The Institute of Urology, University College London Hospital, London, United Kingdom.
University College London Hospitals NHS Foundation Trust, Radiology, London, United Kingdom.
Sex Med Rev. 2020 Apr;8(2):303-313. doi: 10.1016/j.sxmr.2019.07.003. Epub 2019 Aug 29.
Glans hypermobility presents a rarely observed complication of penile prosthesis implantation. It may result in patient dissatisfaction because of painful intercourse, difficulties during penetrative sex, and a poor cosmetic result. This problem may prevent the patient from using an otherwise fully functional implant.
To summarize current knowledge, clarify terminology, and review treatment options of multifaceted diagnosis of floppy glans.
Analysis of published literature and experience of authors' institution.
We reviewed publications that outlined incidence, pathophysiology, diagnostics, and management strategies of floppy glans phenomenon.
Floppy glans phenomenon can result from the soft glans, incorrect position, or size of the implant cylinders or the anatomy of the glans. A careful physical examination with a fully inflated implant will indicate the direction of the droop and can be very helpful in distinguishing the underlying cause of the deformity. In ambiguous cases obtaining a correct diagnosis will often involve imaging-magnetic resonance imaging or penile ultrasound scanning of the inflated device. Cooperation with an experienced uroradiologist is invaluable in such cases. The glanspexy procedure should be performed according to the surgeon's experience and preference.
Understanding the different glans abnormalities and unified terminology is crucial for optimization of the treatment. Medical therapy can always be tried before revision surgery, as long as it is safe for the patient and function of the implant. The accuracy of the position and size of the implant should always be thoroughly assessed before a diagnosis of the real glans hypermobility is made and treatment provided. Skrodzka M, Heffernan Ho D, Ralph D. Floppy Glans-Classification, Diagnosis And Treatment. Sex Med Rev 2020;8:303-313.
龟头过度活动是阴茎假体植入后一种罕见的并发症。它可能导致患者不满意，因为性交疼痛、插入困难和美容效果不佳。这个问题可能会阻止患者使用功能齐全的植入物。
总结当前的知识，澄清术语，并回顾复杂的龟头疲软诊断的治疗选择。
分析已发表的文献和作者机构的经验。
我们回顾了概述龟头疲软现象的发病率、病理生理学、诊断和管理策略的出版物。
龟头疲软现象可由龟头柔软、植入物圆柱体位置或大小不正确、或龟头解剖结构引起。用完全充气的植入物进行仔细的体格检查将指示下垂的方向，并有助于区分畸形的潜在原因。在模棱两可的情况下，获得正确的诊断通常涉及成像-磁共振成像或充气装置的阴茎超声扫描。在这种情况下，与经验丰富的泌尿放射科医生合作是非常宝贵的。龟头固定术应根据外科医生的经验和偏好进行。
了解不同的龟头异常和统一的术语对于优化治疗至关重要。只要对患者和植入物的功能安全，在进行翻修手术之前，总是可以尝试药物治疗。在做出真正的龟头过度活动的诊断并提供治疗之前，应始终彻底评估植入物的位置和大小的准确性。
