Low-flow priapism: risk factors for erectile dysfunction
Low-flow priapism: risk factors for erectile dysfunction
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DOI：
10.1046/j.1464-4096.2001.01510.x
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发表时间：
2002-02-01
影响因子：
4.5
通讯作者：
Farouk, A
中科院分区：
文献类型：
--
作者：
El-Bahnasawy, MS;Dawood, A;Farouk, A
目的评估我们治疗阴茎异常勃起的政策，包括治疗的成功率、术后效力、并发症以及导致这些患者勃起功能障碍的危险因素。患者和方法该研究包括50名诊断为阴茎异常勃起的患者（平均年龄37.1岁，范围22-66岁）（1981-1999年）。他们的记录进行了审查; 33名患者可用于长期评估。评估的因素包括阴茎异常勃起的持续时间、既往复发性发作史、可能的根本原因（例如血液学疾病、药物或创伤）、与性刺激的关系、疼痛和既往治疗的任何尝试。在身体抽吸物中评估完整的血液筛查和血气。在随访时，所有阳痿患者均采用双功超声检查。早期和晚期并发症进行了审查，并询问他们的勃起功能阴茎异常勃起前，任何recursion.Results的中位数（范围）阴茎异常勃起的持续时间为48（6-240）h，几乎一半的患者出现>48 h后阴茎异常勃起的发病。16例患者（32%）报告了既往复发性发作史，其中7例有既往治疗史。阴茎异常勃起的主要原因是特发性或阴茎海绵体内注射罂粟碱。所有患者最初均通过身体抽血和注射麻黄碱进行治疗：如果失败或阴茎异常勃起延长（>48小时），则使用各种分流术。罂粟碱引起的或短暂的阴茎异常勃起患者的住院时间明显缩短。在35例患者的长期随访中（平均66.4个月，范围3-220），只有15例（43%）报告保留了勃起功能，这更可能发生在短暂性阴茎异常勃起（48小时）或罂粟碱以外的原因。多普勒超声检查显示20名阳痿男性有严重的高回声密度阴茎纤维化和高舒张末期血流速度，提示除2名外，其余均存在静脉闭塞性功能不全。在5名男性与分流海绵体造影显示广泛的静脉渗漏，无论网站的分流。5例阴茎纤维化患者的MRI显示低信号不均匀区域，与含铁血黄素沉积和纤维化相对应。在多因素分析中，治疗的最终结果（是否完全消肿）、阴茎异常勃起的持续时间和阴茎纤维化的存在显著影响勃起功能。结论低流量阴茎异常勃起>48 h，未能保持完全消肿后管理，并在后续显着的阴茎纤维化是负责勃起功能障碍的最重要的危险因素，未能实现完全消肿最有害的。
Objective To evaluate our policy of managing priapism for the success rate of the treatments, potency afterward, complications, and the risk factors responsible for erectile dysfunction in these patients.Patients and methods The study included 50 patients (mean age 37.1 years, range 22-66) with a diagnosis of priapism (1981-1999). Their records were reviewed; 33 patients were available for a long-term evaluation. Factors assessed were the duration of priapism, history of previous recurrent attacks, possible underlying causes (e.g. haematological disorders, medications or trauma), relation to sexual stimulation, pain, and any attempt at previous management. A complete blood screen and blood gases were assessed in corporal aspirates. Duplex ultrasonography was used in all impotent patients at their follow-up. Early and late complications were reviewed, and patients asked about their erectile function before priapism, and any recurrence.Results The median (range) duration of priapism was 48 (6-240) h; almost half the patients presented >48 h after the onset of priapism. Sixteen patients (32%) reported a history of previous recurrent attacks, of whom seven had a history of previous treatments. The main cause of priapism was idiopathic or intracavernosal injection with papaverine. All patients were initially treated by corporal blood aspiration and injection with ephedrine: if this failed or if the priapism was prolonged (>48 h) various shunts were used. The hospital stay was significantly shorter among patients with papaverine-induced or brief priapism. In the long-term follow-up of 35 patients (mean 66.4 months, range 3-220) only 15 (43%) reported preserved erectile function, and this was more likely in patients with brief priapism ( 48 h) or from causes other than papaverine. The 20 impotent men evaluated by Doppler ultrasonography had severe echo-dense penile fibrosis and high end-diastolic velocities suggesting veno-occlusive incompetence in all except two. In five men with shunts cavernosography showed extensive venous leakage irrespective of site of the shunt. MRI in five patients with penile fibrosis showed heterogeneous areas of low signal intensity, corresponding with haemosiderin deposition and fibrosis. On urtivariate analysis the final result of management (complete detumescence or not), the duration of priapism and the presence of penile fibrosis significantly influenced erectile function. On multivariate logistic regression only the first remained significant.Conclusions Low-flow priapism for >48 h, failure to maintain complete detumescence after management, and marked penile fibrosis during the follow-up are the most significant risk factors responsible for erectile dysfunction, with failure to achieve complete detumescence the most detrimental.