90例阳萎病人阴茎血压和血流测定的结果分析

本文通过运用超声多普勒多功能仪,对90例阳萎患者在静息时,充血性加压试验和运动试验后的阴茎血压进行测定,分别计算出3种情况下的阴茎动脉收缩压与肱动脉收缩压的比值(PBI),同时描记阴茎背动脉的血流图。并据此从PBI值、血流图的升降幅度、年龄等方面分析血管性和非血管性阳萎的结果区别,并探讨联合运用上述无创伤性方法对阳萎病因进行筛选诊断的价值。     

Vasculogenic impotence and cavernosal oxygen tension

AIMS OF THIS STUDY: To determine the associations, if any, of cavernosal oxygen tension with vasculogenic impotence. MATERIALS AND METHODS: We evaluated penile cavernosal blood gas levels in men with suspected vasculogenic impotence during penile duplex ultrasonography and/or dynamic infusion cavernosometry and cavernosography (DICC). Patients with suspected impotence were evaluated from 1992-1996. Patient ages ranged from 24-75 y (mean 48 y). Eighteen men had arteriogenic impotence diagnosed by abnormal penile duplex ultrasound after injection of a vasoactive agent, and 23 men had venous leakage diagnosed by DICC. RESULTS: Eighteen men with arteriogenic impotence had the following mean blood gas values: pH = 7.38+/-0.01, PCO2 = 45.50+/-0.94, PO2 = 65.17+/-2.16. Twenty-three men with venogenic (venous leak) impotence had the following mean cavernosal blood gas values: pH = 7.41+/-0.01, PCO2 = 42.26+/-0.83, PO2 = 74.17+/-2.51. The differences in PO2 were significant (P<0.05). A subgroup of men with severe venous leakage had PO2 values that were similar to the low arterial PO2 values. CONCLUSION: The low PO2 in patients with arteriogenic impotence, and the subset of men with severe venous leak impotence, support a global concept of low cavernosal PO2 as a mechanism for both arteriogenic and venogenic impotence.     

The role of colour duplex ultrasonography in the diagnosis of vasculogenic impotence.

Colour duplex ultrasonography was used to obtain peak systolic velocity (PSV) readings from cavernosal arteries at rest and during papaverine-induced tumescence. Results from 31 men with vasculogenic impotence were compared with those from 17 men with non-vasculogenic impotence and a control group of 6 potent men. In the flaccid state no significant differences in PSV readings were found between the vasculogenic and control groups. Following the injection of papaverine, men from the vasculogenic group without venous leakage were alone in having significantly lower PSV readings compared with the potent controls. All 23 men with normal penile haemodynamics had a mean PSV greater than or equal to 20 cm/s during tumescence. This was also the case for 19 (61%) of the vasculogenic group, including 9 (69%) of the 13 patients with venous leakage. The remaining 12 men in the vasculogenic group (39%) had a mean PSV less than 20 cm/s, this being diagnostic of an inadequate arterial inflow. Colour duplex ultrasonography can identify patients who have marked arterial insufficiency as the major cause of their impotence and hence allows more rational selection for angiography and revascularisation. Lesser degrees of arterial deficit are difficult to characterise using mean PSV readings alone.     

Internal iliac artery revascularization in the treatment of vasculogenic impotence

Five impotent men underwent internal iliac artery revascularization in conjunction with end-to-side aortobifemoral bypass after preoperative testing suggested a vasculogenic cause for impotence. All patients had abnormal preoperative penile/brachial arterial pressure indices (mean, 0.42 +/- 0.12). Following operation, all patients regained erectile capability and had normal postoperative penile/brachial indices (mean, 0.80 +/- 0.06). One patient developed retrograde ejaculation, emphasizing the need for meticulous nerve-sparing dissection with this operation. Internal iliac artery revascularization in conjunction with end-to-side aortobifemoral bypass is effective in relieving vasculogenic impotence in properly selected patients.     

The effects of bilateral renal transplantation on pelvic hemodynamics and sexual function

Sexual function and internal iliac artery (IIA) patency were determined in 24 patients who had received at least two renal transplants, one in each iliac fossa, at the University of Maryland and Johns Hopkins Hospitals from 1975 to 1979. The pelvic hemodynamics of each patient were assessed with a penile/brachial blood pressure index (PBI). The rate of sexual dysfunction, as determined by questionnaires and personal interviews, was 46% (11 of 24 patients) compared with only 21% (five of 24 patients) after a single transplant. Nine of the 11 patients who were impotent had bilateral IIA occlusion and four of these nine had a PBI less than 0.70. One of the four patients regained full sexual function after a revascularization procedure, which confirmed that this impotence had a vascular etiology. Results of this study show that vascular insufficiency, but not necessarily vasculogenic impotence, was present in at least four of the 11 patients who were impotent (36%) and may have been avoidable by sparing at least one IIA during renal transplant procedures.     

