阴茎折断的诊断与治疗

Diagnosis and treatment of penile fracture

目的探讨阴茎折断的诊断和治疗方法。方法回顾性分析1993年7月至2008年1月泌尿外科收治的12例阴茎折断患者临床资料。患者年龄17—46岁，平均31岁；其中11例由性交失误引起，1例因手淫时自行按压勃起阴茎所致；均有典型的临床表现：可闻及阴茎折断的响声，局部疼痛，阴茎疲软继之瘀血肿胀，远端弯向健侧，皮肤青紫，有2例瘀血范围至阴囊，均无排尿困难及血尿。1例行阴茎海绵体造影，11例行彩色多普勒超声检查。发病至手术时间6—72h，平均16h；11例急诊行“阴茎海绵体白膜修补术”；1例手淫损伤者拒绝手术治疗而采取保守治疗。结果11例手术患者均证实术前阴茎海绵体造影、彩色多普勒超声检查结果，均为单侧海绵体白膜破裂。随访3月-14年，12例患者均能勃起，无排尿困难。11例手术患者阴茎勃起正常，无疼痛、阴茎弯曲及阴茎硬结等并发症，性生活满意；1例保守治疗患者阴茎勃起时向下弯曲，无法完成性交。结论阴茎折断是少见病，借助临床病史、体检可诊断本病，彩色多普勒超声检查可明确损伤部位、大小，急诊手术治疗效果良好，不提倡保守治疗。

Objective To investigate the diagnosis and treatment of penile fracture. Methods Nine patients aged 17-46 years old（ a mean of 31 years old）were treated for penile fracture in our hospital from July 1993 to January 2008.11 cases were due to sexual intercourse, 1 to rolling over the erecting penis during masturbation. All of them had typical clinical presentations including a snapping sound at the time of injury, sudden penile pain, detumescence, penile swelling and deviation; 2 had scrotal haematoma; and none had voiding difficulty and urethral bleeding. One case was performed by cavernosography and 11 cases by color Doppler ultrasonography. The time intervals between injury and operation ranged from 6 hours to 72 hours（ a mean of 16 hours）. 11 cases were operated on immediately,including evacuation of the haematoma and suture of the tunica albuginea. The masturbation patient rejected operation and were treated conservatively. Results All lesions of 11 patients received operation were transverse sections of the unilateral tunica albuginea as confirmed by cavernosography or color Doppler uhrasonography. All 11 operated cases were able to achieve an adequate erection after a follow-up from 3 months to 14 years. No complications, such as deformations, penile plaque, urethral fistula or erectile dysfunction were reported. However, the conservative treated case suffered from coital difficulty because of penile deformation. Conclusion Penile fracture is rare and can be diagnozed by clinical history and examination. Color Doppler uhrasonography is suitable for identifying the disruption of tunica albuginea. The best treatment for penile fracture is surgery and the conservative treatment is not recommended.