十、小结
异常勃起是指在无性刺激及性高潮的情况下,阴茎持续完全勃起或部分勃起4h以上。异常勃起与性刺激无关联。及时诊断和适当的处理可以提高治疗效果并减少勃起功能的损失。缺血性阴茎异常勃起(静脉阻塞、低流量性)表现为海绵体持续坚硬地勃起。在缺血性阴茎异常勃起中,伴有进行性的时间依赖性的缺氧、高碳酸血症和酸中毒。缺血性阴茎异常勃起是一种泌尿外科急症。缺血性阴茎异常勃起应逐步治疗:通过阴茎海绵体抽吸减压、阴茎海绵体注射稀释后的拟交感神经药物、手术分流,并考虑在难治性病例中立即进行阴茎假体植入手术。缺血性阴茎异常勃起是SCD的常见并发症。在患有SCD的男孩和青少年中,间歇性缺血性阴茎异常勃起与非自愿且伴有疼痛的晨勃有关。患过缺血性阴茎异常勃起的患者也有发生间歇性阴茎异常勃起的风险。HFP(非缺血性阴茎异常勃起,动脉性阴茎异常勃起)是由不受控制的阴茎海绵体动脉灌注引起的持续性勃起。通常情况下,阴茎肿胀但不坚硬,且不伴有疼痛。患者常有钝性阴茎创伤(骑跨伤)或医源性阴茎穿刺损伤的病史。HFP患者阴茎海绵体不会缺血,无缺氧、高碳酸血症或酸中毒。HFP一旦被正确诊断,就不需要紧急治疗。泌尿科医师应使用标准化问卷来记录勃起时间延长患者的病史:发病情况、创伤史、血液恶病质病史、使用非法药物、诱因、发病前的勃起功能、每次干预后复发情况及勃起功能恢复情况。根据缺血性阴茎异常勃起的持续时间,干预时间和干预类型分别记录勃起功能结局,将提供循证医学证据,指导临床医师操作。
参考文献
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(张建中 李宏军 编译 孟 彦 刘继红审校)