Measurement of penile brachial index (PBI) in patients with impotence

PBI was measured in 555 patients chosen at random from those who visited our impotence clinic between October 1984 and September 1986. Of 555 patients with impotence 29 (5.2%) showed a low PBI level of less than 0.6. On the basis of carefully taken history, risk factors causing the disturbance of penile blood flow were found in 13 (44.8%) of these 29 patients. They included diabetes mellitus, hypertension, surgery of pelvic organ, vertebral injury, vascular disorder of brain and gangliosympathectomy. Although penile angiography is necessary to make the definite diagnosis of vasculogenic impotence, hospitalization is usually required to perform the examination. Measurement of PBI is useful as a screening test to detect vasculogenic impotence at an outpatient clinic, because this examination is noninvasive and technically easy.     

CAVERNOUS ARTERIAL AND ARTERIOLAR CIRCULATION IN PATIENTS WITH ERECTILE DYSFUNCTION: A POWER DOPPLER STUDY

Purpose

We assessed the morphodynamic features of cavernous arteries and helicine arterioles by power Doppler sonography in vasculogenic and nonvasculogenic impotent men.

Materials and Methods

A total of 40 impotent patients with and without definite vascular risk factors were studied by penile power Doppler sonography. The test was performed during penile flaccidity, after intracavernous injection of 20 mcg. alprostadil and after subsequent genital and audiovisual sexual stimulation. A second injection and stimulation were given if the erectile response observed after the initial injection was less than the maximum erection seen during sexual activity. Morphodynamic parameters evaluated by power Doppler imaging included vessel course, shape, wall thickness and pulsatility, peak systolic velocity, end diastolic velocity, acceleration time and resistance index.

Results

In the nonvasculogenic group all patients who achieved rigid erection showed normal cavernosal artery and helicine arteriole inflow. In these cases the arteriolar picture was characterized by the presence of 3 orders of distal ramifications originating from the cavernous arteries with an acute angle, systolic diastolic flow during penile tumescence and systolic flow alone at full rigidity. In the vasculogenic group patients with normal cavernous artery inflow showed an arteriolar tree that was pathological in 50% and was characterized by a reduced number of ramifications originating perpendicularly from the cavernous arteries and irregular caliber (arteriolar impotence). In the same group patients with reduced cavernous artery inflow also showed normal or pathological arteriolar components (pre-penile arterial impotence and diffused penile arterial impotence).

Conclusions

Power Doppler sonography allows a precise study of the morphodynamics of the cavernous arteries and helicine arterioles. Our preliminary data suggest that the intracavernous arteriolar component may have a significant role in the genesis of some forms of vasculogenic impotence.     

Intracavernous injections of papaverine and phentolamine: correlation with penile brachial index

Eighty-two patients were evaluated for erectile failure with a comprehensive history, physical examination, hormonal testing, noninvasive Doppler examination (PBI), and nocturnal penile tumescence (NPT). After these studies all patients received intracavernous injection with a combination of papaverine (50 mg) and phentolamine (1.66 mg), and both tumescence and rigidity were monitored. Rigidity response was compared with the PBI. The number of patients with a poor rigidity response in each PBI category were: 3 of 5 with a PBI of less than 0.6 (vasculogenic), 7 of 11 with a PBI of 0.6-0.75 (ambiguous), and 25 of 66 with a PBI of 0.75-1.0 (normal). These results indicate only a marginally significant association between PBI and intracavernous injection. The procedure was safe with no long-term sequelae from injection observed, and no surgical intervention was required. Complications of injections included reversible priapism in 11 patients (13.4%), transient dizziness in 10 patients (12.2%), and hematoma in 5 patients (6.2%). This study suggests that intracavernous injection with a drug combination may be a more sensitive screening test for vasculogenic impotence than noninvasive Doppler studies because it more closely simulates the erectile response.     

Hyperemic stress test in diagnosis of vasculogenic impotence

A hyperemic stress test was used to determine vasculogenic impotence in 100 men (50 potent, 50 impotent). Normal potent males had a resting penile: brachial index ratio of 0. 75 and uniformly demonstrated a hyperemic response to the cuff occlusion stress test with a mean of 20 per cent increase in penile pressure. Penile blood pressure did not increase in impotent men, and often it decreased in response to the stress test.     

