2016年,我们报道了第一例由阴茎假体插入模拟装置自动充气引起的高流量阴茎异常勃起和海绵状动脉瘘。
为了提高植入者的意识,我们描述了我们机构的更多案例,并对文献进行了系统的回顾,以了解这种现象的罕见性。
患者人口统计,回顾性提取治疗和结局.对EMBASE的系统搜索,PubMed和PubMedCentral图书馆用于报告自1946年以来模仿自动充气的五海绵体瘘的研究。
确定并报告所有已知的高流量阴茎异常勃起和表现为充气阴茎假体自动充气的上颌动脉瘘病例。
总共确定了4名患者(中位年龄56,范围46-60岁)。在患者1的假定自动充气的翻修手术期间发生了灾难性出血(1.8L),随后的超声(US)证实了栓塞的瘘管。患者2在翻修手术后重新发展了自动充气。超声证实高流量阴茎异常是由五动脉血管引起的。患者3接受了阴茎磁共振成像(MRI)以研究自动充气和残余阴茎弯曲。尽管装置放气,MRI仍显示阴茎肿胀,瘘管已成功栓塞。插入阴茎假体后,与睡眠相关的疼痛性勃起的患者4并未改善。多普勒超声发现2个瘘管被栓塞,但症状没有缓解。随后对两个阴茎动脉进行栓塞以控制他的症状。除了2016年报告患者1的已发表摘要外,没有发现其他出版物。
如果在翻修手术前考虑,通过微创经皮血管栓塞术可以安全地治疗瘘管,避免可能与严重并发症相关的手术.
系统综述支持了这种现象的罕见性。然而,我们的研究确实提供了少数患者的发现。
在充气阴茎假体插入过程中,海绵体动脉受损会产生模仿自动充气的五海绵体瘘,导致灾难性的术中出血或不必要的手术。LeeWG,SatchiM,SkrodzkaM,etal.阴茎假体插入后自动膨胀的罕见原因:案例系列和系统综述。JSexMed2022;19:879-886。
In 2016, we reported the first
case of high flow priapism and arteriocavernosal fistula caused by penile prosthesis insertion that mimicked device autoinflation.
To raise awareness amongst implanters, we describe further cases from our institution and perform a systematic review of the literature to understand the rarity of this phenomenon.
Patient demographics, management and outcomes were extracted retrospectively. A systematic search of the EMBASE, PubMed and PubMed Central libraries for studies reporting arteriocavernosal fistula mimicking autoinflation since 1946 was performed.
To identify and report all known cases of high flow priapism and arteriocavernosal fistula presenting as autoinflation of an inflatable penile prosthesis.
Four patients in total (median age 56, range 46-60 years) were identified. Catastrophic bleeding (1.8L) occurred during revision surgery for presumed autoinflation in Patient 1 and subsequent ultrasound (US) confirmed a fistula which was embolized. Patient 2 redeveloped autoinflation following revision surgery. Ultrasound confirmed high flow priapism from an arteriocavernosal fistula. Patient 3 underwent penile magnetic resonance imaging (MRI) to investigate autoinflation and residual penile curvature. MRI showed a tumescent penis despite a deflated device and the fistula was embolized successfully. Patient 4 with sleep-related painful erections did not improve following insertion of penile prosthesis. Doppler US identified 2 fistulae that was embolized but with no resolution of symptoms. Subsequent embolization of both common penile arteries were done to control his symptoms. No other publications apart from the published abstract from 2016 reporting patient 1 was found.
If considered prior to revision surgery, the fistula can be managed safely by minimally invasive percutaneous angioembolisation avoiding surgery which can potentially be associated with significant complications.
The rarity of this phenomenon was supported by a systematic review. Our study however does present the findings from a small number of patients.
Damage to the cavernosal artery during inflatable penile prosthesis insertion can create an arteriocavernosal fistula that mimics autoinflation, leading to catastrophic intra-operative bleeding or unnecessary surgery. Lee WG, Satchi M, Skrodzka M, et al. A Rare Cause of Autoinflation after Penile Prosthesis Insertion:
Case Series and Systematic Review. J Sex Med 2022;19:879-886.