Van der Horst C, Stuebinger Henrik, Seif Christoph, Melchior Diethild, Martínez-Portillo F J, Juenemann K P
Department of Urology, University Hospital Schleswig Holstein, Campus Kiel, Germany.
Int Braz J Urol. 2003 Sep-Oct;29(5):391-400. doi: 10.1590/s1677-55382003000500002.
The understanding of erectile physiology has improved the prompt diagnosis and treatment of priapism. Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation and failure to subside despite orgasm. Numerous etiologies of this condition are considered. Among others a disturbed detumescence mechanism, which may due to excess release of contractile neurotransmitters, obstruction of draining venules, malfunction of the intrinsic detumescence mechanism or prolonged relaxation of intracavernosal smooth muscle are postulated. Treatment of priapism varies from a conservative medical to a drastic surgical approach. Two main types of priapism; veno-occlusive low flow (ischemic) and arterial high flow (non-ischemic), must be distinguished to choose the correct treatment option for each type. Patient history, physical examination, penile hemodynamics and corporeal metabolic blood quality provides distinction between a static or dynamic pathology. Priapism can be treated effectively with intracavernous vasoconstrictive agents or surgical shunting. Alternative options, such as intracavernous injection of methylene blue (MB) or selective penile arterial embolization (SPEA), for the management of high and low flow priapism are described and a survey on current treatment modalities is given.
对勃起生理的理解有助于阴茎异常勃起的快速诊断和治疗。阴茎异常勃起被定义为在无性刺激情况下阴茎持续长时间勃起，且即使在性高潮后仍不消退。该病症有多种病因，其中包括收缩性神经递质过度释放、引流小静脉阻塞、内在消肿机制故障或海绵体内平滑肌长时间松弛等导致的消肿机制紊乱。阴茎异常勃起的治疗方法从保守的药物治疗到激进的手术治疗不等。必须区分阴茎异常勃起的两种主要类型：静脉闭塞性低流量（缺血性）和动脉性高流量（非缺血性），以便为每种类型选择正确的治疗方案。患者病史、体格检查、阴茎血流动力学和海绵体代谢血液质量有助于区分静态或动态病理情况。阴茎异常勃起可通过海绵体内血管收缩剂或手术分流有效治疗。文中描述了用于处理高流量和低流量阴茎异常勃起的替代方案，如海绵体内注射亚甲蓝（MB）或选择性阴茎动脉栓塞（SPEA），并对当前治疗方式进行了综述。
