前列腺部后尿道-球海绵体反射在原发性早泄发病机制中的意义

Role of bulbocavernosus reflex to stimulation of prostatic urethra in pathologic mechanism of primary premature ejaculation

目的探讨前列腺部后尿道-球海绵体反射（BCR）在原发性早泄（PPE）发病机制中的作用。方法对20名健康成年男性（健康对照组）及42例原发性早泄患者（原发性早泄组）应用一种特制尿道电极刺激前列腺部后尿道，通过诱发球海绵体反射，记录感觉阈值、诱发恒定反射阈值以及潜伏期。同时，采用表面电极，通过电刺激龟头，测定龟头生物感觉阈值。结果健康对照组后尿道感觉闽值、诱发恒定反射阈值、反射潜伏期以及龟头生物感觉阈值分别为（18.2±2.7）mA（0.2ms，1Hz），（34.8±4.2）mA（0.2ms，1Hz），（71.2±5.8）ms和（14.2±1.9）mA（0.04ms，3Hz）；原发性早泄组后尿道感觉阈值、诱发恒定反射阈值、反射潜伏期以及龟头生物感觉阈值分别为（12.4±3.7）mA（0.2ms，1Hz），（23.8±5.6）mA（0.2ms，1Hz），（70.5±6.3）ms和（11.9±2.3）mA（0.04ms，3Hz）。原发性早泄组后尿道感觉阈值、诱发恒定反射阈值、以及龟头生物感觉阈值均低于健康对照组（均P〈0.01）。两组间反射潜伏期差异无统计学意义（P〉0.05）。结论原发性早泄患者存在高兴奋性的前列腺部后尿道-球海绵体反射，这可能在原发性早泄的发病机制中具有重要的作用，同时也为探讨其他有效的治疗方法提供了新的途径。

Objective Primary premature ejaculation （PPE） is a prevalent sexual dysfunction among men while its precise pathologic mechanism has remained poorly understood. In current study the correlation between excitability of bulbocavernosus reflex （ BCR ） to stimulation of prostatic urethra and primary premature ejaculation was studied. Methods Forty-two patients with PPE and 20 normal potent male volunteers were studied by inserting a specially designed Foley catheter with two electrodes mounted on its distal surface （intraurethral catheter electrode） into bladder to evoke the BCR to stimulation of prostatic urethra to record the sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR and latencies of BCR. Also the sensitivity of glans penis to electrical stimulation was detected by two surface electrodes. Results The mean sensory thresholds of BCR to stimulation of prostatic urethra, thresholds to evoke stable BCR, latencies of BCR and sensory thresholds of glans penis were （ 18.2±2.7） mA （0.2 ms in duration, 1 Hz）, （34.8±4.2）mA （0.2 ms, 1 Hz）, （71.2±5.8）ms and （14. 2±1.9） mA （0.04 ms in duration, 3 Hz） in normal potent men respectively and were （12.4±3.7 ） mA （0. 2 ms, 1 Hz）,（23.8±5.6）mA （0.2 ms, 1 Hz）, （70.5±6.3）ms and （11.9±2.3）mA （0.04 ms, 3 Hz） in patients with PPE respectively. Statistically significant differences were seen regarding the sensory thresholds of BCR to stimulation of prostatic urethra, the thresholds to evoke stable BCR and the sensory thresholds of glans penis between two groups （all P 〈 0.01）. No statistically differences were seen regarding the latencies of BCR between two groups （ P 〉 0.05 ）. Conclusion Patients with PPE have hyperexcitable BCR to stimulation of prostatic urethra. It is probably one of the important etiological factors. Moreover the findings may provide new therapeutic modalities of PPE.