早期手术治疗阴茎白膜海绵体破裂的疗效评价

阴茎白膜海绵体破裂为男科急症,若不及时治疗,可导致严重并发症.笔者对我院1998年1月- 2011年1月收治的13例阴茎白膜海绵体破裂采取早期手术治疗的临床资料进行回顾分析,探讨早期手术治疗阴茎白膜海绵体破裂的重要性. 1临床资料 1.1一般资料 本组年龄20～51岁,平均32岁.均有外伤史:粗暴性交致伤10例,口交致伤1例,手淫致伤1例,斗殴致伤1例.临床表现:阴茎剧痛、肿胀,皮肤青紫或伴侧弯畸形.患者均未见排尿困难、尿潴留或尿道外口滴血.受伤后1 ～18 h就诊.     

阴茎白膜及海绵体损伤19例诊治体会

目的提高阴茎白膜及海绵体损伤的诊疗水平。方法对临床怀疑并经辅助检查证实并进行急诊手术修补的19例阴茎白膜及海绵体损伤患者的临床资料进行分析。结果15例均获随访，3例失访，1例因病死亡，随访病例全部勃起功能及性功能正常。结论阴茎白膜及海绵体损伤手术治疗是保证疗效的关键。     

脾动脉栓塞在急诊外伤性脾破裂治疗中的应用价值

目的 评价脾动脉栓塞在急诊外伤性脾破裂治疗中的应用价值.方法 采用Seldinger技术经皮穿刺股动脉,经脾动脉造影,根据脾脏受损程度行脾动脉栓塞治疗急诊外伤性脾破裂101例.结果 术后患者均有左上腹轻度胀痛,左侧胸腔积液56例,腹膜后血肿5例,脾脓肿1例,胰腺炎1例,左下肺膨胀不全1例.96例急诊外伤性脾破裂止血效果...     

脾部分切除治疗外伤性脾破裂15例报告

目的:探讨脾部分切除在脾破裂治疗中的应用.方法:回顾分析我院2001～2007年共15例采用脾部分切除治疗的外伤性脾破裂病人的临床资料,总结手术适应证、手术方法及技巧.结果:15例病人均手术成功,痊愈出院,术后随访1年免疫学及血常规均正常.结论:脾部分切除治疗外伤性脾破裂安全、有效.     

保脾手术治疗小儿外伤性脾破裂25例体会

目的　探讨保脾手术治疗小儿外伤性脾破裂的术式选择及适应证。方法　 1 995年 4月— 2 0 0 2年 4月 ,对 2 5例保脾手术治疗小儿外伤性脾破裂进行回顾性分析。结果　2 5例施行保脾手术患者均恢复良好 ,术后无继发出血 ,均获治愈 ,随访5～ 8年 ,日常学习及生活质量良好。结论　遵循脾损伤治疗原则 ,以保脾手术治疗小儿外伤性脾破裂具有更大的安全性和可行性。     

外伤后高流入性阴茎异常勃起的诊断与治疗

目的 探讨高流入性阴茎异常勃起的病因与发病机制,提高其诊断和治疗水平。方法 分析总结2例外伤后动脉性高流入性阴茎异常勃起病人的临床资料。2例均经多功能彩色多谱勒检查确诊。其中1例行选择性阴部内动脉造影,并用明胶海绵行右侧海绵体动脉栓塞术。结果 本组2例患者中,行超选择性海绵体动脉栓塞术治疗的病例术后阴茎变软,术后随访阴茎勃起功能恢复正常;另1例仅行海绵体穿刺放血后向海绵体内注入阿拉明治疗,阴茎暂时变软,很快又恢复至原来状态,治疗效果不佳。结论 阴茎海绵体血气分析及选择性阴部内动脉造影是诊断海绵体动脉窦状隙瘘的主要依据。超选择性海绵体动脉栓塞术治疗动脉性高流入性阴茎异常勃起是安全而有效的方法。     

