Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.
J Urol. 2010 Apr;183(4):1474-8. doi: 10.1016/j.juro.2009.12.032. Epub 2010 Feb 20.
We assessed penile and bulbospongiosus measurements to develop a quantitative guide to select the surgical approach (perineal vs transscrotal vs transcorporeal) to artificial urinary sphincter cuff placement.
We retrospectively reviewed the intraoperative records of 100 men who underwent artificial urinary sphincter placement (43) or anastomotic urethroplasty (57) from February 2008 to June 2009. Correlations between penile (stretched length and circumference at the shaft base) and bulbospongiosus (distal and proximal circumference) measurements were assessed. Cases were analyzed according to 2 penile circumference groups, including group 1-8.0 cm or less and group 2-8.5 or more.
Mean proximal bulbospongiosus circumference was uniformly larger than distal bulbospongiosus circumference (4.5 vs 3.9 cm). It was about 50% of the penile shaft circumference (mean 8.9 cm, r = 0.70). In group 1 men the average distal bulbospongiosus circumference was 3.4 cm. They were more likely to undergo transcorporeal artificial urinary sphincter cuff placement than those in group 2, who had an average distal bulbospongiosus circumference of 4.1 cm (8 of 22 or 36% vs 1 of 21 or 5%, OR 11.4). Penile length correlated less robustly with distal and proximal bulbospongiosus circumference (r = 0.39 and 0.43, respectively). Patients with urethroplasty had significantly larger urethral measurements than those with the artificial urinary sphincter (proximal and distal bulbospongiosus circumference 4.9 vs 3.7 and 4.1 vs 3.2, respectively) but were significantly younger (47 vs 67 years), and less likely to have erectile dysfunction (11 of 57 vs 34 of 43) or to have undergone radical prostatectomy (0 of 57 vs 37 of 43).
Bulbospongiosus circumference appears to be proportional to penile circumference. The distal bulbospongiosus is uniformly smaller than the proximal bulbospongiosus. The potential need for a perineal or transcorporeal approach to artificial urinary sphincter placement can be anticipated by penile circumference measurements and a combination of clinical factors, such as older patient age, history of radical prostatectomy and impotence.
我们评估了阴茎和球海绵体的测量值，以制定一种定量指南，选择人工尿道括约肌袖带放置的手术方法（会阴入路、阴囊入路或经尿道入路）。
我们回顾性分析了 2008 年 2 月至 2009 年 6 月期间 100 名接受人工尿道括约肌置入术（43 例）或吻合性尿道成形术（57 例）的男性患者的术中记录。评估了阴茎（阴茎根部的伸展长度和周长）和球海绵体（远端和近端周长）测量值之间的相关性。根据 2 个阴茎周长组对病例进行分析，包括组 1-8.0cm 或更小，组 2-8.5cm 或更大。
近端球海绵体的平均周长明显大于远端球海绵体的周长（4.5cm 比 3.9cm）。它大约是阴茎干周长的 50%（平均 8.9cm，r=0.70）。在组 1 男性中，远端球海绵体的平均周长为 3.4cm。他们更有可能接受经尿道人工尿道括约肌袖带放置，而组 2 男性的远端球海绵体的平均周长为 4.1cm（22 例中的 8 例或 36%比 21 例中的 1 例或 5%，OR 11.4）。阴茎长度与远端和近端球海绵体的周长相关性较弱（r=0.39 和 0.43）。接受尿道成形术的患者的尿道测量值明显大于接受人工尿道括约肌的患者（近端和远端球海绵体的周长分别为 4.9cm 比 3.7cm 和 4.1cm 比 3.2cm），但年龄明显较小（47 岁比 67 岁），勃起功能障碍的可能性较低（57 例中的 11 例比 43 例中的 34 例），接受根治性前列腺切除术的可能性较低（57 例中的 0 例比 43 例中的 37 例）。
球海绵体周长似乎与阴茎周长成正比。远端球海绵体的周长始终小于近端球海绵体的周长。通过阴茎周长测量值和一些临床因素（如患者年龄较大、根治性前列腺切除术和勃起功能障碍史）的组合，可以预测会阴或经尿道入路放置人工尿道括约肌的潜在需要。
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