阴茎异常勃起的研究进展

阴茎异常勃起是与性刺激或性欲无关的阴茎的持续痛性勃起，阴茎持续勃起时间超过4—6h，即为阴茎异常勃起。发病率较低，治疗不当可导致阴茎海绵体纤维化，引起勃起功能障碍。其发生常由于过度释放血管松弛性神经递质使疲软功能失调、静脉回流受阻或阴茎海绵体动脉损伤引起。阴茎异常勃起时往往伴有阴茎疼痛和排尿困难或尿潴留。近10余年来，     

前列腺素E1治疗阴茎海绵体勃起功能障碍的护理

笔者报道106例勃起功能障碍(ED)患者实施前列腺素E1(PGE1)阴茎海绵体注射治疗及护理。做好心理护理,提供安全的环境,真诚地关心、帮助患者,给他们提供一个思想感情上安全的环境。建立起满足对方的义务感,加强患者夫妻对性的接触和交流,做好性教育,纠正错误的性观念,做好药物治疗及饮食护理。认为加强心理护理,注重性知识教育,消除或解决心理因素,指导患者夫妻携手共同参与阴茎海绵体注射治疗才是ED康复的最佳方案。     

阴茎海绵体造影诊断静脉性勃起功能障碍的临床价值

目的探讨阴茎海绵体造影(CG)对静脉性勃起功能障碍(ED)的诊断价值。方法由临床筛选的静脉性ED患者80例,对其进行阴茎海绵体造影,对比观察造影结果。结果静脉漏性ED的X线表现分为:背深静脉漏23例、脚静脉漏13例、背浅静脉漏7例、间静脉漏3例、海绵体静脉漏5例、混合静脉漏30例。结论 CG是诊断静脉性ED的可靠方法,可准确显示静脉漏的部位,指导临床治疗。     

阴茎海绵体注射罂粟碱并发症的护理

阴茎内注射罂粟碱可能发生阴茎异常勃起，皮下瘀血，初段血尿，局部感染，海绵体纤维化等并发症，通过对47例勃起功能障碍患阴茎内注射罂粟碱的治疗，护理，体会到专科护理有利于减轻病人的心理压力，及时发现和处理并发症。     

失神经大鼠阴茎海绵体肌电图的检测

目的通过观察失神经大鼠阴茎海绵体肌电图（CC-EMG）的变化，探讨勃起功能的神经机制，为肌电图诊断神经性勃起功能障碍提供实验依据。方法将32只成年雄性Sprague-Dawley大鼠分为正常对照组、海绵体神经损伤组、腹下神经损伤组和盆神经损伤组，每组8只。大鼠神经损伤3周后，于清醒状态下行阴茎CC-EMG检测，比较各组皮下注射阿朴吗啡前、后阴茎CC-EMG的变化，并进行统计学分析。结果各组应用阿朴吗啡前及应用后5min和10min，CC-EMG组内各项观察指标两两比较，差异均无统计学意义（P〉0．05）。正常对照组使用阿朴吗啡后10min，均方根振幅（RMS）均明显高于海绵体神经损伤组、腹下神经损伤组和盆神经损伤组（P〈0．05），而在阿朴吗啡应用前和应用后5min，H／L均明显小于海绵体神经损伤组（P〈0．05）；海绵体神经损伤组阿朴吗啡应用前及应用后5min和10min，H／L均明显高于腹下神经损伤组（P〈0．05），而在应用阿朴吗啡前，MF明显高于腹下神经损伤组（P〈0，05），H／L明显高于盆神经损伤组（P〈0．05）；盆神经损伤组应用阿朴吗啡后10min，MF明届高于腹下神经损伤组（P〈0，05）。结论CC-EMG可以检测出海绵体神经、腹下神经和盆神经损伤大鼠阴茎海绵体的不同肌电变化，这种肌电变化的差异可能反映了这些神经在阴茎勃起功能中的不同作用。     

