男性学信息

器质性阳萎中约30％是由于静脉漏。这种海绵体的病理性引流是海绵体关闭不全(即海绵窦的放松不足,致小静脉压迫不足或白膜中穿透静脉的挤压不足)。作者发现5例由于海绵体引流不良引起的器质性阳萎是由于一根异位阴茎静脉将血液导八股静脉所致,故对阴茎海绵内注射血管活性药物反应不良及反应不规则者,作海绵体造影可显示异位阴茎静脉。在阴茎内注射7.5mg罂粟硷及0.25mg酚妥拉明并用多普勒超声定位后,在局麻下双重结扎该静脉并切断之,可取得良好效果。若多普勒     

阴茎扭曲矫正术

为探索合适的手术方式使阴茎扭曲恢复常态，作者对阴茎扭曲严重者，采用改良的Ｎｅｓｂｉｔ法，于阴茎扭曲方向对侧的阴茎海绵体，与阴茎长轴呈４５度角，平行切除椭园形白膜多块，并将该侧阴茎根部白膜与对侧耻骨结节固定。对阴茎扭曲较轻的，将扭曲方向对侧的阴茎海绵体白膜单纯折叠缝合。随访３个月，两例患者的阴茎在疲软或勃起状态下均外观正常，阴茎扭曲得到了完全纠正。作者认为，按照一定的角度采用切除或折叠的方法，以缩短扭曲方向对侧阴茎海绵体的白膜长度，都能使阴茎扭曲得到满意的矫正。     

135例静脉性阳萎手术病人的护理

１３５例静脉性阳萎手术病人的护理同济医科大学附属协和医院桂友英，吴淑香静脉性阳萎是一种器质性疾病，发病率占阳萎疾病的４０％［１］。病因是阴茎海绵体静脉血流受阻。如先天性或医源性阴茎海绵体与龟头间瘘管、白膜静脉畸形等，使阴茎不能勃起。我院１９８９年２月...     

阴茎Peyronie病治疗进展

正常阴茎体检触诊质地柔软,恰似海绵状,具有弹性,解剖学称之为阴茎海绵体（ｃｏｒｐｕｓｃａｖｅｒ－ｎｏｓｏｕｍ）。倘若海绵体纤维变性,引起斑块和瘢痕化,可出现勃起不良,或出现阴茎弯曲畸形,影响性生活。纤维瘢痕主要发生于阴茎海绵体白膜（ｔｕｎｉｃａａｌｂ...     

海绵体神经在前列腺尖部及远端的行程与分布

目的 观察海绵体神经在前列腺尖部及其远端的行程和分布,探讨海绵体神经与周围 组织的关系.方法 3具成年男性尸体尿道和阴茎标本,自前列腺尖部至阴茎头连续切片行HE染色和神经纤维嗜银染色,观察海绵体神经在前列腺尖部及其远端尿道膜部阴茎的行程与分布.结果 海绵体神经纤维束行于前列腺尖部和尿道膜部约3点到9点处,距离尿道腔约3～5 mm,向远端进入阴茎海绵体近段.自尿道膜部向前走行与海绵体静脉丛并行进入海绵体中隔.结论 海绵体神经在前列腺尖部以及阴茎近段与尿道及海绵体静脉关系密切,该部位尿道和海绵体静脉相关手术容易损伤海绵体神经.     

