Ridgley Joanne, Raison Nicholas, Sheikh M Iqbal, Dasgupta Prokar, Khan M Shamim, Ahmed Kamran
GKT School of Medicine, King's College London, London, UK.
Urology Department, Guy's Hospital, Guy's and St Thomas Trust, London, UK.
Turk J Urol. 2017 Mar;43(1):1-8. doi: 10.5152/tud.2017.59458. Epub 2017 Mar 1.
Ischaemic priapism is a rare condition characterised by little or no cavernosal blood flow, pain and rigidity of the penis. Immediate intervention is required to restore blood flow, prevent necrosis and erectile dysfunction. This review was conducted to determine the best course of treatment and identify areas in current guidelines to which improvements could be made.
PubMed, Ovid, MEDLINE (1946-December 2016) and the Cochrane Library were searched as sources for literature. Key studies in each of the areas of management were identified and analysed.
A total of 45 articles were reviewed. The first step in treatment should be aspiration of corporeal blood. Further studies are needed to make firm recommendations as to whether irrigation should follow, as currently literature is inconclusive. If this fails to cause detumescence, sympathomimetics should be injected. The sympathomimetic of choice is phenylephrine as it is effective, specific and causes minimal cardiovascular side effects. It should be injected at a concentration of 100-500 μg/mL, with 1 mL being injected every 3-5 minutes for up to an hour (maximum 1mg in an hour). Surgical shunting is the next step, except in the cases of delayed priapism (48-72 hours duration) where immediate penile prosthesis insertion may be considered more appropriate. Distal shunts should be performed first, followed by proximal ones to minimise damage leading to erectile dysfunction. There exists little evidence recommending one shunting procedure over another. The final intervention is insertion of a penile prosthesis. Literature suggests that an inflatable prosthesis inserted immediately will yield the greatest patient satisfaction.
A review of the literature has highlighted areas in which further research needs to be done to make conclusive recommendations, including whether irrigation should accompany aspiration and efficacy of shunting procedures. Further studies are required to ensure that patients receive the treatment most likely to cause detumescence and maintain erectile function.
缺血性阴茎异常勃起是一种罕见病症，其特征为海绵体血流量极少或无血流、阴茎疼痛且僵硬。需要立即进行干预以恢复血流、预防坏死及勃起功能障碍。开展本综述旨在确定最佳治疗方案，并找出当前指南中可改进之处。
检索了PubMed、Ovid、MEDLINE（1946年至2016年12月）及Cochrane图书馆作为文献来源。确定并分析了各管理领域的关键研究。
共审查了45篇文章。治疗的第一步应是抽吸海绵体血液。由于目前文献尚无定论，因此是否应随后进行冲洗还需要进一步研究以做出确切推荐。若这未能导致消肿，则应注射拟交感神经药。首选的拟交感神经药是去氧肾上腺素，因为它有效、具有特异性且引起的心血管副作用最小。应以100 - 500μg/mL的浓度注射，每3 - 5分钟注射1mL，持续1小时（1小时内最大剂量为1mg）。下一步是进行手术分流，但对于延迟性阴茎异常勃起（持续48 - 72小时）的情况，可考虑更适合立即插入阴茎假体。应首先进行远端分流，然后进行近端分流，以尽量减少导致勃起功能障碍的损伤。几乎没有证据表明一种分流手术优于另一种。最后的干预措施是插入阴茎假体。文献表明，立即插入可膨胀假体将使患者满意度最高。
文献综述突出了需要进一步研究以做出确切推荐的领域，包括抽吸时是否应进行冲洗以及分流手术的疗效。需要进一步研究以确保患者接受最有可能导致消肿并维持勃起功能的治疗。