闭合性阴茎海绵体破裂的诊断和治疗

目的探讨闭合性阴茎海绵体破裂的诊断和治疗。方法回顾性分析5年来收治的6例阴茎折断患者的临床资料。结果6例均有典型的临床表现，均依据病史和体检确诊。单侧阴茎海绵体破裂4例，左阴侧茎海绵体破裂伴尿道海绵体被膜撕裂1例，双侧阴茎海绵体破裂伴尿道断裂1例。均行急诊手术修补。4例随访9个月到5年，无疼痛、硬结和成角，其中1例有轻度阴茎勃起不坚和勃起角度减小。结论闭合性阴茎海绵体破裂的诊断主要依据典型病史和临床表现，辅助检查可有选择的使用。急诊手术可减少并发症的发生。     

剪切波超声弹性成像测量阴茎海绵体硬度的方法学研究

目的探讨应用剪切波超声弹性成像(SWE)技术进行阴茎海绵体硬度测量的检查方法。方法 30例健康志愿者,选用Aixplorer誖新声威特种鉴别诊断超声系统的SWE技术成像功能对阴茎海绵体进行横、纵切面观察,测量指标为组织硬度。结果所有受检者均成功记录双侧阴茎海绵体硬度值,SWE技术成像效果最佳的仪器设置为图像优化调至"Pen";选择不同扫查切面所得的阴茎海绵体硬度数值无明显差异;选取海绵体中段测量成功率100%。结论应用SWE技术进行阴茎海绵体硬度测量时图像优化应设置为"Pen",可任意选择横、纵切面进行测量,测量时建议选取海绵体中段。     

阴茎助勃器白膜外植入术治疗驴静脉性勃起功能障碍的相关研究

目的探讨阴茎助勃器白膜外植入术治疗驴静脉性勃起功能障碍的效果。方法通过测量阴茎助勃器植入前后勃起状态下的海绵体内压,来确定阴茎助勃器白膜外植入术治疗驴静脉性勃起功能障碍的效果。结果助勃器植入术治疗驴静脉性勃起功能障碍,阴茎海绵体压力变化为基础压（26.7±9.4）mm Hg和加压后压（40.3±8.9）mm Hg,差异有统计学意义（P〈0.01）;且1个月,2个月,3个月加压后和术后加压后压比较无明显差异（P〉0.05）。结论阴茎助勃器白膜外植入术治疗驴静脉性勃起功能障碍可有效提高勃起硬度并且效果稳定长久,反复有效,研制阴茎助勃器有助于男性静脉性勃起功能障碍的治疗。     

缺血性阴茎异常勃起的护理

总结17例缺血性阴茎异常勃起患者的护理。缺血性阴茎异常勃起的主要治疗方法有保守治疗、阴茎海绵体穿刺放血、阴茎头阴茎海绵体分流术。做好患者的心理护理、用药护理,加强阴茎海绵体穿刺冲洗的观察及护理,阴茎头阴茎海绵体分流术前做好患者准备、术后密切病情观察,可提高缺血性阴茎异常勃起的治愈率。     

剪切波超声弹性成像评价阴茎海绵体硬度

目的探讨剪切波弹性成像(SWE)技术用于阴茎海绵体硬度定量分析的临床价值。方法选取70~87岁老年人作为海绵体组织退化组;18~30岁的健康志愿者作为海绵体组织健康组。选用Aixplorer新声威特种鉴别诊断超声系统的SWE成像功能对阴茎海绵体中段进行横、纵切面观察,并测量组织硬度。结果海绵体组织退化组所有受检者左侧海绵体横、纵切面硬度值为(15.1±2.3)kPa、(16.0±2.5)kPa,右侧阴茎海绵体硬度横、纵切面硬度值为(15.9±2.1)kPa、(16.5±2.6)kPa;海绵体组织健康组所有受检者左侧海绵体横、纵切面硬度值为(23.9±2.7)kPa、(24.1±2.6)kPa,右侧阴茎海绵体横、纵切面硬度值为(24.1±2.8)kPa、(24.3±2.9)kPa;两组受检者阴茎海绵体的硬度值差异均有统计学意义(P均<0.05)。结论 SWE可检测阴茎海绵体由于组织结构的变化而发生的硬度改变,安全、无创,操作简便,可重复性高,具有良好的临床应用前景。     

