阴茎神经电生理检查在男性性功能障碍诊治中的应用进展
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摘要
阴茎神经电生理检查包括躯体神经和自主神经检测,其在男性性功能障碍的诊治发挥着重要的作用,其主要包括:阴部体感诱发电位、海绵体肌反射、皮肤交感反应、海绵体肌电图等,在ED和早泄的诊断以及治疗方案的选择和疗效评价等方面具有较好的应用价值。然而,由于男性勃起和射精中枢相关脑、脊髓、外周神经通路机制复杂,阴茎神经电生理技术仍存在许多未知领域,仍未被临床广泛接受与开展,尚缺乏深入细致的研究,本文就近年来在此方面的研究进展及本研究中心的相关工作作一综述,以便为今后研究提供参考。
Electrophysiological examination of penile nerves involves detection of somatic and autonomic nerves, including dorsal nerve somatosensory evoked potential, cavernous muscle reflex, skin sympathetic response, cavernous electromyography, and others, which plays an important role in the diagnosis of male sexual dysfunction, such as ED and premature ejaculation, as well as in the selection of treatment methods and evaluation of therapeutic effects. Due to the complex mechanisms of the brain, spinal cord and peripheral nerve pathways relating to erectile and ejaculatory centers in men and many unknown areas in penile electrophysiological techniques, penile electrophysiological examination has not been widely accepted by doctors and patients. Further studies are needed to provide more scientific and convincing evidence in this field. Natl J Androl, 2019, 25(6): 559-565
Electrophysiological examination of penile nerves involves detection of somatic and autonomic nerves, including dorsal nerve somatosensory evoked potential, cavernous muscle reflex, skin sympathetic response, cavernous electromyography, and others, which plays an important role in the diagnosis of male sexual dysfunction, such as ED and premature ejaculation, as well as in the selection of treatment methods and evaluation of therapeutic effects. Due to the complex mechanisms of the brain, spinal cord and peripheral nerve pathways relating to erectile and ejaculatory centers in men and many unknown areas in penile electrophysiological techniques, penile electrophysiological examination has not been widely accepted by doctors and patients. Further studies are needed to provide more scientific and convincing evidence in this field. Natl J Androl, 2019, 25(6): 559-565
引文
[1] Perretti A,Catalano A,Mirone V,et al.Neurophysiologic evaluation of central-peripheral sensory and motor pudendal pathways in primary premature ejaculation.Urology,2003,61(3):623-628.
[2] Xin ZC,Chung WS,Choi YD,et al.Penile sensitivity in patients with primary premature ejaculation.J Urol,1996,156 (3):979-981.
[3] 苏新军,罗春华,程跃,等.勃起前后阴茎感觉定量阈值测定在早泄诊断中的应用研究,现代实用医学,2013,25(11):1250-1251.
[4] Hill BJ,Janssen E,Kvam P,et al.The effect of condoms on penile vibrotactile sensitivity thresholds in young,heterosexual men.J Sex Med,2014,11(1):102-106.
[5] You HS.The partial neurectomy of the dorsal nerve of the penis for patient with premature ejaculation.Korean J Androl,2000,18:143-148.
[6] 王飞翔,朱广友,翁少峥,等.阴茎定量感觉检测技术在神经损伤后性功能障碍评估中的应用,中国男科学杂志,2016,30(1):3-6,15.
[7] Salonia A,Saccà A,Briganti A,et al.Quantitative sensory testing of peripheral thresholds in patients with lifelong premature ejaculation:A case-controlled study.J Sex Med,2009,6(6):1755-1762.
[8] Yiou R,De Laet K,Hisano M,et al.Neurophysiological testing to assess penile sensory nerve damage after radical prostatectomy.J Sex Med,2012,9(9):2457-2466.
[9] 党静霞编著.肌电图诊断与临床应用(第2版).北京:人民卫生出版社,2017.22-23.
[10] 顾慎为,寿丽革,唐涌志,等.阴茎背神经传导速度测定在阳萎诊断中的价值.男性学杂志,1991,5(1):10-12,42.
[11] 沈稚舟.糖尿病性ED的阴茎背神经传导速度测定的意义.国外医学.内分泌学分册,1989,7:104-105.
[12] Yang CC,Bradley WE,Berger RE.The effect of pharmacologic erection on the dorsal nerve of the penis.Muscle Nerve,1997,20(11):1439-1444.
