使用间羟胺无效的阴茎异常勃起4例

报告了４例使用间羟胺阴茎海绵体注射治疗无效的阴茎异常勃起，分别采用抽吸放血法或海绵体穿刺灌洗法，以及阴茎－尿道海绵体分流术，白血病确诊后采用化学疗法。结果２例持续勃起时间在１３ｈ内的阴茎异常勃起恢复正常，１例慢性粒细胞白血病经化疗后，２７ｄ后疲软，但功能未能恢复，１例勃起７２ｈ以上未能恢复，出现海绵体纤维化。讨论了阴茎异常勃起的治疗效果同其类型、勃起持续时间、病因有密切关系，以及应当选择的治疗方法     

海绵体抽吸冲洗法治疗阴茎异常勃起体会

阴茎异常勃起是指无性欲要求时阴茎持续痛性勃起．自Ｖｉｒａｇ（１９８２）首先采用罂粟碱注射于阴茎海绵体治疗阳萎以来，阴茎海绵体内注射（ＩＣＩ）已广泛应用于临床，由此引起的阴茎异常勃起病例也明显增多．我院自１９９３－０１～２０００－０９应用海绵体抽吸冲洗法治疗阴茎异常勃起１８例，获得了满意效果，现报道如下．１一般资料 本组１８例，所有病人均为海绵体内注射罂粟碱酚妥拉明后致异常勃起，其中注射后重复性交７例．年龄２１～４７岁，平均 ２６．４岁；就诊时持续勃起时间 ７～１２ｈ １１例，１３～２４ｈ ３例， ２５…     

藻酸双酯钠致阴茎异常勃起2例

2例男性冠心病或心肌供血不足患者用藻酸双酯钠治疗(剂量不详)出现阴茎异常勃起.例1,35岁冠心病患者用藻酸双酯钠静脉滴注治疗.第7天患者出现阴茎异常勃起,持续32 h后入院.患者经阴茎海绵体穿刺放血,用去氧肾上腺素+低分子肝素+生理盐水行阴茎海绵体冲洗,3 d后阴茎勃起消退.例2,41岁患者因心肌供血不足用藻酸双酯钠静脉滴注治疗.第3天患者出现阴茎异常勃起,持续72 h后入院.患者经阴茎海绵体冲洗及阴茎头体分流术后症状未改善.之后,再次行阴茎头体分流术加阴茎海绵体扩张术.次日阴茎勃起完全消退.     

阴茎异常勃起的诊断和治疗(附7例报告)

目的根据不同原因,区分低流量型和高流量型阴茎异常勃起,提高阴茎异常勃起的诊治水平。方法7例阴茎异常勃起患者年龄20~46岁,平均35岁。持续勃起时间4~68h,平均22h。其中服用两地那非后性交勃起异常1例,膀胱癌转移至阴茎1例,白血病1例,有外伤史者1例,不明诱因者3例。对异常勃起分型,治疗及预后进行分析。结果7例患者中1例为高流量型,6例为低流量型。1例高流量型患者行选择性阴部内动脉栓塞后治愈,6例低流量型患者,均先行肝素盐水及肾上腺素盐水龟头-阴茎海绵体冲洗,但效果不理想,随后改行龟头——阴茎海绵体分流术,5例患者术后1至5天恢复正常,1例患者术中行病理活检为膀胱癌转移至阴茎,有阴茎全切术。结论详细询问病史、阴茎海绵体血气分析、彩色多谱勒检查、阴部内动脉造影等是区分高流量型和低流量型阴茎异常勃起的重要方法。阴茎异常勃起如保守治疗无效,应立刻进行手术治疗。     

12例阴茎异常勃起临床分析

目的 提高阴茎异常勃起的诊断和治疗水平.方法 阴茎异常勃起患者12例,均诊断为低流量型.12例患者中2例保守治疗有效;10例保守治疗无效后行海绵体内药物注射,其中2例注射美蓝20mg,8例注射间羟胺2～10mg;2例保守治疗、海绵体内药物注射后依然复发的患者行手术分流.随访2～117个月,平均48个月.结果 12例患者中10例保守治疗患者未复发;2例手术患者手术后也未再复发,但并发阴茎勃起功能障碍.2例白血病患者分别死于随访第4个月和第12个月.结论 完整的病史、仔细体检对阴茎异常勃起的诊断非常重要,治疗应以保守治疗为主,尽可能减少创伤.     