Idiopathic segmental thrombosis of the corpus cavernosum as a cause of partial priapism

Idiopathic segmental thrombosis of the corpus cavernosum as a cause for partial priapism is an uncommon event. Diagnosis and treatment in the past have principally involved invasive methods. We present a case in which both conventional invasive methods and noninvasive imaging were used.     

Analysis of preformed xenoreactive antibodies in the discordant guinea pig to rat model using a guinea pig fibroblast-like cell line

In the discordant guinea pig (gp) to rat model of xenotransplantation, circulating xenoreactive natural antibodies (XNA) recognizing gp antigens are usually determined by an ELISA using membrane extracts of gp platelets. We analysed the lung-derived, fibroblast-like cell line JH 4 to detect XNA by ELISA or immunoblot, which was compared to primary gp cells, i.e. platelets, liver- and spleen cells. All membrane extracts proved to be useful to detect rat XNA directed against gp antigens by ELISA. In general, IgM responses of Lewis or C6 deficient PVG rats (PVG/C6-) were higher as compared to IgG responses. However, we observed great inter-individual variabilities. The strongest IgM response of Lewis rat sera was observed when the JH 4 cell line or gp liver cells were used as antigen. JH 4 cells also showed the strongest xenoreactivity with sera from PVG/C6- rats. These data demonstrate that JH 4 cells prove useful as antigen source for XNA ELISA. In immunoblot, individual sera of the two different rat strains showed the same antigen patterns using a gp membrane extract of one particular cell type. However, the different gp cell types showed a distinct pattern of antigen expression. Whereas the JH 4 cells, platelets and spleen cells express xenoreactive proteins of the same size, a unique pattern of proteins was detected in liver cells.     

剪切波弹性成像定量评价阴茎海绵体硬度

目的 探讨实时剪切波弹性成像（SWE）定量评价阴茎海绵体硬度的价值。方法 收集150名健康志愿者,根据年龄分为5~12岁组、13~18岁组、19~30岁组、31~50岁组、51~70岁组。采用SWE成像功能定量测量其阴茎海绵体的杨氏模量值。结果 随年龄增大,其阴茎海绵体硬度值增加,5~12岁组为（9.05±0.85）kPa、13~18岁组为（11.01±1.34）kPa、19~30岁组为（12.03±0.85）kPa、31~50岁组为（16.33±1.56）kPa、51~70岁组为（24.46±1.81）kPa。结论 SWE技术定量测量阴茎海绵体杨氏模量值无创、简便、安全,有重要临床应用价值。     

内皮素-1在糖尿病性勃起功能障碍大鼠阴茎海绵体平滑肌细胞表型转化中作用

目的探讨内皮素-1（endothelin-1,ET-1）在糖尿病性勃起功能障碍（erectile dysfunction,ED）大鼠阴茎海绵体平滑肌细胞（corpus cavernosum smooth musclecells,CCSM）表型转化中的作用。方法采用链脲佐菌素建立糖尿病性ED大鼠模型,采用改良组织块贴壁法体外培养正常大鼠及糖尿病性ED大鼠CCSM,将CCSM分为对照组、糖尿病性ED组、对照＋ET-1组和糖尿病性ED＋ET-1组,其中对照＋ET-1组与糖尿病性ED＋ET-1组加入10^-7mol／LET-1,对照组与糖尿病性ED组加入PBS缓冲液。采用RT—PCR法检测4组碱性调宁蛋白（calponin 1,Cnnl）和骨桥蛋白（osteopontin,OPN）mRNA表达情况。结果糖尿病性ED＋ET-1组CnnlmRNA表达水平（3．51±0．15）低于对照组（10．21±1．52）和糖尿病性ED组（4．79±0．56）,糖尿病性ED组和对照＋ET-1组（5．04±0．64）低于对照组（P〈0．01）;糖尿病性ED＋ET-1组OPNmRNA表达水平（6．97±0．74）高于对照组（1．22±0．21）和糖尿病ED组（5．35±0．62）,糖尿病性ED组和对照＋ET-1组（4．98±0．46）高于对照组（P〈O．01）。结论ET-1不仅对收缩型CCMS有促表型转化作用,对合成型CCMS也有促表型转化作用,且ET-1对CCSM的作用是不可逆的。     