半环形切口治疗闭合性阴茎海绵体损伤5例

闭合性阴茎海绵体损伤较为少见,多由性交姿势不当引起,严重者需急诊手术治疗。笔者2009-05至2012—12采用半环形切口手术5例,取得较好效果。     

微圈栓塞海绵体动脉瘘治疗外伤性阴茎异常勃起的疗效评价

目的评价微弹簧圈超选择性栓塞治疗外伤性高流量性阴茎异常勃起的技术与疗效。方法2002年6月至2006年3月我科共收治典型高流量性阴茎异常勃起患者7例。所有患者均有会阴部外伤病史。彩色超声均诊断阴茎单侧海绵体动脉瘘,且均经血管造影证实。所有动脉海绵体瘘均经微导管超选择插管,微圈栓塞。栓塞术后即刻对患者阴茎勃起状态进行体检评价,并分别于术后3、6个月对患者进行彩色超声随访,对勃起功能则长期随访评价。结果超选择动脉插管及栓塞均获得成功。其中6例首次治疗即使用微圈栓塞,另1例是在明胶海绵颗粒栓塞1周后复发,再次栓塞时使用的微圈技术。所有患者栓塞后即刻至1h检查,阴茎勃起状态明显消退。7例使用微圈栓塞患者长期随访阴茎勃起功能正常。结论超选择微圈栓塞对治疗高流量性阴茎异常勃起安全、有效。微圈应作为首选栓塞物取代传统的海棉颗粒。     

蛛网膜下腔出血并颅内血肿疑为动脉瘤破裂的手术探查治疗

目的探讨自发性蛛网膜下腔出血并颅内血肿疑为动脉瘤破裂的治疗策略。方法总结2005年5月～2010年8月9例蛛网膜下腔出血并颅内血肿疑为动脉瘤破裂的急诊手术探查治疗,9例入院时均呈昏迷,其中5例一侧瞳孔散大,3例双侧瞳孔散大,3例呼吸不规则;均在入院1～2 h内急诊手术探查。结果 9例中发现前交通动脉瘤2例,后交通动脉瘤3例,大脑中动脉瘤4例,均在显微镜下行血肿清除、动脉瘤夹闭;死亡2例,术后完全清醒6例,植物生存1例。结论对蛛网膜下腔出血并颅内血肿疑为动脉瘤破裂患者入院时病情危重,未行DSA或CTA检查,为争取抢救时间,可急诊手术探查,效果满意。     

可屈性硅橡胶—银假体阴茎植入治疗阳萎22例报告

1994年10月～1996年12月,作者用可屈性硅橡胶—银阴茎假体,阴茎海棉体内植入治疗阳萎22例,疗效满意,报告如下。1 临床资料1.1 一般资料 本组22例阳萎患者,年龄28～65岁,平均48.5岁,其中28～31岁4例,32～45岁9例,46～60岁5例,61～65岁4例。病史:6～12个月4例,1～5年11例,6～10年6例,21年1例。22例术前均行罂粟碱或PEG,阴茎海棉体注射,观察5～15min,勃起角均小于70°,16例经院内外做血糖,血脂,EPS常规,性激素测定及NPT(测量带法),PBl及海绵体造影等检查,诊断心理性阳萎为主者8例,器质性阳萎9例,混合性5例,6例同时伴有早泄,22例均经中西医多种方法治疗不愈而要求手术。     

