Abnormal penis

Introduction An abnormal erection of the penis refers to a state of continuous erection of the penis that is not related to sexual desire. The penis continues to erect for more than 6 hours and is already an abnormal erection. Traditionally, abnormal penile erections are classified into primary (specific) and secondary. According to hemodynamics, it is divided into low blood flow type (ischemic) and high blood flow type (non-ischemic). Abnormal erection of the penis is also divided into acute, intermittent (recurrent or intermittent, such as sickle cell anemia) and chronic (usually high blood flow type). In the early stage of abnormal penile erection, it is a physiological penile erection, and later developed into a high blood flow type.

Cause

The cause of abnormal penis:

(A) Causes of the disease: According to statistics, 30% to 40% of abnormal penile erections are primary. Most of the causes are unknown. Secondary causes are: thromboembolic disease (sickle cell anemia, fat embolism, etc.), neurological diseases (spinal cord injury and lesions, spinal stenosis, etc.), tumors (prostate cancer, kidney cancer and other metastatic cancer, leukemia, melanoma) Etc.), trauma (perineal or genital damage, etc.), infection or poisoning (dysentery, rabies, etc.), drugs (antidepressants, alpha-adrenergic blockers, anticoagulants, etc.), total parenteral nutrition, penis Intracavernous injection of vasoactive agents and the like.

1. Sickle cell anemia: 8% of African Americans have sickle cell anemia. In a literature review of 321 infant patients, 6.4% of patients had abnormal erections. Due to abnormal endothelial adhesion, relative acidity during erection, mild acidosis caused by hypoventilation during sleep, mild trauma during masturbation or sexual intercourse, siltation of the sputum erythrocyte sponge. When the erectile venous passage of the sleeping penis is under maximum compression, the deposited red blood cells block the submucosal venules, causing extensive venous obstruction. In a study of human homozygous sickle cell disease, 42% of patients had an intermittent erection of sleep that lasted for 2 to 6 hours. Although almost all cases of low-flow abnormal erections have recently been reported in 2 cases of high-flow abnormal erections.

2. Intracavernous injection: Intracavernous vasoactive drug injection is a common method for diagnosing and treating erectile dysfunction (ED), which is achieved by smooth muscle relaxation. Smooth muscle relaxation is temporary, and the smooth muscle regains its ability to contract after the drug acts. In patients who are overdose or overly sensitive to drugs, smooth muscle does not restore contractility, resulting in an abnormal erection. Literature review The diagnosis and treatment of erectile dysfunction (ED) by intracavernous injection of papaverine, the incidence of abnormal erection in the first diagnostic test was 5.3%, and the family treatment was 0.4%. Most abnormal erections occur in patients with neurological or psychological ED.

3. Neurological disorders: Patients with abnormal erections can be seen in patients with spinal stenosis, spinal cord injury, and herniated discs. The mechanism may be that parasympathetic nerves induce increased release of erectile neurotransmitters or interfere with sympathetic inhibition. Under spinal or general anesthesia, disinfection stimulates the genitals with abnormal erections and may affect transurethral surgery. This exaggerated reflex erection may be the result of anesthesia-suppressed impulsive blockade, which mostly disappears after anesthesia.

4. Malignant tumors: Although tumor cell infiltration itself does not cause abnormal erection, venous return obstruction or invasion of cavernous sinus can cause stasis and thrombosis. Tumors that have been reported to metastasize to the penis and cause abnormal erections are: leukemia, prostate cancer, kidney cancer, and melanoma.

5. Drugs: Antihypertensive drugs such as hydralazine (hydralazine), guanethidine, phenothiazines, especially chlorpromazine, antidepressants such as trazodone, are associated with abnormal erection.

In animal experiments, the injection of trazodone and chlorpromazine into the dog's corpus cavernosum can cause an increase in arterial blood flow, an increase in venous resistance, and an erection. The rats were injected with a trazodone metabolite, m-chloropiperazin, and the cavernous nerve discharge was increased.

The mechanism by which these drugs cause abnormal erection may be related to alpha adrenergic blockade or stimulation of serotonin 1C or 1D receptors. However, only a small number of patients with abnormal erections taking these drugs, and non-dose specificity, suggest that autonomic dysfunction may be the main cause.

6. Total parenteral nutrition: Total parenteral nutrition can cause abnormal erections, especially when intravenously applying 20% fat emulsion. This type of abnormal erection is a low flow type, similar to patients with sickle cell disease. The mechanism may be: 1 increased blood coagulation; 2 adverse reactions to blood cell components; 3 fat embolism. It is recommended to use 10% fat emulsion, slow infusion and mixing with amino acid-dextrose solution to prolong the infusion rate to prevent abnormal erection.