阴茎勃起机理的研究进展

阴茎勃起机理的研究近年来已经取得了相当大的进展,不仅修正和完善了传统的理论,也对阳萎和阴茎异常勃得的机理和治疗产生了深远的影响。现就勃起机理的研究现状作一综述。阴茎的解剖研究阴茎勃起组织包括位于背侧的一对阴茎海绵体和位于腹侧的尿道海绵体,各自为阴茎白膜所包裹,三者由阴茎筋膜围成一体。供应阴茎的阴茎背、深动脉发自阴部内动脉。阴茎背动脉行走于阴茎海绵体的阴茎筋膜和白膜之间。阴茎深动脉(阴茎海绵体动脉)作为中心动脉,从阴茎脚进入,经阴茎海绵体导向阴茎末端。背、深动脉系统之间有众多的吻合支沟通。对于阴茎的静脉引流尚有争论,Deysach发现背     

闭合性阴茎海绵体白膜破裂的诊断与治疗

目的探讨阴茎海绵体白膜破裂的诊断与治疗。方法回顾性分析我院2012年7月～2017年12月收治的10例阴茎海绵体白膜破裂患者的临床资料。均依据病史、典型的临床表现及彩色多普勒超声检查确诊,均急诊行白膜修补手术治疗。结果 10例患者手术均取得成功,平均手术时间26(15～40) min,术后1周左右切口愈合拆线,平均住院7(6～8) d。2～3个月后复查阴茎形态恢复正常,随访3～24个月未出现海绵体白膜纤维化、阴茎硬结、阴茎弯曲及痛性勃起等并发症,性功能正常。结论阴茎白膜破裂的诊断主要依据典型外伤史及临床表现,彩色多普勒超声检查是诊断该病可靠的辅助检查,急诊海绵体白膜修补术是治疗闭合性阴茎海绵体白膜破裂有效方法。     

阴茎背深静脉包埋术治疗静脉性勃起功能障碍

阴茎背深静脉漏是导致血管性ED的原因之一。笔者于2003年2月～2006年3月采用阴茎海绵体白膜包埋阴茎背深静脉手术方式治疗原发静脉性ED9例获得较好疗效，现报道如下。     

两种阴茎海绵体增粗手术方法的探讨

目的:探讨用自体大隐静脉或ePTFE人工血管增粗阴茎海绵体术式的可行性。方法:应用自体大隐静脉移植或ePTFE人工血管置入切开分离的双侧阴茎海绵体白膜，扩大阴茎海绵体周径及其体积。结果:用上述两种方法完成阴茎增粗并延长术17例患者，随访12～24个月，阴茎外形、勃起功能及性生活均满意。结论:所用的两种手术方法使阴茎增粗效果显著，尤以勃起时更为明显，是动态功能性阴茎增大的良法。其远期疗效和并发症尚有待进一步观察。     

植入性阴茎静脉压迫装置:在犬模型中的初步经验

作者设计了一种静脉压迫装置植入于阴茎根部白膜外,因为它不须暴露静脉并结扎,故无海绵体神经受损的危险,它仅暂时阻断静脉回流,故侧支循环很少发生。全麻下13条成年杂种狗的阴茎干剥脱至基底部,实验性阴茎静脉压迫装置紧贴置放使环绕近侧阴茎干,电刺激海绵体神经30秒诱发勃起。     

Study of human penile venous system and hypothesis on its behavior during erection

To determine the role of the venous outflow restriction during human erection, we compared intracavernous pressure with deep dorsal vein pressure in 6 normal subjects during papaverine-induced erection and penile saline infusion. In addition, flows necessary to produce and maintain erection were measured in 10 cadavers before and after resection of the deep dorsal vein alone or together with ligation of the cavernous veins. Elongation of tunica albuginea was measured at the crural and mid portions of the penis. At rigidity there was complete blockage of the venous return through the emissary veins. The venous outflow through the cavernous veins was reduced but still persisted. The distention of the tunica albuginea was less important at the crural portion than at the distal portion and could explain why the cavernous veins were not blocked completely.     