Lithium decreased endothelium‐mediated,but not nonadrenergic noncholinergic,relaxation of guinea pig corpus cavernosum in vitro: a role for nitrergic system

Lithium causes erectile dysfunction in patients but its mechanism is yet unknown. The aim of our study was to verify the effect of acute lithium administration on the nonadrenergic noncholinergic (NANC)‐ and endothelium‐mediated relaxation of guinea pig isolated corpus cavernosum. Although lithium (0.5, 1, and 5 mm ) had no effect on the neurogenic relaxations, it significantly (P < 0.001) attenuated the relaxant responses to acetylcholine in a concentration‐dependent manner. Combination of low concentration of lithium (0.5 mm ) with either 0.1 or 1 μm l ‐NAME significantly (P < 0.001) reduced the endothelium‐mediated relaxation. Although the Nitric oxide (NO) precursor l ‐arginine at 1 mm did not alter the relaxant responses to acetylcholine in control strips, it improved the inhibition by lithium (1 mm ) of relaxant responses to acetylcholine. Sodium nitroprusside (SNP; 10 nm –1 mm ) produced similar concentration‐dependent relaxations in both groups. Our experiments indicated that lithium can result in impairment of the NO‐mediated endothelium‐dependent but not NANC relaxation of guinea pig corpus cavernosum.     

Protective effect of quercetin,a polyphenolic compound,on mouse corpus cavernosum

Flavonoids are plant‐based phenolic compounds, and quercetin is the most abundant dietary member of this family. One of the most important characteristics of quercetin is its antioxidant property. The aim of this study was to investigate antioxidant effects of quercetin on corpora cavernosa of mice. Corpora cavernosa were isolated in organ baths, precontracted with phenylephrine (0.5 μm ) and relaxant responses were mediated by acetylcholine (0.1–1 μm ), electrical field stimulation (EFS, 1–16 Hz, 0.5 ms, 30 V) or acidified sodium nitrite (a NaNO₂, 0.5 mm ). Superoxide anion generators; pyrogallol (50 μm ), hydroquinone (100 μm ), LY 83583 (6‐Anilinoquinolin‐5,8‐quinone, 10 μm ) and superoxide dismutase (SOD) inhibitor; diethyldithiocarbamic acid (DETCA, 8 mm ) were used in order to expose corpus cavernosa to oxidant stress. Acetylcholine (0.1–1 μm ) induced relaxant responses were significantly inhibited in LY 83583 (10 μm ) and DETCA + LY 83583 applicated trials. EFS‐induced relaxant responses were significantly inhibited in DETCA (8 mm ) and DETCA + LY 83583 administrated trials. On the other hand, acidified sodium nitrite‐induced responses were inhibited by all of the superoxide anion generators tested. Quercetin (10 μm ) failed to improve the inhibitions on endothelium and electrically stimulated responses. Acidified sodium nitrite (0.5 mm ) mediated relaxant responses were significantly restored by quercetin except the groups in which LY 83583 were used. The data suggest that quercetin acts as a protective agent in mouse corpus cavernosum, increasing the bioavailability of exogenous nitric oxide by protecting it from superoxide anion (O₂^–).     

