Kogan B A
Division of Urology, Albany Medical College, Albany, New York, USA.
J Urol. 2000 Dec;164(6):2058-61.
The intraoperative evaluation of erection is a major advance in hypospadias surgery. We determined the advantages of erections induced pharmacologically over those induced by intracorporeal saline injection for evaluating chordee during hypospadias surgery.
During the repair of hypospadias or chordee without hypospadias 56 boys 6 months to 13 years old underwent pharmacological erection induced by 14 microg. alprostadil administered intracavernously. Phenylephrine (40 microg. ) was given for detumescence. We monitored the adequacy of erection and detumescence, changes in blood pressure and pulse, and in 3 cases intracorporeal pressure. Intraoperative artificial erection was also induced in 30 patients.
Erection occurred within 1 minute of injection. It was judged to be excellent in 47 cases and adequate in 6, while it failed in 3 probably due to injection outside of the corpora. Erection involved the whole penis, in contrast to artificial erection when tourniquet placement altered the erection and left the penile base flaccid. The degree of chordee remained stable during evaluation compared to artificial erection when curvature varied with the force of the saline injection. Erection persisted during chordee repair as long as the corpora were not opened. Detumescence occurred within seconds in all cases in which phenylephrine was given. There were no cases of priapism, and systemic blood pressure and pulse did not change. Intracorporeal pressure during pharmacological erection was 47 to 70 mm. Hg, whereas during artificial erection pressure was 50 to 250 mm. Hg depending on how much saline was injected and how rapidly fluid drained through the tourniquet. Chordee was induced by over injection.
Pharmacological erection in hypospadias repair is effective and reliable with no significant complications. It is especially valuable in severe hypospadias and in patients with a large suprapubic fat pad. Artificial erection with saline injection should be performed with only moderate force since over filling is unphysiological and may falsely induce chordee.
术中阴茎勃起评估是尿道下裂手术的一项重大进展。我们确定了在尿道下裂手术中评估阴茎下弯时，药物诱导勃起相对于海绵体内注射生理盐水诱导勃起的优势。
在尿道下裂或无尿道下裂的阴茎下弯修复手术中，56名6个月至13岁的男孩接受了海绵体内注射14微克前列地尔诱导的药物性勃起。使用去氧肾上腺素（40微克）使其消肿。我们监测了勃起和消肿的充分程度、血压和脉搏的变化，并在3例中监测了海绵体内压力。30例患者还进行了术中人工勃起。
注射后1分钟内出现勃起。47例勃起效果极佳，6例效果尚可，3例可能因注射到海绵体之外而失败。勃起涉及整个阴茎，而人工勃起时，止血带的放置会改变勃起状态，使阴茎根部松弛。与人工勃起相比，评估期间阴茎下弯程度保持稳定，人工勃起时弯曲度会随生理盐水注射力度而变化。只要海绵体未打开，阴茎下弯修复过程中勃起就会持续。在所有使用去氧肾上腺素的病例中，数秒内即可消肿。无阴茎异常勃起病例，全身血压和脉搏未发生变化。药物性勃起时海绵体内压力为47至70毫米汞柱，而人工勃起时压力为50至250毫米汞柱，具体取决于注射的生理盐水量以及液体通过止血带排出的速度。过度注射会诱发阴茎下弯。
尿道下裂修复术中药物性勃起有效且可靠，无明显并发症。在重度尿道下裂和耻骨上脂肪垫较大患者中尤其有价值。生理盐水注射人工勃起时力度应适中，因为过度充盈不符合生理状态，可能会错误地诱发阴茎下弯。
