Institute of Urology, University College Hospital London, London, United Kingdom; 2nd Department of Urology, National and Kapodistrian University of Athens, Athens, Greece.
Institute of Urology, University College Hospital London, London, United Kingdom.
J Urol. 2014 Jan;191(1):164-8. doi: 10.1016/j.juro.2013.07.034. Epub 2013 Jul 24.
The current management of ischemic priapism that is refractory to conventional medical therapy is a form of shunt procedure that diverts blood away from the corpus cavernosum. We assessed the outcome of the T-shunt and intracavernous tunneling for the management of ischemic priapism.
During a 36-month period 45 patients presented with prolonged ischemic priapism. Patients were divided into subgroups according to the duration of priapism. All patients had an unsuccessful primary treatment, and underwent a T-shunt and intracavernous tunneling with cavernous muscle biopsies. All patients completed an IIEF-5 (International Index of Erectile Function-5) questionnaire preoperatively and 6 months postoperatively.
Resolution of the priapism using a T-shunt and snake maneuver occurred in all patients with a priapism duration of less than 24 hours and in only 30% of those with priapism lasting more than 48 hours. After a 6-month median followup the IIEF-5 score was significantly reduced from a mean of 24 (range 23 to 25) preoperatively to 7.7 (range 5 to 24), which was related to the duration of the priapism (p <0.0005). All patients with priapism for more than 48 hours had necrotic cavernous smooth muscle on biopsy and had severe erectile dysfunction requiring the insertion of a penile prosthesis. Those patients with moderate and mild erectile dysfunction were treated with phosphodiesterase type 5 inhibitors.
The success of the T-shunt with snake tunneling is dependent on the duration of priapism. When it is less than 24 hours the results are favorable, although erectile dysfunction is still present in 50% of patients. In those with a priapism duration greater than 48 hours the technique usually fails to resolve the priapism and all patients end up with erectile dysfunction due to smooth muscle necrosis.
对于常规药物治疗无效的缺血性阴茎异常勃起，目前的治疗方法是分流术，即将血液从海绵体分流。我们评估了 T 分流和隧道内隧道术治疗缺血性阴茎异常勃起的效果。
在 36 个月的时间里，有 45 例患者出现了长时间的缺血性阴茎异常勃起。根据阴茎异常勃起的持续时间将患者分为亚组。所有患者均未接受过初次治疗，均接受 T 分流和隧道内隧道术，并进行海绵体肌肉活检。所有患者在术前和术后 6 个月均完成了 IIEF-5（国际勃起功能指数-5）问卷。
对于持续时间小于 24 小时的患者，T 分流和蛇形手法均可使阴茎异常勃起完全缓解，而持续时间超过 48 小时的患者仅 30%缓解。在中位随访 6 个月后，IIEF-5 评分从术前的平均 24 分（范围 23 至 25）显著降低至 7.7 分（范围 5 至 24），这与阴茎异常勃起的持续时间有关（p <0.0005）。所有持续时间超过 48 小时的阴茎异常勃起患者的海绵体平滑肌活检均有坏死，且勃起功能严重受损，需要植入阴茎假体。那些中、轻度勃起功能障碍患者则接受了磷酸二酯酶 5 抑制剂治疗。
T 分流和蛇形隧道术的成功与否取决于阴茎异常勃起的持续时间。当持续时间小于 24 小时时，结果是有利的，尽管仍有 50%的患者存在勃起功能障碍。当持续时间超过 48 小时时，该技术通常无法解决阴茎异常勃起问题，所有患者最终都会因平滑肌坏死而导致勃起功能障碍。