[13] Herbaut AG,Sattar AA,Salpigides G,et al.Sensory conduction velocity of dorsal nerve of the penis during pharmacoerection:A more physiological technique?Eur Urol,1996,30(1):60-64.
[14] Kiwamoto H,Kanda H,Onishi N,et al.Measurement of nerve conduction velocity of the dorsal nerve of the penis.Hinyokika Kiyo,1988,34(6):1007-1010.
[15] Xin ZC,Choi YD,Rha KH,et al.Somatosensory evoked potentials in patients with primary premature ejaculation.J Urol,1997,158 (2):451-455.
[16] 陈涛伟,戴玉田.阴茎神经电生理在早泄诊断及治疗中应用价值的初步研究(硕士论文).南京:南京大学,2014.13-45.
[17] Xin ZC,Choi YD,Seong DH,et al.Sensory evoked potential and effect of SS-cream in premature ejaculation.Yonsei Med J,1995,36 (5):397-401.
[18] Xia JD,Zhou LH,Han YF,et al.A reassessment of penile sensory pathways and effects of prilocaine filidocaine cream in primary premature ejaculation.Int J Impot Res,2014,26(5):186-190.
[19] Yang BB,Xia JD,Hong ZW,et al.No effect of abstinence time on nerve electrophysiological test in premature ejaculation patients.Asian J Androl,2018,20(4):391-395.
[20] 黄巍,邵西仓,李晓裔.阴茎体感诱发电位在法医鉴定中的应用价值.中国法医学杂志,2010,25(6):423-424.
[21] Korkmaz S,Karadag MA,Hamamcioglu K,et al.Electrophysiological identification of central sensitization in patients with chronic prostatitis.Urol J,2015,12(4):2280-2284.
[22] Pietrangeli A,Bove L ,Innocenti P,et al.Neurophysiological evaluation of sexual dysfunction in patients operated for colorectal cancer.Clin Auton Res,1998,8(6):353-357.
[23] Pietrangeli A,Pugliese P,Perrone M,et al.Sexual dysfunction following surgery for rectal cancer — a clinical and neurophysiological study.J Exp Clin Cancer Res,2009,28:128.
[24] Zhu GY,Shen Y,Liu HG.Forensic Medical Assessment for Neurologic Erectile Dysfunction:58 Case Reports.Fa Yi Xue Za Zhi,2015,31(5):369-372.
[25] 郭应禄,胡礼泉主编.男科学.北京:人民卫生出版社,2004.684-689.
[26] 邵蓓,王汛,李澄棣,等.海绵体肌反射在神经系统病变定位诊断中的应用.中国神经科学杂志,2003,19(2):102-104.
[27] 周长扩,徐祗顺.后尿道-球海绵体反射在原发性早泄及射精迟缓发病机制中的研究(博士论文).济南:山东大学,2010.15-52.
[28] Amarenco G,Kerdraon J.Clinical value of ipsi- and contralateral sacral reflex latency measurement:A normative data study in man.Neurourol Urodyn,2000,19(5):565-576.
[29] Pop-Busui R,Hotaling J,Braffett BH,et al.Cardiovascular autonomic neuropathy,erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes:Findings from the DCCT/EDIC.J Urol,2015,193(6):2045-2051.
[30] Del Sorbo F,Elia AE,De Joanna G,et al.Normal cardiovascular reflex testing in patients with parkin disease.Mov Disord,2007,22(4):528-532.
[31] Derouet H,Jost WH,Osterhage J,et al.Penile sympathic skin response in erectile dysfunction.Eur Urol,1995,28(4):314-319.
[32] Valles-Antuňa C,Fernandez-Gomez J,Escaf S,et al.Sympathetic skin response in patients with erectile dysfunction.BJU Int,2009,104(11):1709-1712.
[33] Zhu GY,Shen Y.Sympathetic skin response:A new test to diagnose erectile dysfunction.Asian J Androl,2001,3(1):45-48.
[34] 黎银明,靖俊,洪志伟,等.甲状腺激素阴茎神经电生理诱发早泄的作用机制.医学研究生学报,2017,9(30):943-947.