阴茎异常勃起的诊断和治疗(附10例报告)

目的提高急诊处理阴茎异常勃起的能力。方法回顾10例阴茎异常勃起患者的临床资料、诊疗过程及随访结果,结合文献资料进行分析。结果10例患者中8例为低流量型,2例为高流量型。8例低流量型患者行海绵体灌洗或阴茎头-海绵体分流术治愈;2例高流量型患者海绵体灌洗同样有效。结论阴茎海绵体血气分析、彩色多谱勒检查、阴部内动脉造影等是区分高流量型和低流量型阴茎异常勃起的重要方法,治疗阴茎异常勃起首选海绵体药物灌洗,如无效应进行手术治疗。     

海绵体抽吸冲洗法治疗阴茎异常勃起的临床观察

阴茎异常勃起是指缺乏性刺激的阴茎持续勃起或在性高潮后仍不能转入疲软状态,勃起持续时间超过4～6h。阴茎异常勃起分为2种类型:低血流量阴茎异常勃起是因静脉流出量减少和静脉血液滞留;高血流量阴茎异常勃起是因海绵体动脉损伤引起血流灌注量过度增加[1]。高血流量阴茎异常勃起非常少见。笔者自1994年1月-2006年11月应用海绵体抽吸冲洗法治疗阴茎异常勃起18例,获得较满意治疗效果,现报道如下。1临床资料1.1一般资料选取阴茎异常勃起患者18例,年龄20～47     

勃起功能障碍治疗药物的不良反应

１海绵体内注射 海绵体内注射治疗勃起功能障碍（ＥＤ）仅在８０年代被接受。据报道，最常见的并发症是勃起延长或局部纤维化。罂粟碱致海绵体纤维化发生率至少５％。良好的注射技术可使之降至最低限度。使用小号针头有助于减少因操作引起的疼痛。如刺破阴茎静脉可发生血肿和瘀斑。亦可发生感染，其他罕见断针和海绵体炎。长期随访结果令人失望。１．１罂粟碱和酚妥拉明 海绵体内注射两药治疗ＥＤ可采用单独或联合用药，其引起的阴茎异常勃起发生率为２％～１５％，其中神经系统疾病所致的阳痿最常见。据报道，罂粟碱引起阴茎异常勃起致死１…     

阴茎异常勃起8例报告

阴茎异常勃起以往比较少见 ,近年来随着临床药物治疗与男性性功能障碍诊疗工作的开展 ,阴茎异常勃起作为泌尿男科临床急症越来越多见 ,正确及时的诊断与治疗 ,才能使患者的性功能得以恢复。我院 1992年～ 2 0 0 0年共收治 8例 ,现报告如下。1　临床资料本组年龄 2 4～ 5 6岁 ,平均 34岁。发病至就诊时间最短 6ｈ ,最长 4ｄ。发病原因 :药物性假体 3例 ,白血病 1例 ,外伤性 1例 ,特发性 3例。治疗方法 :单纯阴茎海绵体穿刺抽吸术 3例 ,阴茎海绵体尿道海绵体分流术 4例 ,阴茎头阴茎海绵体分流术 +阴茎背动脉结扎术 1例。治疗后 5例出现ＥＤ ,3…     

阳萎病人阴茎海绵体内血浆中VIP含量的研究

本文对正常人，器质性和精神性阳萎病人进行了研究，在阴茎勃起前后；测定阴茎海绵体内血浆中VIP浓度。对各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体，每次注射药物间隔时间达30min以上，于海绵体内注射药物前后抽取海绵体内血液，测定血浆中VIP的含量。正常人及各类阳萎病人，在阴茎海绵沐内注射血管活性药物后，所有阴茎发生了勃起，在阴茎勃起过程中，海绵体内血浆中VIP浓度显著升高（P＜0．01）。同时，周围静脉内注射罂粟碱和酚妥拉明混合液体的受检者，在静脉注射药物后；周围静脉血浆中VIP浓度没有显著性变化（P＜0．05）。本实验证实，VIP是参与人类阴茎勃起反应的重要神经递质。     

Nitric oxide as a mediator of cocaine-induced penile erection in the rat.