The mechanism of blood outflow from the cavernous tissue of human penis by computer graphics

There are two theories concerning the mechanisms of human penile erection and its maintenance. One theory goes that the artery responsible for blood inflow into the cavernous space relaxes, while the vein responsible for blood outflow actively contracts. The other theory asserts that no active closing mechanism in present in the penile venous system, but rather the erection is totally controlled by the amount of blood inflow. In order to corroborate the vascular construction of the penis, we prepared serial sections of the penis specimens obtained at autopsy and observed these sections by light microscopy, and we investigated the construction of veins which let blood flow out from the corpus cavernosum penis by computer graphics. As a result, we were unable to find any valves in the blood outflow system. Moreover, efferent vessels were seen to let blood flow from the cavernous spaces, after running immediately below the tunica albuginea for a small distance, to the tunica albuginea, running obliquely through inner veins toward the outside of the tunica albuginea in the direction of the long axis of the penis; then these veins are continuous to the veins on the tunica albuginea. From the above-mentioned structures we can infer the following mechanism of penile erection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hypothesis of human penile anatomy, erection hemodynamics and their clinical applications

Aim： To summarize recent advances in human penile anatomy, hemodynamics and their clinical applications. Methods： Using dissecting, light, scanning and transmission electron microscopy the fibroskeleton structure, penile venous vasculature, the relationship of the architecture between the skeletal and smooth muscles, and erection hemodynamics were studied on human cadaveric penises and clinical patients over a period of 10 years. Results： The tunica albuginea of the corpora cavernosa is a bi-layered structure with inner circular and outer longitudinal collagen bundles. Although there is no bone in the human glans, a strong equivalent distal ligament acts as a trunk of the glans penis. A guaranteed method of local anesthesia for penile surgeries and a tunical surgery was developed accordingly. On the venous vasculature it is elucidated that a deep dorsal vein, a couple of cavernosal veins and two pairs of para-arterial veins are located between the Buck＇s fascia and the tunica albuginea. Furthermore, a hemodynamic study suggests that a fully rigid erection may depend upon the drainage veins as well, rather than just the intracavemosal smooth muscle. It is believed that penile venous surgery deserves another look, and that it may be meaningful if thoroughly and carefully performed. Accordingly, a penile venous surgery was developed. Conclusion： Using this new insight into penile anatomy and physiology, exact penile curvature correction, refined penile implants and promising penile venous surgery, as well as a venous patch, for treating Peyronie＇s deformity might be performed under pure local anesthesia on an outpatient basis. （Asian J Androl 2006 Mar; 8： 225-234）     

Mechanisms of venous occlusion during canine penile erection: an anatomic demonstration

Hemodynamic studies have clearly demonstrated that intracorporeal injection of papaverine causes an increase of venous outflow resistance, and we therefore undertook a study of the venous drainage of the canine penis to delineate the anatomic changes in the venular structure during papaverine-induced erection. In 11 dogs, the corpora cavernosa were examined by corrosion casting in six and serial trichrome staining and histologic sectioning in five. Low-power scanning electron microscopy of the corrosion casts demonstrated the existence of a venular plexus interposed between the tunica albuginea and the sinusoidal spaces. After papaverine injection, this subalbugineal venular plexus is compressed between the dilated sinusoids from below and the tunica albuginea from above, such that venous drainage is effectively impeded. Examination of two cadaveric human penile corrosion casts by low-power scanning electron microscopy revealed evidence of a similar subalbugineal venular plexus draining into the emissary veins along the shaft of the penis. Based on the above, a model for the anatomic basis of venous occlusion during penile erection is outlined. Along with arteriolar and sinusoidal smooth-muscle relaxation, this can account for the three basic hemodynamic changes necessary for erection: increased arterial inflow, increased intracorporeal pressure, and increased venous outflow resistance.     

Electron microscopic findings of penile tissues in veno-occlusive dysfunction: Is penile biopsy necessary?

In this study, we examined the biopsy patterns of penile tissues taken during operation from patients subjected to surgical treatment for veno-occlusive dysfunction, and evaluated the importance of penile biopsy. We evaluated the findings from 17 patients with venous impotence. Fourteen of them underwent total vein ligation and the rest penile prosthesis implantation. Tissue speciments taken from superficial and deep dorsal veins, tunica albuginea and corpus cavernosum during operation were examined under electron microscope. Tissue specimens taken from 3 cadavers were used as the control group. Although the deep and superficial vein specimens of all patients did not show significant differences, oedema and increase of fibroblasts in collagen fibres of the corpus cavernosum and tunica albuginea were demonstrated. We concluded that penile biopsy as an invasive method does not give enough information about the choice of treatment for erectile dysfunction.     