Magnetic resonance diagnosis of traumatic penile fracture

PURPOSE: To report our experience with MRI in the preoperative evaluation of patients with traumatic penile fractures. MATERIALS AND METHODS: Between January 1998 and December 2001, we performed MRI examinations on five patients (aged 29-48 years; mean age 40 years) with suspected traumatic fracture of the penis occurred during sexual intercourse. In all cases, T1-weighted SE, T2-weighted FSE and GRE sequences in the axial, coronal and sagittal planes were acquired. The study was performed without IV administration of paramagnetic contrast agents and in conditions of detumescence. A small-sized surface coil was used in four cases and a body coil was used in one case. All patients had suspected penile fracture with indications for surgical repair. The MR examination was performed within 12 to 48 hours of the trauma and was requested to aid surgical planning. RESULTS: The MR image quality was adequate in all cases. The examination documented unilateral rupture of the corpus cavernosum in all patients. This finding was associated with haematoma located both subcutaneously and inside the corpus cavernosum itself. In no case was there rupture of both corpora cavernosa. In only one patient was there a suspicion of injuries to the urethral corpus spongiosum, which was confirmed by surgery along with the other MR findings. DISCUSSION AND CONCLUSIONS: Many imaging methods are available to evaluate traumatic penile lesions: ultrasound, colour-Doppler ultrasound, urethrography, cavernosography, angiography and MRI. In agreement with the literature, our experience shows that MRI is useful in evaluating penile injuries owing to its multiplanar capabilities, its good spatial resolution and its excellent tissue contrast resolution. These characteristics enabled a more adequate surgical approach. In our view, MRI can be regarded as an emerging method to obtain helpful diagnostic information, with no risks for the patient.     

Penile fracture: MRI demonstration of a urethral tear associated with a rupture of the corpus cavernosum

We report a case of traumatic urethral tear associated with a rupture of the corpus cavernosum, demonstrated on MRI. We discuss the potential role of a non-invasive preoperative assessment by MRI. Received 10 February 1997; Revision received 5 June 1997; Accepted 6 June 1997     

Endovascular embolization of posttraumatic high-flow priapism: Uncommon arteriovenous fistula of the corpus cavernosum

Priapism is a persistent penile erection lasting more than four hours without sexual arousal or stimulation. We report on a high-flow priapism, an uncommon arteriovenous fistula of the corpus cavernosum after a straddle trauma which was successfully embolized. At follow up no recurrent episodes of priapism occurred without symptoms of erectile dysfunction or other complications.     

Pharmacology of penile erection in humans

The pharmacologic aspects of erection, including neuropharmacology and erectile responses to exogenous agents, are reviewed. The pharmacology of erection is complex and still incompletely understood. Older evidence suggesting acetylcholine as the primary neurotransmitter has been shown to be insufficient. Our recent experiments utilizing strips of human corpus cavernosum indicate the need to consider the roles of other erectogenic substances, such as vasoactive intestinal polypeptide, endothelium-derived relaxation factor (EDRF), and prostaglandins. From the results of these studies, three stages in the development of an erection are postulated: (1) withdrawal of alpha-adrenergic neuromuscular activity, (2) inhibition of alpha-adrenergic activity by endogenous substances such as prostaglandin E₁ and vasoactive intestinal polypeptide, and (3) activation of NANC neurotransmission and direct relaxation of smooth muscle by endogenous substances such as EDRF.     

Pharmacoangiography of the penile arteries

Angiography may play an important role in the evaluation of patients with erectile failure and in whom abnormal Doppler studies indicate arterial insuffiency. The angiographic examination should give information about major pelvic arteries as well as the peripheral branches of the internal pudendal artery. We describe a method for performing pharmacoangiography of the penile arteries, which involves the local injection of a vasodilator into the corpus cavernosum. Angiography during pharmacologic erection provides optimal visualization of the penile arteries and helps to differentiate functional from organic vascular disorders.     

Pharmacoangiography of the penile arteries

Angiography may play an important role in the evaluation of patients with erectile failure and in whom abnormal Doppler studies indicate arterial insuffiency. The angiographic examination should give information about major pelvic arteries as well as the peripheral branches of the internal pudendal artery. We describe a method for performing pharmacoangiography of the penile arteries, which involves the local injection of a vasodilator into the corpus cavernosum. Angiography during pharmacologic erection provides optimal visualization of the penile arteries and helps to differentiate functional from organic vascular disorders.     