1. The effect of local application of cocaine to the corpus cavernosum on intracavernous pressure (ICP), an experimental index for penile erection, was examined in Sprague-Dawley rats anaesthetized with chloral hydrate. The potential involvement of dopamine, noradrenaline or nitric oxide as the chemical mediator in this process, and the pharmacological action of cocaine as a local anaesthetic in the induced increase in ICP, were also investigated. 2. Intracavernous (i.c.) administration of cocaine (40, 80 or 160 micrograms) to the corpus cavernosum resulted in a dose-related increase in both amplitude and duration of ICP. 3. The elevation of ICP induced by cocaine (160 micrograms, i.c.) was not significantly influenced by prior injection into the corpus cavernosum of either the D1 or D2 dopamine receptor antagonist, R-(+)-SCH 22390 (250 pmol) or (-)-sulpiride (250 pmol). 4. Similarly, penile erection promoted by cocaine (160 micrograms, i.c.) was not appreciably affected by i.c. pretreatment with the alpha 1-, alpha 2-, or beta-adrenoceptor antagonist, prazosin (50 pmol), yohimbine (50 pmol) or propranolol (5 nmol). 5. Whereas lignocaine (4 mumol, i.c.) depressed penile erection induced by papaverine (400 micrograms, i.c.), local application of cocaine (160 micrograms) into the corpus cavernosum still elicited significant elevation in ICP in the presence of lignocaine or papaverine. 6. The increase in ICP induced by cocaine (160 micrograms, i.c.) was attenuated dose-dependently by prior cavernosal administration of the NO synthase inhibitor, N omega-nitro-L -arginine methyl ester (L-NAME, 0.5, 1 or 5 pmol) or NG-monomethyl-L-arginine (L-NMMA, 2.5, 5 or 10 pmol). The blunting effect of L-NAME or L-NMMA was reversed by co-administration of the NO precursor, L-arginine (1 nmol, i.c.). 7. Pretreatment by local application into the corpus cavernosum of methylene blue (2.5 mumol), an inhibitor of cytosolic guanylyl cyclase, antagonized cocaine-induced penile erection. 8. Direct i.c. administration of a NO donor, nitroglycerin (10 or 20 nmol), mimicked the local action of cocaine by promoting a significant increase in ICP. 9. It is concluded that cocaine may induce penile erection by increasing ICP via a local action on the corpus cavernosum. This process did not appear to involve either dopamine or noradrenaline as the chemical mediator, nor the pharmacological action of cocaine as a local anaesthetic. On the other hand, it is likely that initiation and maintenance of penile erection elicited by cavernosal application of cocaine engaged an active participation of NO and subsequent activation of guanylyl cyclase in the corpus cavernosum.     

慢性粒细胞白血病性阴茎异常勃起二例并文献复习

目的探讨白血病性阴茎异常勃起的诊断和治疗方法。方法回顾性分析2例白血病性阴茎异常勃起患者的临床资料。结果2例阴茎异常勃起均为慢性粒细胞白血病所致,均有不同程度的脾肿大、胸骨压痛及血常规异常等情况。2例患者均及时进行以化疗为主的综合治疗措施,取得了较好的效果。结论以阴茎异常勃起为首发症状的白血病极易误诊。确诊后应以化疗措施为主,进行综合治疗,必要时进行外科治疗,尽可能防止性功能受损。     

氦氖激光对罂粟碱肌内注射所致硬结的疗效观察

目的 探讨氦氖激光照射治疗罂粟碱肌内注射所致硬结的疗效.方法 将60例行罂粟碱肌内注射所致硬结患者随机分为治疗组与对照组各30例.治疗组予氦氖激光局部照射硬结处皮肤,对照组予土豆片外敷,观察2组注射部位硬结、疼痛消退的程度.结果 治疗组有效率为90%,明显高于对照组的60%,2组比较差异有统计学意义（P〈0.01）.结论 应用氦氖激光治疗罂粟碱肌内注射所致硬结疗效显著,操作简单,安全可靠,值得临床推广使用.     

酚妥拉明与阿拉明联合治疗毛细支气管炎并心衰疗效分析

目的 探讨酚妥拉明与阿拉明联合治疗小儿毛细支气管炎并心衰的疗效.方法 将120例毛细支气管炎患儿随机分成两组,两组均采用综合治疗,观察组加用酚妥拉明与阿拉明静注,对治疗前后症状、体征持续时间、气道阻力参数进行比较.结果 观察组在治愈率、缓解喘憋,缩短哮鸣音及咳嗽持续时间、改善心衰、肺功能、降低气道阻力的作用均明显优于对照组(P＜0.05).结论 酚妥拉明与阿拉明联合治疗小儿毛支并心衰,可缩短病程,改善心、肺功能,疗效确切,且方便、安全,可作为佐治毛支的辅助药物.     

Effect of sildenafil citrate and a nitric oxide donating sildenafil derivative, NCX 911, on cavernosal relaxation and superoxide formation in hypercholesterolaemic rabbits

