Levine J F, Saenz de Tejada I, Payton T R, Goldstein I
Department of Urology, Boston University School of Medicine, Massachusetts.
J Urol. 1991 Apr;145(4):764-7. doi: 10.1016/s0022-5347(17)38445-8.
Veno-occlusive priapism may be associated with prolonged corporeal ischemia, subsequent fibrosis of the corpora and impotence. We report on 6 patients who presented with an unusual sequela of veno-occlusive priapism, recurrent episodes of prolonged erections or priapism. In all cases the subsequent episodes were idiopathic and veno-occlusive, occurred with a frequency ranging from several times per day to once per month and were symptomatically disabling. Pharmacocavernosometry ruled out mechanical occlusion of corporeal venous drainage by demonstrating elevated flows to maintain intracavernosal pressures following smooth muscle contraction and markedly decreased flow rates following smooth muscle relaxation. Treatment of the recurrent episodes with intracavernous self-injection of phenylephrine resulted in successful detumescence. The use of oral phenylpropanolamine reduced the frequency and duration of the recurrences, and markedly reduced the need for adrenergic self-injection. It is proposed that this syndrome may develop secondary to the initial ischemic episode, resulting in a functional alteration of the adrenergic and/or endothelial-mediated mechanisms that control penile tumescence and maintain penile flaccidity.
静脉闭塞性阴茎异常勃起可能与阴茎体长期缺血、随后的阴茎海绵体纤维化及阳痿有关。我们报告6例患者，他们出现了静脉闭塞性阴茎异常勃起的一种不寻常后遗症，即反复出现长时间勃起或阴茎异常勃起发作。在所有病例中，随后的发作均为特发性且为静脉闭塞性，发作频率从每天数次到每月一次不等，且症状严重影响生活。阴茎海绵体测压通过显示在平滑肌收缩后为维持海绵体内压力而升高的血流以及在平滑肌松弛后明显降低的血流速率，排除了阴茎体静脉引流的机械性阻塞。通过阴茎海绵体内自我注射去氧肾上腺素治疗反复发作者，成功实现了消肿。口服苯丙醇胺减少了复发的频率和持续时间，并显著减少了肾上腺素能自我注射的需求。有人提出，该综合征可能继发于最初的缺血发作，导致控制阴茎勃起和维持阴茎疲软的肾上腺素能和/或内皮介导机制发生功能改变。
