Pryor John, Akkus Emre, Alter Gary, Jordan Gerald, Lebret Thierry, Levine Laurence, Mulhall John, Perovic Sava, Ralph David, Stackl Walter
Institute of Urology, London University, London, UK.
J Sex Med. 2004 Jul;1(1):116-20. doi: 10.1111/j.1743-6109.2004.10117.x.
There are three different types of priapism: low-flow, ischemic, anoxic or veno-occlusive priapism; high-flow, arterial or nonischemic priapism; and recurrent or stuttering priapism.
To provide recommendations/guidelines concerning state-of-the-art knowledge for the diagnosis and treatment of priapism.
An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Priapism Committee, there were 10 experts from six countries.
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.
Concerning ischemic priapism, persistent cavernous smooth muscle relaxation and failure of contraction is a compartment syndrome with increasing intracavernosal anoxia, rising pCO2 and acidosis. Urgent medical attention should be sought for an erection lasting >4 hours; 90% with priapism >24 hours develop complete erectile dysfunction. After diagnosis and counselling, intracavernosal aspiration and alpha-blockers should precede surgical shunting. Concerning high-flow priapism (congenital, traumatic or iatrogenic), intervention is not urgent and often unnecessary. Definitive management is by selective embolization with autologous blood clot. Concerning recurrent/stuttering priapism, the pathophysiology may be central or local (sickle cell disease). Management needs to be individualized; androgen deprivation has proved useful but has adverse effects.
There is need for prospective, clinical trials to define safe and effective management strategies for patients with low-flow, high-flow or recurrent priapism.
阴茎异常勃起有三种不同类型：低流量型、缺血型、缺氧型或静脉闭塞型阴茎异常勃起；高流量型、动脉型或非缺血型阴茎异常勃起；以及复发性或间歇性阴茎异常勃起。
提供有关阴茎异常勃起诊断和治疗的最新知识的建议/指南。
与主要的泌尿外科和性医学协会合作进行了一次国际咨询，召集了来自60个国家的200多名多学科专家组成17个委员会。委员会成员为各种男性和女性性医学主题确定了具体目标和范围。关于各自性医学主题的最新知识的建议代表了来自五大洲的专家在两年时间内形成的意见。阴茎异常勃起委员会有来自六个国家的10名专家。
专家意见基于循证医学文献的分级、委员会内部广泛讨论、公开报告和辩论。
关于缺血型阴茎异常勃起，海绵体平滑肌持续松弛和收缩功能障碍是一种间隔综合征，伴有海绵体内缺氧增加、pCO2升高和酸中毒。勃起持续超过4小时应紧急就医；阴茎异常勃起超过24小时的患者中有90%会出现完全勃起功能障碍。诊断和咨询后，应先进行海绵体内抽吸和使用α受体阻滞剂，然后再进行手术分流。关于高流量型阴茎异常勃起（先天性、创伤性或医源性），干预并不紧急，而且通常没有必要。 definitive management is by selective embolization with autologous blood clot.关于复发性/间歇性阴茎异常勃起，其病理生理学可能是中枢性或局部性的（镰状细胞病）。管理需要个体化；雄激素剥夺已被证明有用，但有不良影响。
需要进行前瞻性临床试验，以确定低流量型、高流量型或复发性阴茎异常勃起患者的安全有效的管理策略。