Effects of some divalent cations on nitrergic relaxations in the mouse corpus cavernosum

Acute effects of some divalent cations (Cd²⁺, Ni²⁺, Co²⁺, Zn²⁺, Mn²⁺ and Sn²⁺) were investigated on neurogenic and endothelium-dependent relaxations in the isolated mouse corpus cavernosum. Neither neurogenic nor endothelium-dependent relaxation was affected by cations at the concentrations used (up to 100 μ M ), except Cd²⁺. Although Cd²⁺ (20 and 40 μ M ) did not cause any significant alteration in the acetylcholine- (ACh) or sodium nitroprusside- (SNP) induced relaxation, it inhibited electrical field stimulation- (EFS) produced relaxation significantly. Zn²⁺ and selenium could not reverse this inhibitory action. Cd²⁺ did block the EFS-evoked guanethidine-sensitive contraction in the presence of N^G-nitro- L -arginine. Elevation of external Ca²⁺ content significantly reduced the inhibitions due to Cd²⁺ on the EFS-induced relaxation and on the EFS-evoked guanethidine-sensitive contraction. In the Ca²⁺-omitted medium, EFS-induced relaxation disappeared, while acetylcholine-elicited relaxation resisted. Verapamil was ineffective on the relaxation produced by EFS or acetylcholine. However, it significantly diminished phenylephrine-induced contractions. These findings suggest that unlike other cations at the concentrations used in the present study, Cd²⁺ may have an effect on an external Ca²⁺-dependent mechanism at the neuronal level, and this effect may be responsible for its acute inhibitory action on the neurogenic relaxation in the mouse corpus cavernosum.     

Comparative effects of sildenafil, phentolamine, yohimbine and L-arginine on the rabbit corpus cavernosum

Penile erection involves relaxation of smooth muscle of corpus cavernosum and associated arterioles. Sildenafil, a highly selective inhibitor of phosphodiesterase type 5, is effective in the treatment of erectile dysfunction. The aim of this study is to investigate the effect of sildenafil on smooth muscle of the rabbit corpus cavernosum (RCC) and to compare its effect with those of phentolamine, yohimbine and L-arginine. The effects of sildenafil, phentolamine, yohimbine and L-arginine were studied on the response of the RCC to electrical field stimulation (EFS) as well as on the phenylephrine (PE, 3 x 10(-6) M)-induced tone. EFS caused transient, frequency-dependent relaxation of the RCC that was inhibited by the nitric oxide synthase inhibitor NG-nitro-L-arginine (3 x 10(-5) M). Sildenafil (1 x 10(-9)-1 x 10(-6) M) and phentolamine (1 x 10(-9)-1 x 10(-6) M) enhanced the EFS-induced relaxation in a concentration-dependent manner with ED50 of 0.056 +/- 0.004 and 0.572 +/-0.035 microM at 8 Hz, respectively, yohimbine (3 x 10(-7)-3 x 10(-5) M) and L-arginine (3 x 10(-6)-3 x 10(-4) M) did not show significant effects (ED50 at 8 Hz = 35.84 +/-2.24 and 2.164 +/- 0.174 microM, respectively). Sildenafil (1 x 10(-9) and 1 x 10(-8) M) potentiated the EFS-induced relaxation caused by L-arginine (3 x 10(-5) m). Sildenafil, phentolamine, yohimbine and L-arginine reduced the PE-induced tone to different extents; the ED50 values were 0.81 +/- 0.097, 0.49 +/- 0.025 and 13.97 +/- 1.10 microM, respectively. Maximum concentration of L-arginine used failed to produce 50% relaxation (ED20 = 221.82 +/- 15.71 microM). The muscle relaxant effects of different combinations of sildenafil and L-arginine on PE-induced tone did not differ significantly from the sum of the individual effects. The results demonstrate that sildenafil, when compared to other drugs used in penile erection dysfunction, shows the highest potency on the nitrergic transmission in the RCC. On the other hand, phentolamine was found to possess the highest potency in inducing relaxation of RCC proving that its action is independent on the stimulated neurogenic system. In addition, the combination of less effective doses of sildenafil and L-arginine has a potential advantage on erectile functions. The importance of this combination remains to be solved clinically.