Hypercholesterolaemia promotes erectile dysfunction through increased superoxide formation and negation of nitric oxide (NO) bioactivity in cavernosal tissue. The source of superoxide has not been clearly defined, however. Sildenafil (Viagra), the standard therapy for erectile dysfunction, may also be rendered more effective by the presence of an NO donor. One drug that intrinsically fulfils this criterion is sildenafil nitrate (NCX 911), an NO donating derivative of sildenafil. The objective of this study, therefore, was to determine the source of superoxide and its effect on erectile function in corpus cavernosum from hypercholesterolaemic rabbits and to determine whether NCX 911 confers an improvement over sildenafil citrate in this model. Hypercholesterolaemia elicited an increase in superoxide formation by rabbit cavernosal tissue and a reduction of carbachol-stimulated relaxation both of which were reversed by diphenylene iodonium chloride and apocynin (NADPH oxidase inhibitors). In response to sodium nitroprusside, hypercholesterolaemia also caused an attenuation of cavernosal relaxation which was not reversed with NADPH oxidase inhibitors. Both sildenafil citrate and NCX 911 significantly reversed impaired carbachol-stimulated relaxation and inhibited superoxide formation by cavernosal tissue from hypercholesterolaemic rabbits, NCX 911 being more potent. NCX 911 also augmented cavernosal cGMP levels, an effect blocked by the guanylyl cyclase inhibitor, 1H-{1,2,4}oxadiazolo {4,3-a}quinoxalin-1-one (ODQ). These data demonstrate that hypercholesterolaemia promotes erectile dysfunction through an augmentation of superoxide derived from NADPH oxidase in cavernosal tissue. It also indicates that NO donating sildenafil may be therapeutically more beneficial than conventional sildenafil in treating erectile dysfunction with an oxidative stress-related aetiology.     

Relaxant mechanisms of 3, 5, 7, 3', 4'-pentamethoxyflavone on isolated human cavernosum

We have investigated effects and mechanisms responsible for the activity of 3, 5, 7, 3', 4'-pentamethoxyflavone (PMF) on isolated human cavernosum. PMF is the major flavone isolated from Kaempferia parviflora claimed to act as an aphrodisiac. PMF caused relaxation of phenylephrine precontracted human cavernosal strips, and this effect was slightly inhibited by N(G)-nitro-l-arginine, a nitric oxide synthase inhibitor, but not by ODQ (soluble guanylate cyclase inhibitor), TEA (tetraethylammonium, blocker of voltage-dependent K(+) channels) or glybenclamide (blocker of ATP-dependent K(+) channels). PMF did not significantly inhibit the relaxant activity of glyceryltrinitrate or acetylcholine on human cavernosal strips precontracted with phenylephrine. In contrast, sildenafil (phosphodiesterase inhibitor) potentiated the relaxant activity of glyceryl trinitrate but not of acetylcholine. In normal Krebs solution with nifedipine (blocker of l-type Ca(2+) channels), or in Ca(2+)-free Krebs solution, PMF caused a further inhibition of human cavernosum contracted with phenylephrine. In human cavernosum treated with thapsigargin (inhibitor of sarcoplasmic reticulum Ca(2+)-ATPase) in Ca(2+)-free medium, PMF suppressed the concentration-response curve of human cavernosum to phenylephrine and a further suppression was found when SKF-96365 (a blocker of store-operated Ca(2+) channels and Y-27632 (inhibitor of Rho-kinase)), but not nifedipine, were added sequentially. Thus, PMF had only a weak effect on the release of nitric oxide, and had no effect as a K(ATP)- or K(Ca) channel opener, a phosphodiesterase inhibitor, a store-operated Ca(2+) channel blocker or a Rho-kinase inhibitor. Therefore, these studies suggest that PMF causes relaxation of human cavernosum through voltage-dependent Ca(2+) channels and other mechanisms associated with calcium mobilization.     

Nicotine in High Concentration Causes Contraction of Isolated Strips of Rabbit Corpus Cavernosum

It is well known that cigarette smoke can cause erectile dysfunction by affecting the penile vascular system. However, the exact effects of nicotine on the corpus cavernosum remains poorly understood. Nicotine has been reported to cause relaxation of the corpus cavernosum; it has also been reported to cause both contraction and relaxation. Therefore, high concentrations of nicotine were studied in strips from the rabbit corpus cavernosum to better understand its effects. The proximal penile corpus cavernosal strips from male rabbits weighing approximately 4 kg were used in organ bath studies. Nicotine in high concentrations (10^-5~10^-4 M) produced dose-dependent contractions of the corpus cavernosal strips. The incubation with 10^-5 M hexamethonium (nicotinic receptor antagonist) significantly inhibited the magnitude of the nicotine associated contractions. The nicotine-induced contractions were not only significantly inhibited by pretreatment with 10^-5 M indomethacin (nonspecific cyclooxygenase inhibitor) and with 10^-6 M NS-398 (selective cyclooxygenase inhibitor), but also with 10^-6 M Y-27632 (Rho kinase inhibitor). Ozagrel (thromboxane A2 synthase inhibitor) and SQ-29548 (highly selective TP receptor antagonist) pretreatments significantly reduced the nicotine-induced contractile amplitude of the strips. High concentrations of nicotine caused contraction of isolated rabbit corpus cavernosal strips. This contraction appeared to be mediated by activation of nicotinic receptors. Rho-kinase and cyclooxygenase pathways, especially cyclooxygenase-2 and thromboxane A₂, might play a pivotal role in the mechanism associated with nicotine-induced contraction of the rabbit corpus cavernosum.