7. Traumatic perineal or genital trauma caused by thrombosis or severe bleeding of the base of the penis, tissue edema, blocked penile venous return, causing abnormal erection (low flow type). Trauma or intracavernous injection causes rupture of the cavernous artery, resulting in unregulated cavernous sinus blood deposits, causing abnormal erections (high flow patterns). Typical post-traumatic high-flow abnormal erections typically occur during sleep erections, which cause rupture of damaged arteries, resulting in unregulated high-speed blood flow into the corpus cavernosum. However, due to partial compensation of venous return, the hardness of the erection is low and there is no ischemia or pain.

(B) pathogenesis: Traditionally, abnormal erections are classified as primary, special or secondary. In hemodynamics, it can be divided into two different types: low flow (ischemia) and high flow (non-ischemic). Since the low-flow state is due to venous obstruction and the high-flow state is due to an increase in arterial blood flow, Witt et al. (1990) performed a new classification: venous obstruction and arterial. An abnormal erection can be manifested as acute, intermittent or chronic. Physiologically, the blood gas level of the corpus cavernosum is similar to that of the systemic venous blood, and reaches the arterial level when the erection occurs. It must be remembered that every abnormal erection begins with a normal physiological erection, and the corpus cavernosum is normal. High-flow cavernous blood oxygen levels were normal, but after 6 h of low-flow type, blood gas showed signs of ischemia and acidosis. When in doubt, blood gas analysis and duplex ultrasound can help to differentiate the diagnosis.

The study found that low-flow abnormal erectile corpus cavernosum venous return delay to 15min, angiography only the dorsal artery and ball artery development. High-flow abnormal erectile corpus cavernosum and angiography showed that the venous return accelerated, ruptured cavernous artery caused the cavernous blood to accumulate.

It is generally believed that this disease is caused by obstruction of penile venous return due to various reasons, but it has been suggested by foreign countries that the pathogenesis of this disease is not caused by venous return, but mainly due to excessive arterial blood flow. The relationship between the two is still unclear. After the penis continues to erect more than normal time, the corpus cavernosum microcirculation disorder, local hypoxia and deposition of metabolites, increased permeability of the blood vessel wall, tissue edema, continuous swelling and pain of the penis, increased tension, further aggravated Microcirculatory disorders. If the cause is still not removed in time, the blood circulation of the penis is improved, and finally the embolization of the blood vessel cavity can be caused. Fibrosis in advanced cavernous tissue will eventually lose erectile capacity.

an examination

Related inspection

Penis examination penis ultrasound

Diagnosis of penile abnormalities:

Abnormal erection of the penis is common 5 to 10 years old and 20 to 50 years old. Generally, only the corpus cavernosum is involved, and most cases occur when the penis is congested at night.

If the abnormal erection of the low blood flow type penis lasts for several hours, it is painful due to tissue ischemia, and the penis is hard and erect. High blood flow type, the penis is rarely painful, and the penis cannot reach full erection hardness. There is usually a history of perineal or penile trauma. In most cases of this type, the penis can still return to full erection after arterial embolization or surgical ligation of the blood vessels, but it usually takes weeks to months.

Medical history:

1. Sudden onset in the absence of sexual stimulation, often at night, erections last for hours or days, accompanied by pain in the penis, waist and pelvis.

2. The corpus cavernosum is solid and the urethral sponge and glans are soft.

3. There is a history of intrathecal injection of vasoactive drugs.

Physical examination: The corpus cavernosum is hard, congested, tender, and the penis head and urethral sponge are soft, normal urination, sometimes accompanied by urination and difficulty in defecation.

Differential diagnosis

Identification of abnormal confusing symptoms of the penis:

Penile induration: often occurs in middle-aged and older men. The condition can be mild, moderate or severe, and the symptoms can occur slowly or overnight.

Common symptoms of penile sclerosis include;

1. A hard plaque that may be painless on the penis.

2. The penis bent on the upper side of the penis will bend the penis upwards (this is the more common case), while the hard block that appears on the underside of the penis will bend the penis downward.

3. Some patients' lumps appear on both the upper and lower sides of the penis, shortening and deforming the penis.

4. Feel uncomfortable or painful when the penis is erect.

5. Erectile dysfunction.

Penile injury: Not common, can be classified according to the location, extent and anatomical pathology. Generally, according to the presence or absence of skin damage, it is divided into closed injury and open injury. The so-called penile injury refers to the separation of penile skin, subcutaneous tissue, corpus cavernosum and urethral sponge, which are divided into complete type and incomplete type.

Short penis: The small penis (micropenis) refers to the normal length and diameter ratio of the penis appearance, but the length of the penis body is less than 2.5 standard deviations above the average length of the normal penis. The length of the penis refers to the straightening of the penis head as much as possible, which is equivalent to the distance from the top of the penis to the pubic symphysis when the penis is fully erect. Adults generally have a penis relaxation length of less than 3 cm for a small penis.

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