阴茎体白膜两侧睾丸鞘膜移植阴茎增粗术实验研究

目的:探讨犬阴茎体白膜两侧自体睾丸鞘膜移植阴茎增粗术的治疗效果及手术并发症。方法:取5只雄性杂种狗自体睾丸鞘膜移植于阴茎白膜两侧的纵形切口,以扩大阴茎白膜腔、增大阴茎海绵体容积、增粗阴茎;手术前后进行疲软及勃起状态下阴茎海绵体周径的测量及两侧阴茎海绵体动态灌注测压(DIC);术后3个月行组织学检查。结果:施行5只10侧,术后3个月勃起状态下阴茎海绵体周径平均增加21.1%,疲软状态下增粗不明显,DIC参数与术前相比无统计学差异;无其他严重并发症;组织学检查移植物内轻度炎性反应和纤维化,其上有白膜的重新形成。结论:该手术方法使勃起状态下阴茎增粗效果显著,是一种安全的、真正针对勃起组织的阴茎增粗方法。     

The origin of lymphatic capillaries in murine testes

It is known that the seminiferous tubules are bathed in a sea of lymph in mice, which are commonly used in reproductive and immunological studies. Although testicular lymphatic vessels arising from the tunica albuginea can be macroscopically observed in mice, the exact distribution of the lymphatic capillaries remains unclear. In the present study, we investigated the distribution of lymphatic capillaries in normal testes by immunohistochemical staining with monoclonal antibodies against lymph vessel endothelium HA-receptor 1 (LYVE-1) and a platelet endothelial cell adhesion molecule (CD31). Moreover, normal lymphocytes were locally injected into the testes of recipient mice, and their migration was investigated with the use of LYVE-1 and CD31. The results showed that lymphatic capillaries were in and just beneath the tunica albuginea but not in the interstitium between the seminiferous tubules. It was also noted that these were abundant in the thickened tunica albuginea adjacent to the epididymis, but they were scarce in the thin tunica albuginea opposite the epididymis. When normal lymphocytes were locally injected into testes, the injected lymphocytes migrated between the seminiferous tubules and then drained into the lymphatic vessels in the tunica albuginea. These results suggest that tissue fluid might drain from lymphatic capillaries that arise just beneath the tunica albuginea.     

Complex tunica albuginea cysts: a review of the literature

Only 27 cases of tunica albuginea cysts have been reported. We review tunica albuginea cysts and describe the complex tunica albuginea cyst, a new entity not previously defined. A careful orderly approach to these lesions will result in a possible testicular sparing operation.     

Morphological changes in penile vessels during erection: the mechanism of obstruction of arteries and veins at the tunica albuginea in dog corpora cavernosa

The present study deals with morphological changes during erection both in the penile deep artery supplying the corpus cavernosum and in veins draining it. These vessels were shown to maintain wide lumina in the flaccid state. In the erect state induced by injection of papaverine, the postcavernous venules were compressed between the cavernous sinuses and the tunica albuginea. Simultaneously, the penile deep artery and the penetrating vein were strangulated by stretched collagen bundles in the inner layer of the tunica albuginea. Quite noteworthy was a wedge-shaped connective tissue mass between the penetrating vein and the postcavernous venules converging to it, and plugged, in the erect state, towards the penetrating vein to effectively stem the venous outflow. When the rigid state was induced by papaverine injection and following intracavernous injection of a fixative by high pressure, the arterial and venous obliteration mentioned above was so intense that the vessels almost lost their lumina, resulting in the cavernous sinuses becoming isolated from the systemic circulation.