最依赖性提高ICP(P<0.05),对MBp没有显著影响(P>0.05).结论 川芎嗪呈剂量-效应依赖性地增强兔阴茎勃起效应.     

勃乐斯阴茎海绵体内注射治疗心理性阳萎

本院至今共收治阳萎门诊病人８０例，其中心理性阳萎６０例（已除外血管性、神经性、内分泌性因素）。用勃乐斯阴茎海绵体注射获得满意疗效，报告如下。临床资料１．一般资料：本组男性６０例，年龄２１～６５岁，平均４０岁，病程６月～２０年，平均１１．５年，诉晨间均有自发性阴茎勃起，同房前１０分钟，海绵体内注射勃乐斯一支（含前列腺素E１３０μg）。２．结果：５分钟后阴茎充分勃起，持续时间从２０分钟至２小时不等，平均４７分钟，无异常持续勃起。其中３例出现轻微头晕，自行好转，１例因药物部分注于皮下，出现包皮水肿，６…     

选择性阴茎背神经分支切断术治疗原发性早泄

目的:评价选择性阴茎背神经分支切断术治疗原发性早泄(PPE)的安全性和有效性。方法:2003年9月～2006年12月,对483例PPE实施了选择性阴茎背神经分支切断术,患者年龄21～71岁,平均32岁。术中保留两条分支,其余分支均予以切除。切除分支3支者89例,4支者183例,5支者125例,6支者38例,7支者32例,8支者12例,9支者3例,10支者1例。手术后4周开始性生活,随访3～36月。结果:术后所有病例阴茎敏感性均下降,射精潜伏期延长显效352例,好转93例,无效38例,总有效率92.13%。无切口感染,无切口出血,无勃起功能障碍。结论:选择性阴茎背神经切断术致阴茎敏感性下降效果确切,治疗PPE安全、有效。     

阴茎背神经局部解剖学研究及其临床意义

目的:研究正常人阴茎背神经数目、走行和分布及其在阴茎背神经选择性切断术治疗原发性早泄手术中的应用价值。方法:解剖38具成年男性尸体阴茎,显露阴茎背神经,记录阴茎背神经的数目及走行、分布。选择314例原发性早泄患者行阴茎背神经选择性切断术,患者年龄20～45岁,病程1～22年。结果:38具尸体阴茎背神经平行分布于阴茎背侧和两侧面,4具尸体阴茎背神经分支分布到阴茎腹侧面;38具尸体阴茎背神经数目为(3.6±1.2)支,其中7支1例,6支1例,5支6例,4支9例,3支14例,2支7例。314例原发性早泄患者阴茎背神经数目为(7.0±1.9)支:其中5支64例,6支56例,7支52例,8支40例,9支33例,10支28例,11支25例,12支11例,13支5例。手术后阴道内射精潜伏期为(4.31±1.87)min,性生活满意度为(61±17)%,与手术前[(1.24±0.32)min;(23±6)%]相比,差异有显著性(P均<0.01)。结论:阴茎背神经数目异常增多可能是原发性早泄的病理学基础,阴茎背神经选择性切断术治疗原发性早泄安全、有效。     

Potentiation of reflex erectile responses in the anaesthetized rat by the selective melanocortin receptor 4 agonist MB243

OBJECTIVE

To assess the potentiation of erectile responses induced by electrical stimulation (ES) of the dorsal penile nerve (DPN) in the urethane‐anaesthetized rat by the selective melanocortin receptor 4 agonist MB243.

MATERIALS AND METHODS

Intracavernosal and blood pressures (ICP and BP, respectively) were monitored in urethane‐anaesthetized rats after complete spinal cord transection at the thoracic level. Erectile responses were induced by ES of the DPN (train of square wave pulses of 1 ms and 6 V for 20 s at 1, 2 and 5 Hz) after i.v. injection of either saline or MB243, 3 mg/kg, in two groups of six rats. The maximal and mean ICP, and the area under the curve (AUC) of the ICP response, corrected for the corresponding BP, were measured and used as an index of erectile function (ICPmax/BP, ICPmean/BP and AUC/BP, respectively).

RESULTS

MB243 increased the number of spontaneous erections between the injection and the first ES when compared with the vehicle group, but this difference was not statistically significant. ES of the DPN induced frequency‐dependent erectile responses, the mean (sem ) ICPmean/BP was 0.26 (0.02), 0.34 (0.04) and 0.39 (0.05) after administration of saline (vehicle) at 1, 2 and 5 Hz, respectively. All the variables, except the ICPmax/BP at 5 Hz, were significantly increased in the group injected with MB243 when compared with the vehicle group (P < 0.05 for ICPmax/BP and ICPmean/BP; P < 0.01 for AUC/BP). The AUC/BP showed the greatest increases of (+79%, +60% and +44% at 1, 2 and 5 Hz, respectively) in the group injected with MB243 compared with the vehicle group.

CONCLUSION

Erectile responses induced by ES of the DPN in spinalized, urethane‐anaesthetized rat are suitable for evaluating the proerectile facilitator activity of selective peripherally restricted melanocortin receptor 4 agonists. This model represents a valuable alternative to the classically used cavernous/pelvic nerve stimulated model.     

