Magoha G A
Department of Surgery, College of Health Sciences, University of Nairobi.
East Afr Med J. 1995 Jun;72(6):399-401.
Early this century, the aetiology of priapism was solely attributed to "systemic disease and local irritation of lower genital tract and neurologic lesion". Corpora cavernosa incision described by Young was the only form of treatment. However, the aetiology, diagnosis and treatment options for the management of priapism and prolonged erections have evolved significantly in the past several years. Before the use of pharmacological agents for the production of erections, idiopathic priapism became the most common aetiology. Causes of priapism from newer psychotropic medications such as trazodone to intra-cavernosal injection therapy with pharmacological agents have increased the number of patients with priapism presenting to the urologist. The management of priapism has remained controversial and has perplexed and continued to frustrate many urologists. A recent and more thorough knowledge of the pathophysiological basis of priapism and the clear differentiation between the low flow veno- occlusive priapism and high flow arterial priapism have significantly improved the diagnostic protocol for patients with priapism. Colour doppler ultrasound evaluation and cavernosal blood gas determinations have become mandatory and greatly improved specific diagnosis. Priapism must be considered a urological emergency and early surgical intervention with corpus cavernosum aspiration and pharmacological lavage with normal saline alpha-adrenegic agonists should be instituted immediately. This will avoid the risk of erectile impotence with considerable medico-legal consequences. Precious time must not be wasted in the older unproven conservative methods including hot and cold water enemas, and vigorous prostatic massage.
本世纪初，阴茎异常勃起的病因仅被归因于“全身性疾病、下生殖道局部刺激及神经病变”。杨（Young）所描述的海绵体切开术是唯一的治疗方式。然而，在过去几年里，阴茎异常勃起及持续性勃起的病因、诊断和治疗方法有了显著发展。在使用药物诱发勃起之前，特发性阴茎异常勃起成为最常见的病因。从新型精神药物如曲唑酮导致的阴茎异常勃起，到使用药物进行海绵体内注射治疗引发的阴茎异常勃起，使得泌尿外科医生接诊的阴茎异常勃起患者数量增加。阴茎异常勃起的治疗一直存在争议，困扰并持续令许多泌尿外科医生感到沮丧。最近对阴茎异常勃起病理生理基础的更深入了解，以及对低流量静脉闭塞性阴茎异常勃起和高流量动脉性阴茎异常勃起的明确区分，显著改进了阴茎异常勃起患者的诊断方案。彩色多普勒超声评估和海绵体血气测定已成为必需手段，并极大地改善了特异性诊断。阴茎异常勃起必须被视为泌尿外科急症，应立即进行早期手术干预，即海绵体抽吸及用生理盐水α-肾上腺素能激动剂进行药物灌洗。这将避免勃起功能障碍的风险，否则会带来相当严重的医疗法律后果。绝不应在包括热水和冷水灌肠以及强力前列腺按摩等较陈旧且未经证实的保守方法上浪费宝贵时间。