IIEF-5在血管性勃起功能障碍诊断中的应用

目的:评价国际勃起功能简化量表(IIEF-5)对血管性勃起功能障碍(ED)病因区分的意义,以指导血管性ED诊断及治疗。方法:将103例ED患者分为4组,非血管性ED组37例(37/103,35.9%)、动脉性ED组18例(18/103,17.5%)、静脉性ED组35例(35/103,34.0%)、混合性ED组13例(13/103,12.6%),其IIEF-5得分与海绵体血管活性药物注射试验结果、多普勒超声检查结果及双核素检测结果进行比较,以非参数检验的多个独立样本检验(Kruskal-WallisTEST)比较各组之间IIEF-5得分差异的显著性。结果:上述4组之间的IIEF-5得分没有统计学差异(P=0.253)。结论:IIEF-5不能作为一种诊断工具用于鉴别血管性ED的病因以及判断血管病变严重程度。     

Assessment of donor limb hemodynamics in femorofemoral bypass for claudication

During a 5-year period (1975 to 1980), 44 patients underwent femorofemoral bypass for unilateral disabling claudication caused by iliac atheroocclusive disease. All patients had complete Doppler arterial examination performed pre- and postoperatively, including segmental thigh and ankle pressure and calculation of an ankle/brachial (A/B) index for each limb. In 37 patients, standard treadmill exercise testing was performed before and after femorofemoral grafting. Hemodynamic improvement in the symptomatic limb was evidenced by an increase in resting A/B index from a mean of 0.54 +/- 0.14 before to 0.76 +/- 0.22 after operation (P less than 0.001). Exercise tests which were abnormal in all 37 recipient limbs preoperatively were improved. Six of the seven unimproved recipient limbs had associated femoropopliteal occlusion. Donor limb mean resting ankle/brachial index fell from 0.93 +/- 0.22 before to 0.83 +/- 0.22 after surgery (P less than 0.05). However, in 13 of 23 donor limbs, exercise response which had been normal before surgery became abnormal. Additionally, in 14 patients with abnormal donor limb exercise response before grafting, seven limbs had a significantly worsening of the exercise response postoperatively. These findings were not related to the patency of the superficial femoral artery in the donor limb. Deterioration in donor limb hemodynamics noted in 20 (45%) of the 44 patients in this series suggests that strict patient selection criteria should be maintained. Unlike in healthy subjects, an arteriographically patent atherosclerosis iliac artery may not support flow requirements of bilateral lower limb exercise.     

Automated Bedside Measurement of Penile Blood Flow Using Pulse-Volume Plethysmography

Purpose To evaluate the efficiency of the form PWV/ABI (pulse wave velocity/ankle brachial pressure index) for measuring penile blood pressure (PBP) and the penile brachial pressure index (PBI). Methods We measured PBP and the PBI using both form PWV/ABI and Doppler ultrasonography in 40 men with surgical disorders. Results By using pulse-volume recording, the form PWV/ABI can simultaneously measure PBP and bilateral brachial artery pressure, and calculate the PBI automatically. The data obtained showed strong correlations with those obtained by the conventional Doppler ultrasound technique. Moreover, measurements were completed within 5 min at the bedside and the data were stored in the device's memory. Conclusion The form PWV/ABI is a useful tool for assessing pelvic hemodynamics and diagnosing vasculogenic impotence.     

Exercise in hemodialysis patients after treatment with recombinant human erythropoietin

To assess the effect of substantial increases in blood hemoglobin (Hb) caused by treatment with recombinant human erythropoietin (rhEPO) on exercise capacity in maintenance hemodialysis patients, we evaluated 10 patients (7 men and 3 women) at a mean age of 44.3 +/- 8.4 years on maintenance hemodialysis for a mean of 29.7 +/- 30.2 months by treadmill exercise to exhaustion. The patients were tested before administration of rhEPO and after a minimum 1 g/dl rise in Hb. With a change in Hb from 7.1 +/- 1.4 to 9.8 +/- 2.1 g/dl, peak oxygen consumption (VO2 peak) with exercise increased 50.3 +/- 9% (T1 = 15.1 +/- 5.3, T2 = 22.7 +/- 4.6 ml O2/kg/min, p less than 0.05). Respiratory exchange ratio (RER) at a given submaximal exercise level (3 mph, 6% of elevation) decreased significantly (T1 = 1.13 +/- 0.24, T2 = 0.92 +/- 0.08, p less than 0.05). The rhEPO-mediated increase in Hb was associated with an increased VO2 peak--an improvement of the peak exercise capacity and a reduced submaximal RER--reflecting a reduction in anaerobic metabolism at activities of daily living.     

Thermography as a diagnostic measure of vasculogenic impotence

There is no correlation between penile-brachial index (PBI) and thermography. While it has been shown to be of significant value in other areas of medicine, thermography is non-contributory to the diagnosis of vasculogenic impotence.     