阴茎背根神经阻滞在男性儿童导尿困难中的应用探讨（附20例报告）

目的：探讨男性儿童在尿道外括约肌无法松弛而致导尿困难时应用阴茎背根神经阻滞（DPNB）的临床价值。方法：回顾性分析总结20例导尿困难的男性儿童应用1％利多卡因进行DPNB的经验。导尿过程中患儿的疼痛程度用Oucher量表评估。结果：20例患儿均为尿道外括约肌的无法松弛而致导尿管插入困难者,应用DPNB后,均导尿成功。背根神经阻滞后,患儿在导尿过程中较麻醉前疼痛减少（P〈0．05）。平均操作时间8（6～12）min。导尿过程以及导尿后无并发症。结论：虽然DPNB并非男性儿童导尿时的常规操作,但尿道外括约肌紧张所致导尿困难时应用DPNB安全有效。     

A simple and reliable monitoring system to confirm the preservation of the cavernous nerves

BACKGROUND: It is important to establish a procedure with which to confirm the preservation of the cavernous nerves during nerve-sparing radical surgery. For this purpose, we examined changes in intracavernous pressure (ICP) following electrical stimulation of the neurovascular bundle (NVB) with respect to the continuity of the cavernous nerves. METHODS: Six cases of radical prostatectomy and eight cases of radical cystoprostatectomy were examined. In all cases, prior to prostate removal, electrical stimulation of the site where the NVB was determined to run was performed and the changes in ICP measured. In eight cases, ICP changes were also measured following prostate removal. RESULTS: Prior to prostate removal, ICP changes could be measured in all 28 sides of 14 cases. These changes were classified into two patterns: stimulation-related increases of convex waveform (t1) were observed in 24 sides (85.7%); and waveforms with reversed type (t2), which was thought to be an incomplete type t1, were observed in four sides (14.3%). There were no ICP changes following non-sparing or incomplete sparing of NVB macroanatomically. Of five sides where the NVB was supposedly completely preserved macroanatomically, ICP changes consisted of type t1 on three sides, t2 on one side and type t2 or no change on a single side. All measurements were obtained within 10 min. Neither electrical stimulation nor measurement of ICP caused any adverse effects. CONCLUSION: Intraoperative stimulation of the NVB while monitoring ICP changes provides a simple and reliable method of accurately evaluating the preservation of the cavernous nerves.     

经皮穴位电刺激复合药物全麻行控制性降压的控压效应分析

目的:探讨经皮穴位电刺激复合药物全麻行控制性降压至不同平均动脉血压(MAP)水平的控压效应变化.方法:54只雄性比格犬随机分为9组,每组6只,控压组动物均以异氟烷复合硝普钠行控制性降压术,单纯全麻组不行控制性降压,实验组采用经皮穴位电刺激(TEAS)干预处理.结果:在行控制性降压至基础MAP60%水平时,在血压回升阶段,实验组动物MAP的回升速度和幅度均高于同水平对照组,在回升30 min时基本恢复至基础水平,对照组仍显著低于其基础水平(P<0.05);与单纯全麻组相比,50%基础MAP对照组、40%基础MAP对照组苏醒时间明显增加(P<0.05);60%基础MAP、40%基础MAP实验组被动放血量明显减少(P<0.05),50%基础MAP、30%基础MAP实验组术中自然失血量明显减少(P<0.05).结论:TEAS能加快机体MAP的恢复,并有效缩短了实验动物的苏醒时间;同时能不同程度的减少术中失血量,从而对机体起到保护作用.     

Penile Arterial Doppler Evaluation in Basal Condition and after Intracavernous Injection of Papaverine

In diagnostic screening, 73 impotent patients were submitted to a Doppler study of the deep penile arteries under basal conditions and after oral nitroglycerin (Basal-DOPPLER) and after intracavernosal injection of 30 mg of papaverine (ICIP-DOPPLER), as well as other tests. The results of the Basal-DOPPLER and the erectile response to intracavernosal administration of 30 mg papaverine (ICIP-30), indicative of the condition of the deep penile arteries, were in total agreement for 33 cases, partial agreement for 29 cases and totally in disagreement for 11 cases. The agreement between the results of the ICIP-DOPPLER and the ICIP-30 was total for 40 cases, partial for 24 and totally lacking for 9. In many of the cases for whom the response to ICIP-30 was less than would have been expected from the ICIP-DOPPLER, abnormal venous outflow was later shown. Our data support the hypothesis that papaverine acts on the venous component of erection. The ICIP-DOPPLER was found to be apparently more reliable than the Basal-DOPPLER for evaluating the arterial component of erection, but Basal-DOPPLER is still the basic screening test before any such invasive test as the ICIP are used, since these latter are not always accepted immediately by the patients.     

Electrical stimulation of the dorsal clitoral nerve reduces incontinence episodes in idiopathic faecal incontinent patients: a pilot study

Aim Faecal incontinence (FI) has a significant impact on quality of life. This study investigates whether stimulation of the dorsal genital nerve (DGN) improves FI symptoms. Method Ten female patients suffering from idiopathic FI (median age 60 years) were included in the study. Stimulation was applied twice daily for 3 weeks at the maximal tolerable stimulation amplitude (pulse width, 200 μs; pulse rate, 20 Hz). Patients kept a 3‐week bowel diary prior to stimulation, during stimulation and after the final stimulation. FI severity scores, FI Severity Visual‐Analogue Score (VAS), FI Quality of Life Score (FIQL), sphincter function and rectal volume tolerance were assessed at baseline, immediately after stimulation and 3 weeks after stimulation. Results Nine patients completed the study. The Wexner score (P = 0.027) and the St Mark’s score (P = 0.035) improved after stimulation in seven and six of the patients and improvement was maintained 3 weeks after stimulation (P = 0.048 and P = 0.049, respectively). The number of incontinent episodes was reduced in seven out of nine patients (P = 0.025). Improvement was maintained for 3 weeks after stimulation (P = 0.017). Subjective assessments of FI severity using the VAS score and the FIQl score did not improve during stimulation. Sphincter function and rectal volume tolerability were unaffected. Conclusion DGN stimulation reduced the number of FI episodes in most patients suffering from idiopathic FI. Sphincter function and rectal volume tolerability were not affected. DGN stimulation may represent a new treatment for idiopathic FI.