[35] Xia J,Chen T,Chen J,et al.The sympathetic skin response located in the penis as predictor of the response to sertraline treatment in patients with primary premature ejaculation.J Sex Med,2014,11(11):2801-2808.
[36] Hong Z,Feng Y,Ding H,et al.Relationship between amyloid precursor protein in seminal plasma and abnormal penile sympathetic skin response in lifelong premature ejaculation.J Sex Med,2017,14(1):98-105.
[37] Kati B,Ay H.Evaluation of dapoxetine treatment success in lifelong premature ejaculation patients with penile sympathetic skin response.Andrologia,2018,50(9):e13076.
[38] Wagner G,Gerstenberg T,Levin RJ.Electrical activity of corpus cavernosum during flaccidity and erection of the human penis:A new diagnostic method?J Urol,1989,142(3):723-725.
[39] Stief CG,Thon WF,Djamilian M,et al.Single potential analysis of cavernous electrical activity.Urol Res,1991,19(5):277-280.
[40] Truss MC,Djamilian MH,Tan HK,et al.Single potential analysis of cavernous electrical activity.Four years' experience in more than 500 patients with erectile dysfunction.Eur Urol,1993,24(3):358-365.
[41] 马永江,陈凯,王家华.阴茎海绵体肌电图仪临床应用的初步报告.男性学杂志,1994,8(3):167-168.
[42] 胡剑麟,陈斌,徐杰,等.101例ED患者阴茎海绵体肌电图检测结果分析.中国男科学杂志,2010,24(1):54-57,59.
[43] Jiang XG,Holsheimer J,Mano L,et al.Application of correlation techniques in the analysis of corpus cavernosum electromyographic signals.Asian J Androl,2007,9 (3):369-376.
[2] Xin ZC,Chung WS,Choi YD,et al.Penile sensitivity in patients with primary premature ejaculation.J Urol,1996,156 (3):979-981.
[3] 苏新军,罗春华,程跃,等.勃起前后阴茎感觉定量阈值测定在早泄诊断中的应用研究,现代实用医学,2013,25(11):1250-1251.
[4] Hill BJ,Janssen E,Kvam P,et al.The effect of condoms on penile vibrotactile sensitivity thresholds in young,heterosexual men.J Sex Med,2014,11(1):102-106.
[5] You HS.The partial neurectomy of the dorsal nerve of the penis for patient with premature ejaculation.Korean J Androl,2000,18:143-148.
[6] 王飞翔,朱广友,翁少峥,等.阴茎定量感觉检测技术在神经损伤后性功能障碍评估中的应用,中国男科学杂志,2016,30(1):3-6,15.
[7] Salonia A,Saccà A,Briganti A,et al.Quantitative sensory testing of peripheral thresholds in patients with lifelong premature ejaculation:A case-controlled study.J Sex Med,2009,6(6):1755-1762.
[8] Yiou R,De Laet K,Hisano M,et al.Neurophysiological testing to assess penile sensory nerve damage after radical prostatectomy.J Sex Med,2012,9(9):2457-2466.
[9] 党静霞编著.肌电图诊断与临床应用(第2版).北京:人民卫生出版社,2017.22-23.
[10] 顾慎为,寿丽革,唐涌志,等.阴茎背神经传导速度测定在阳萎诊断中的价值.男性学杂志,1991,5(1):10-12,42.
[11] 沈稚舟.糖尿病性ED的阴茎背神经传导速度测定的意义.国外医学.内分泌学分册,1989,7:104-105.
[12] Yang CC,Bradley WE,Berger RE.The effect of pharmacologic erection on the dorsal nerve of the penis.Muscle Nerve,1997,20(11):1439-1444.
[13] Herbaut AG,Sattar AA,Salpigides G,et al.Sensory conduction velocity of dorsal nerve of the penis during pharmacoerection:A more physiological technique?Eur Urol,1996,30(1):60-64.
[14] Kiwamoto H,Kanda H,Onishi N,et al.Measurement of nerve conduction velocity of the dorsal nerve of the penis.Hinyokika Kiyo,1988,34(6):1007-1010.
[15] Xin ZC,Choi YD,Rha KH,et al.Somatosensory evoked potentials in patients with primary premature ejaculation.J Urol,1997,158 (2):451-455.
[16] 陈涛伟,戴玉田.阴茎神经电生理在早泄诊断及治疗中应用价值的初步研究(硕士论文).南京:南京大学,2014.13-45.
