Contemporary management of penile fracture

Penile fracture (PF) is an uncommon injury defined as the rupture of the tunica albuginea and corpus cavernosum of the penis, usually resulting from direct blunt trauma to the erect penis during sexual intercourse or masturbation. PF is one of the few urologic emergencies. This article reviews the status, contemporary management, and the controversies of the diagnostic approaches and therapeutic modalities of penile fractures. It is usually diagnosed only clinically with the history of the patient, inspection, and physical examination. However, additional imaging procedures such as cavernosography, ultrasonography, magnetic resonance imaging, and retrograde ureterography may also be indicated whenever the diagnosis or the extent of the severity and location of the rupture is not clear, and/or when an accompanying urethral injury is suspected. Although the diagnosis of PF is usually easily recognized, optimal therapy remains controversial. The most widely accepted approach for the treatment of PF is early surgical treatment, but some investigators still advocate nonoperative conservative management.     

阴茎折断2例报告

阴茎折断又称闭合性阴茎海绵体破裂,是临床较少见的泌尿男科急症,是指阴茎在勃起状况下,受到直接外力作用,致使白膜及阴茎海绵体破裂或并发尿道损伤。阴茎折断的保守治疗因其并发症多,目前已弃用,尽早手术治疗成为主要治疗手段。我科曾收治2例,应用阴茎血肿清除加白膜修补术,取得满意效果,现报告如下。1临床资料1.1病例一患者某某,男,33岁,因外伤后阴茎肿痛8小时入院。患者晨间性交时取女上位,由于女方活动度过大,致使阴茎滑出阴道,撞击于女方会阴。当即闻及特征性“喀嚓”音,随即出现勃起状态消失,迅速萎软并伴有疼痛。检查:阴茎松软,青紫…     

阴茎折断合并尿道损伤的临床诊断及急诊治疗

目的:分析阴茎折断合并尿道损伤患者的临床资料,总结阴茎折断合并尿道损伤患者的急诊治疗经验,以期提高临床对此类疾病的认识。方法:回顾性分析我院2000年3月至2011年12月收治的12例阴茎折断合并尿道损伤患者的临床资料,整理其随访资料,分析此类患者的疾病诱因、临床表现、诊断方法、治疗方法及预后情况。结果:12例患者均就急诊,患者自觉阴茎折断到就诊时间为(9.1±1.6)h,其中2例患者为转诊至我院;阴茎折断合并尿道损伤原因:7例为性交不慎,3例醉酒后勃起撞击折断,2例为手淫折断;患者口述临床表现:阴茎受外力作用后,听见咔嚓的折断音,阴茎即刻变软,剧烈疼痛,排尿困难;临床检查所见:阴茎肿胀、青紫淤血,阴茎形状萎软偏向一侧,4例患者出现尿道口滴血;确诊方法:12例患者中6例依靠患者病史及临床检查确诊,6例患者通过B超检查确诊;2例轻症患者采用保守治疗,1个月后痊愈;10例患者行急诊手术治疗,麻醉下切开阴茎,探查损伤情况,行海绵体破裂缝合、尿道修补等;术后随访1年,共8例有并发症,主要为排尿困难、勃起障碍,经尿道扩张术和心理辅导后消失;术后3年随访,10例患者排尿、勃起均正常。结论:阴茎折断合并尿道损伤临床少见,根据患者病史、临床表现、临床检查可以确诊,病情轻者保守治疗,病情重者急诊手术治疗均可获得满意预后,同时还应加强对患者的心理辅导,避免出现心理障碍性勃起障碍。     

Is penile biopsy a useful tool in the diagnosis and management of erectile dysfunction?

(Ultra)structural analysis of penile biopsies used to be regarded as the ultimate solution to select candidates for reconstruction of the penile vascular in- and outflow tract. However, in the literature, (ultra)structural and biochemical analysis of penile biopsies has revealed no clear consensus concerning the relationship between corporeal histology and erectile dysfunction. The large biologic variation may be one of the most important reasons for the controversial outcome of light and electron microscopy studies. Furthermore, although the prevailing opinion is that the majority of cavernous abnormalities are generalized and that penile biopsies are representative, different views still exist. Moreover, there is a potential risk of damage to the corpus cavernosum. Therefore, we conclude that the use of penile biopsies to support the clinical diagnosis of erectile dysfunction should be considered obsolete.     

Pharmacologic penile rehabilitation

Penile rehabilitation therapy following radical prostatectomy is a new area of interest in urology. Preliminary clinical evidence supports the use of early pharmacologic penile rehabilitative therapies; however, large prospective multicenter placebo-controlled trials are needed to determine the benefits and costeffectiveness of particular pharmacologic penile rehabilitative therapies and of therapies in both nervesparing and non-nerve-sparing radical prostatectomy patients. This paper presents and analyzes recent medical literature pertaining to pharmacologic penile rehabilitation therapy after radical prostatectomy.     

Foscarnet-induced penile ulceration

Foscarnet is used to treat herpes viruses, including drug-resistant cytomegalovirus (CMV) and herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2). There are some reports of intravenous foscarnet-induced penile and vulvar ulceration. The authors report a case of the development of severe penile ulcers after the initiation of intravenous foscarnet therapy.     

Purple penile papules

Molluscum contagiosum may present in a variety of clinical and pathologic guises. We present the clinicopathologic features of an unusual case that initially was misinterpreted as bowenoid papulosis. The relevant histologic attributes of this case include the presence of a violaceous hyperplastic squamous epithelium adjacent to the infected keratinocytes. The presence of this violaceous cytoplasmic staining should prompt a search for molluscum in the appropriate clinical context.     

Common penile dermatoses

Urologists often encounter penile dermatoses stemming from varied etiologies. Although lesion biopsy and referral to a dermatologist is always a viable option, urologists can deliver excellent patient care when aware of the current knowledge of common penile lesions and recommended treatments. This article describes common dermatoses of the male genitalia and their treatment, including fungal, bacterial, viral, parasitic, cutaneous, environmental/iatrogenic, drug-induced, specific balanitides, and neoplastic sources.     

阴茎癌围手术期的护理

目的:针对阴茎癌患者手术部位的特殊性和患者心理接受程度,对患者进行围手术期护理及心理健康教育,减轻患者心理负担及术后的疼痛和不适感,减少手术后并发症,有利于疾病的康复,大大提升患者战胜疾病的信心。方法:通过回顾性分析对32例阴茎癌患者围手术期的护理,给予制定护理方案,实施护理措施,解决护理问题。结果:32例阴茎癌患者能积极配合治疗和护理,对疾病有了正确的认识,取得良好的效果。结论:针对阴茎癌患者,通过有特色的专科护理和心理健康教育,使治疗达到最佳效果,提高患者手术后的生活质量。     

Atypical pigmented penile macules

We describe three patients with pigmentary lesions of the penis that simulated malignant melanoma. The pathologic features were unimpressive, although one lesion may have represented a melanoma in evolution. The biologic potential of such lesions and their appropriate therapy remain to be defined.     

阴茎紫癜一例

患者男,25岁,已婚.因阴茎多次出现红点,于2005年9月来我院诊治.3个月前患者在性生活后次日小便时发现阴茎体上出现红色淤点,无痛痒,禁欲几日后皮疹便自行消退,如此反复多次后,遂来我科就诊.患者既往体健,近期无服药史,无腹痛及关节痛,无发热史.