Sildenafil citrate vs intracavernous alprostadil for patients with arteriogenic erectile dysfunction: a randomised placebo controlled study

We compared the effectiveness of sildenafil citrate and alprostadil in improving arterial penile inflow (peak systolic velocity (PSV)) and penile rigidity in 55 patients with erectile dysfunction caused by atherosclerosis. A total of 35 patients with pure vasculogenic impotency were randomly assigned to alprostadil (Av group; n=11), sildenafil (Sv group; n=12), or placebo (P group; n=12), and 20 patients with nonvasculogenic impotency were randomly assigned to alprostadil (A group; n=10) or Sildenafil (S group; n=10): Av and A used alprostadil injection (capable of giving a full erection) once a week for 1 month, Sv and S took daily oral sildenafil (25 mg) for 1 month, and P took daily oral placebo for one month. The PSV was measured with Duplex sonography and penile rigidity was assessed using the IIEF-15 questionnaire, both of which were administered before and after treatment. Although both treatments improved penile rigidity, they increased PSV only in the Av and Sv groups. Our results suggest that alprostadil and oral therapy should be the starting therapy in men with vasculogenic impotency, whereas alprostadil should be avoided as the first-line approach in men with nonvasculogenic impotency.     

Mean platelet volume,platelet distribution width and platelet count in erectile dysfunction: A systematic review and meta‐analysis

The aim of this study was to investigate the relationship between mean platelet volume (MPV), platelet distribution width (PDW), platelet count (PC) and erectile dysfunction (ED). We searched for observational studies from PubMed, EMBASE, Web of Science and CNKI up to 31 March 2016. Two reviewers independently selected the studies and extracted the data. MPV, PDW, and PC and mean differences in these platelet indices between healthy subjects and ED patients were explored using the Comprehensive Meta‐Analysis software package. Seven studies including 795 patients and 524 healthy subjects met the inclusion criteria. The MPV was significantly larger in patients with ED than controls with the standardised mean difference of 0.596 fL (95% CI: 0.378, 0.815, p < 0.001). In ED patients, the pooled mean difference in MPV between vasculogenic ED patients and nonvasculogenic ED patients was 0.706 fL in case–control studies (95% CI: 0.410, 1.002, p < 0.001). There was no significant difference in PDW and PC between healthy subjects and ED patients. The available data suggest that larger MPV was associated with ED. Patients with vasculogenic ED tend to have higher MPV than nonvasculogenic ED patients. Further studies are needed to assess whether increased MPV in ED patients is associated with increased cardiovascular disease.     

双功能超声和彩色多普勒显像对血管性阳萎的诊断分析

５９例阳萎患者海绵体内注射罂粟硷前后的双功能超声和彩色多普勒显像，与阴茎血压、灌注性阴茎海绵体造影和部分手术结果进行分析对比，发现１１例血管正常（１９％），１９例动脉功能不全（３２％），２９例静脉漏（４９％）。对阴茎海绵体双功能超声和彩色多普勒显像诊断血管性阳萎的临床价值作了探讨。     

Prediction of morbidity after lung resection with risk factors using treadmill exercise test.

OBJECTIVE: To predict accurate morbidity after lung resection using treadmill exercise test. METHODS: A total of 130 patients (108 men and 22 women, with mean age 67.1+/-11.4 years (range, 34-78 years)) of 1129 patients underwent standard lobectomy were performed both treadmill exercise test and spirometry preoperatively. We measured maximum oxygen uptake/body weight (VO2max/BW) and change in arterial blood oxygen pressure from rest to symptom-limited maximum loading (delta aPaO2) and calculated exercise-induced hypoxemia (delta PaO2/delta VO2/BW), and retrospectively compared these parameters for patients with and without complications. RESULTS: There were five patients with severe postoperative complications, including three requiring use of a respirator, two with home oxygen therapy. %Vital capacity, VC (%, 80.2+/-13.2 vs. 92.5+/-20.9, P=0.026), delta PaO2 (Torr, -29.3+/-4.3 vs. -13.2+/-10.8, P=0.0004), VO2max/BW (ml/min/kg, 16.5+/-2.9 vs. 20.6+/-5.1, P=0.018) and delta PaO2/delta VO2/BW (Torr/ml/min/kg, -1.98+/-0.26 vs. -0.57+/-0.47) were significantly associated with worse outcome. All the five patients with complications had delta PaO2/delta VO2/BW<-1.7. CONCLUSIONS: Treadmill exercise testing is a good method for assessment of cardiopulmonary reserve. Limited resection must be performed if delta PaO2/delta VO2/BW is under -1.7.     

Role of frenular penile-brachial index in the assessment of penile vasculature

The evaluation for vasculogenic causes of impotence includes penile Doppler studies. These are often time-consuming and tedious procedures. A retrospective study of the last 54 penile Doppler examinations was carried out to determine if an abbreviated study would accurately reflect the status of the penile vasculature. The frenular sound is easily auscultated. There is statistically significant correlation between frenular penile-brachial index (PBI) and corporal PBI. We therefore recommend that the frenular PBI be used as a screening procedure. More complete Doppler studies including corporal measurements are only necessary when the frenular PBI is not normal.