CAJ | 학술논문

目的评估16点法阴茎白膜折叠术治疗阴茎弯曲的长期手术效果、患者满意度及对性功能的影响. 方法 2004年8月至2010年12月,我们利用16点法阴茎白膜折叠术治疗92例阴茎弯曲患者,其中86例获长期随访.86例患者年龄20～66岁,平均32岁.53例为先天性阴茎弯曲,33例为阴茎海绵体硬结症(Peyronie disease,PD)引起的继发性阴茎弯曲.其中下弯45例,侧弯23例(向左侧弯曲13例,向右侧弯曲10例),上弯18例.手术适应证包括阴茎弯曲影响外观、性交困难、不能性交或性交时女方感到不适者,阴茎弯曲角度30°～ 90°,阴茎勃起时长度超过10 cm.排除重度阴茎弯曲(弯曲角度＞90°),或伴有严重的沙漏样畸形、巨大硬结斑块的PD患者.术前评价包括勃起功能国际问卷-5(international index of erectile function 5,IIEF-5)和勃起时疼痛感.建议患者术后第3周开始每日服用小剂量5型磷酸二酯酶(phosphodiesterase type 5,PDE-5)抑制剂连续2～3个月.术后随访内容包括手术并发症、阴茎弯曲复发、患者满意度和性功能状态. 结果 86例术后随访35～ 107个月,平均79个月.86例中82例患者(95.3％)和77例配偶(89.5％)表示总体上满意.79例(91.8％)阴茎勃起完全伸直,7例勃起时轻微弯曲但不影响性生活.35例(40.7％)术后阴茎勃起长度缩短,平均缩短1.3 cm,但患者均对术后阴茎长度表示满意.术后无患者出现手术相关的阴茎勃起功能障碍,IIEF-5评分显示术后性功能显着改善,小剂量服用PDE-5抑制剂2～3个月的患者性功能改善更明显.术后未发生出血、尿道损伤、感染等手术相关并发症. 结论 16点法阴茎白膜折叠术是治疗向任何方向弯曲的轻、中度阴茎弯曲有效且安全的手术方法,长期随访结果显示术后患者外观和性功能均可达到满意的效果.
목적 평고16점법음경백막절첩술치료음경만곡적장기수술효과、환자만의도급대성공능적영향. 방법 2004년8월지2010년12월,아문이용16점법음경백막절첩술치료92례음경만곡환자,기중86례획장기수방.86례환자년령20～66세,평균32세.53례위선천성음경만곡,33례위음경해면체경결증(Peyronie disease,PD)인기적계발성음경만곡.기중하만45례,측만23례(향좌측만곡13례,향우측만곡10례),상만18례.수술괄응증포괄음경만곡영향외관、성교곤난、불능성교혹성교시녀방감도불괄자,음경만곡각도30°～ 90°,음경발기시장도초과10 cm.배제중도음경만곡(만곡각도＞90°),혹반유엄중적사루양기형、거대경결반괴적PD환자.술전평개포괄발기공능국제문권-5(international index of erectile function 5,IIEF-5)화발기시동통감.건의환자술후제3주개시매일복용소제량5형린산이지매(phosphodiesterase type 5,PDE-5)억제제련속2～3개월.술후수방내용포괄수술병발증、음경만곡복발、환자만의도화성공능상태. 결과 86례술후수방35～ 107개월,평균79개월.86례중82례환자(95.3％)화77례배우(89.5％)표시총체상만의.79례(91.8％)음경발기완전신직,7례발기시경미만곡단불영향성생활.35례(40.7％)술후음경발기장도축단,평균축단1.3 cm,단환자균대술후음경장도표시만의.술후무환자출현수술상관적음경발기공능장애,IIEF-5평분현시술후성공능현착개선,소제량복용PDE-5억제제2～3개월적환자성공능개선경명현.술후미발생출혈、뇨도손상、감염등수술상관병발증. 결론 16점법음경백막절첩술시치료향임하방향만곡적경、중도음경만곡유효차안전적수술방법,장기수방결과현시술후환자외관화성공능균가체도만의적효과.
Objective To assess the long-term surgical outcomes,patient's satisfaction and functional results of correction for patients with penile curvature by 16-dot minimal tension plication.Methods Between August 2004 and December 2010,92 patients with penile curvature underwent surgical correction of penile curvature by 16-dot minimal tension plication.Of them,86 patients (53 patients with congenital penile curvature and 33 patients with Peyronie's disease (PD)) were reached for long-term follow-up.Indications for operation included patients with 30 to 90 degrees of penile curvature,penile length greater than 10 cm and patients who had one or more symptoms,such as difficulty or inability to vaginal penetration and partner discomfort during sexual intercourse.Patients were excluded from study if they had severe penile curvature (greater than 90 degrees),hourglass deformities or large plaques.Preoperative evaluation included international index of erectile function 5 (IIEF-5) questionnaire score,pain on erection and physical examination.Patients were recommended daily low dose phosphodiesterase type 5 (PDE-5) inhibitors 2 weeks after surgery and maintained for 2 to 3 months.At follow-up,recurrence rate,complications,erectile function,patients and partner's satisfaction with the surgery were assessed.Results The mean time of follow-up was 79 months (range,35-107 months).Of 86 patients who had been reached for long-term follow up,82 patients (95.3％) and 77 partners (89.5％) reported overall satisfaction after the surgery.Complete penile straightening was achieved in 79 patients (91.8％).Slight residual curvatures were observed in 7 patients,but did not affect their sexual intercourse.Postoperative penile length shortening (median penile length loss 1.3 cm) was noted in 35 patients (40.7％),which did not affect their sexual intercourse.In addition,no de novo erectile dysfunction was observed,and sexual function was significantly improved evidenced by the IIEF-5 scores,especially in the patients who had received PDE-5 inhibitors for 2 to 3 months.There were no surgery-related complications,such as hematoma,urethral injury,or infection.Conclusion The longterm results demonstrate that correction of penile curvature using 16-dot plication is a simple and safe method to achieve cosmetic and functional satisfaction in patients with mild to moderate penile curvature.