Munarriz R M, Yan Q R, ZNehra A, Udelson D, Goldstein I
Department of Urology, Boston University School of Medicine, Massachusetts, USA.
J Urol. 1995 Jun;153(6):1831-40. doi: 10.1016/s0022-5347(01)67324-5.
A 9 1/2-year pharmaco-cavernosometry/pharmaco-cavernosography and pharmaco-arteriography study was performed in 131 men with persistent changes in erectile function following blunt pelvic or perineal trauma. The goal was to determine the incidence of hemodynamic impairment, and to characterize the location and pattern of abnormal venous drainage. Corporeal veno-occlusive dysfunction was identified in 62% of the cases and cavernous artery insufficiency in 70%. Pharmaco-cavernosography revealed abnormal venous drainage confined to the proximal corpora in 91% of the cases. Patients with pelvic trauma had significantly more abnormal sites of venous drainage (3 or more sites in 61%) and more severe degrees to which venous structures filled with contrast medium (23% had 3+ degree of luminal filling) than did patients with perineal trauma (61% had 1 or 2 sites of venous drainage and 92% had 1+ or 2+ degree of luminal filling). Pharmaco-arteriography revealed site specific arterial occlusive lesions consistent with the site of impact. Traumatic vasculogenic impotence is hypothesized as being the result of direct impact injury to the fixed proximal corpora and its arterial inflow bed. The exerted perineal impact force is estimated to range from 50 to 500 pounds, depending on the weight of the individual, height of the fall, speed at contact and surface hardness. Traumatic veno-occlusive dysfunction is theorized to be the consequence of focal intracavernous wound repair and permanent focal alterations in erectile tissue compliance. Traumatic vasculogenic impotence afflicts an estimated 600,000 American men of whom 250,000 have sports-related injuries. Future consideration should be given to the development of appropriate protective perineal equipment.
对131名骨盆或会阴钝性创伤后勃起功能持续改变的男性进行了为期9年半的药物海绵体测压/药物海绵体造影和药物动脉造影研究。目的是确定血流动力学损害的发生率，并描述异常静脉引流的位置和模式。62%的病例发现海绵体静脉闭塞功能障碍，70%发现海绵体动脉供血不足。药物海绵体造影显示，91%的病例异常静脉引流局限于近端海绵体。与会阴创伤患者相比，骨盆创伤患者的静脉引流异常部位明显更多（61%有3个或更多部位），静脉结构内造影剂充盈程度更严重（23%有3级或以上管腔充盈）（61%的会阴创伤患者有1个或2个静脉引流部位，92%有1级或2级管腔充盈）。药物动脉造影显示特定部位的动脉闭塞性病变与撞击部位一致。创伤性血管源性阳痿被认为是固定近端海绵体及其动脉流入床受到直接撞击损伤的结果。根据个体体重、跌落高度、接触速度和表面硬度，估计施加的会阴冲击力范围为50至500磅。创伤性静脉闭塞功能障碍理论上是海绵体内局灶性伤口修复和勃起组织顺应性永久性局灶性改变的结果。据估计，创伤性血管源性阳痿折磨着60万美国男性，其中25万患有与运动相关的损伤。未来应考虑开发合适的会阴防护装备。
