Chiang I-Ni, Chang Shang-Jen, Kuo Yuh-Chen, Liu Shih-Ping, Yu Hong-Jeng, Hsieh Ju-Ton
National Taiwan University Hospital-Urology, Taipei, Taiwan.
J Sex Med. 2008 Nov;5(11):2725-33. doi: 10.1111/j.1743-6109.2008.00894.x. Epub 2008 Jun 18.
Penile gangrene is a rare but troublesome problem with high mortality rates. The etiologies could be infectious, traumatic, or vasculogenic. The treatment algorithm is controversial because of limited case numbers.
To describe our experiences in treating the patients with ischemic penile gangrene, to review the related literatures, and to try to summarize a practical algorithm for penile gangrene.
We retrospectively reviewed the medical records of five patients with penile gangrene treated between 1996 and 2006. Data obtained include the patients' ages initial presentation, detailed histories, comorbidity, renal status, other vascular diseases, coagulation profile, treatment course, histology presentations, and prognosis were obtained.
Comparison of the patients' ages, presentations, underlying diseases, the duration of conservative treatments, surgical options, resected penile length, and prognosis.
All of the five patients underwent partial penectomy. One patient underwent immediate surgery while the other four had delayed partial penectomy because of progressive distal penile gangrenous change. There was no postoperative wound infection noted in any of the five patients and all had survived after 1 year follow-up. Three of them could void independently with a neourethra meatus. Two of them kept suprapubic cystostomy as a result of bladder outlet obstruction caused by an enlarged prostate and bed-ridden status.
Penile dry gangrene is an irreversible process. Early partial penectomy and correction of the underlying disease can prevent wound liquefaction, preserve more penile length, and improve quality of life.
阴茎坏疽是一个罕见但棘手的问题，死亡率很高。其病因可能是感染性、创伤性或血管源性的。由于病例数量有限，治疗方案存在争议。
描述我们治疗缺血性阴茎坏疽患者的经验，回顾相关文献，并尝试总结一种实用的阴茎坏疽治疗方案。
我们回顾性分析了1996年至2006年间治疗的5例阴茎坏疽患者的病历。获取的数据包括患者年龄、初始表现、详细病史、合并症、肾脏状况、其他血管疾病、凝血指标、治疗过程、组织学表现和预后。
比较患者的年龄、表现、基础疾病、保守治疗时间、手术选择、切除阴茎长度和预后。
5例患者均接受了部分阴茎切除术。1例患者立即接受手术，另外4例因阴茎远端进行性坏疽改变而延迟行部分阴茎切除术。5例患者术后均未出现伤口感染，随访1年后全部存活。其中3例可通过新尿道口自主排尿。另外2例因前列腺增生导致膀胱出口梗阻及卧床状态而保留耻骨上膀胱造瘘。
阴茎干性坏疽是一个不可逆的过程。早期行部分阴茎切除术并纠正基础疾病可防止伤口液化，保留更多阴茎长度，并改善生活质量。