血红素加氧酶-一氧化碳系统舒张离体大鼠阴茎海绵体平滑肌作用的研究

 目的 探讨血红素加氧酶-一氧化碳(HO-CO)系统对离体大鼠阴茎海绵体平滑肌的舒张效应,并初步探讨其舒张作用的机制.方法 采用离体大鼠阴茎海绵体肌条张力记录法,观察氯高铁血红素(Hemin)诱导的HO-CO系统对去氧肾上腺素(PE)预收缩的阴茎海绵体肌条的舒张作用;采用放射免疫法,观察Hemin诱导的HO-CO系统对离体大鼠阴茎海绵体组织中cGMP和cAMP水平的影响.结果 Hemin对10 μmol/L PE诱导收缩的离体大鼠阴茎海绵体肌条具有浓度依赖性松弛作用,1、3、10、30、100 μmol/L的Hemin对PE诱导收缩的阴茎海绵体肌条的松弛效应分别为(3.2±1.2)%、(10.6±2.2)%、(21.5±2.7)%、(38.0±3.1)%和(66.5±3.8)%(P<0.01);100 μmol/L的Hemin对大鼠阴茎海绵体组织中cGMP和cAMP的水平均无影响.结论 HO-CO系统能有效舒张离体大鼠阴茎海绵体平滑肌,其机制可能与CO- cGMP或CO-cAMP通路无关.     

A dual-radioisotope technique for the evaluation of penile blood flow during tumescence.

A technique is described for concomitant study of both arterial and venous penile blood flow during tumescence. Dual-isotope acquisition is started after labeling red cells in vivo with 99mTc. Xenon-133 in saline is then injected into the corpus cavernosum followed with vasoactive drugs to induce an erection. The resulting xenon and technetium time-activity curves are inputs for a one-compartment model. In 14 subjects, the average peak arterial flow rate (PAF) for normal males was calculated as 13.0 +/- 1.28 ml/min (avg +/- s.d.) compared to 16.1 +/- 5.14 and 5.02 +/- 1.78 ml/min for patients with venous leak (VL) or arterial insufficiency (AI), respectively. Peak venous flows (PVF) were 4.25 +/- 1.17, 12.1 +/- 3.75, and 3.78 +/- 1.00 ml/min for normal, VL and AL respectively. Al patients have significantly lower PAF than normal (p = 0.002) or VL patients (p = 0.018), and VL patients had significantly higher PVF than normal (p = 0.012) or Al (p = 0.018). The technique may be helpful in the study of impotence.     

Preservation of organs related to future sexual function during prostate stereotactic body radiotherapy: feasibility analysis through a re-optimization process

Preserving the quality of life and sexual function of patients with a localized prostate cancer remains a challenge for physicians and a major issue for patients. The present study aimed at demonstrating the feasibility of a dosimetric preservation of the sexual organs during prostate stereotactic radiotherapy planning. Patients from a single centre were retrospectively included in the RPAH-2 trial and randomized in Arm B if they presented with either a low- or intermediate- risk prostate cancer. A 37.5Gy in 5 fractions stereotactic body radiotherapy was delivered on the prostate gland. The corpus cavernosum, penile bulb and internal pudental arteries were retrospectively delineated before a re-optimization process. During this process, RPAH-2 trial dose constraints were respected on Gross Tumor Volume (GTV), Planning Target Volume and usual organs at risk. Pre-defined dose setting delivered to corpus cavernosum, penile bulb and internal pudental arteries were collected and compared before and after the re-optimization process. Nine patients were included in the study. A decrease of the median of each investigated dose setting (except D90% for corpus cavernosum) was reported after the re-optimization for corpus cavernosum, penile bulb and internal pudental arteries. Our study demonstrated the feasibility of a dosimetric preservation of structures considered as relevant to preserve sexual function after prostate stereotactic radiotherapy.     

Acute partial segmental thrombosis of the corpus cavernosum: imaging findings on ultrasound, computed tomography, and magnetic resonance imaging

Partial segmental thrombosis of the corpus cavernosum is a rare disease of unknown etiology; the thrombosis is always located in the proximal part of the corpus cavernosum, usually unilaterally. Typical clinical presentation with perineal pain and swelling in combination with cross-sectional imaging allows one to confidentially establish this diagnosis.