[17] Xin ZC,Choi YD,Seong DH,et al.Sensory evoked potential and effect of SS-cream in premature ejaculation.Yonsei Med J,1995,36 (5):397-401.
[18] Xia JD,Zhou LH,Han YF,et al.A reassessment of penile sensory pathways and effects of prilocaine filidocaine cream in primary premature ejaculation.Int J Impot Res,2014,26(5):186-190.
[19] Yang BB,Xia JD,Hong ZW,et al.No effect of abstinence time on nerve electrophysiological test in premature ejaculation patients.Asian J Androl,2018,20(4):391-395.
[20] 黄巍,邵西仓,李晓裔.阴茎体感诱发电位在法医鉴定中的应用价值.中国法医学杂志,2010,25(6):423-424.
[21] Korkmaz S,Karadag MA,Hamamcioglu K,et al.Electrophysiological identification of central sensitization in patients with chronic prostatitis.Urol J,2015,12(4):2280-2284.
[22] Pietrangeli A,Bove L ,Innocenti P,et al.Neurophysiological evaluation of sexual dysfunction in patients operated for colorectal cancer.Clin Auton Res,1998,8(6):353-357.
[23] Pietrangeli A,Pugliese P,Perrone M,et al.Sexual dysfunction following surgery for rectal cancer — a clinical and neurophysiological study.J Exp Clin Cancer Res,2009,28:128.
[24] Zhu GY,Shen Y,Liu HG.Forensic Medical Assessment for Neurologic Erectile Dysfunction:58 Case Reports.Fa Yi Xue Za Zhi,2015,31(5):369-372.
[25] 郭应禄,胡礼泉主编.男科学.北京:人民卫生出版社,2004.684-689.
[26] 邵蓓,王汛,李澄棣,等.海绵体肌反射在神经系统病变定位诊断中的应用.中国神经科学杂志,2003,19(2):102-104.
[27] 周长扩,徐祗顺.后尿道-球海绵体反射在原发性早泄及射精迟缓发病机制中的研究(博士论文).济南:山东大学,2010.15-52.
[28] Amarenco G,Kerdraon J.Clinical value of ipsi- and contralateral sacral reflex latency measurement:A normative data study in man.Neurourol Urodyn,2000,19(5):565-576.
[29] Pop-Busui R,Hotaling J,Braffett BH,et al.Cardiovascular autonomic neuropathy,erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes:Findings from the DCCT/EDIC.J Urol,2015,193(6):2045-2051.
[30] Del Sorbo F,Elia AE,De Joanna G,et al.Normal cardiovascular reflex testing in patients with parkin disease.Mov Disord,2007,22(4):528-532.
[31] Derouet H,Jost WH,Osterhage J,et al.Penile sympathic skin response in erectile dysfunction.Eur Urol,1995,28(4):314-319.
[32] Valles-Antuňa C,Fernandez-Gomez J,Escaf S,et al.Sympathetic skin response in patients with erectile dysfunction.BJU Int,2009,104(11):1709-1712.
[33] Zhu GY,Shen Y.Sympathetic skin response:A new test to diagnose erectile dysfunction.Asian J Androl,2001,3(1):45-48.
[34] 黎银明,靖俊,洪志伟,等.甲状腺激素阴茎神经电生理诱发早泄的作用机制.医学研究生学报,2017,9(30):943-947.
[35] Xia J,Chen T,Chen J,et al.The sympathetic skin response located in the penis as predictor of the response to sertraline treatment in patients with primary premature ejaculation.J Sex Med,2014,11(11):2801-2808.
[36] Hong Z,Feng Y,Ding H,et al.Relationship between amyloid precursor protein in seminal plasma and abnormal penile sympathetic skin response in lifelong premature ejaculation.J Sex Med,2017,14(1):98-105.
[37] Kati B,Ay H.Evaluation of dapoxetine treatment success in lifelong premature ejaculation patients with penile sympathetic skin response.Andrologia,2018,50(9):e13076.
[38] Wagner G,Gerstenberg T,Levin RJ.Electrical activity of corpus cavernosum during flaccidity and erection of the human penis:A new diagnostic method?J Urol,1989,142(3):723-725.
[39] Stief CG,Thon WF,Djamilian M,et al.Single potential analysis of cavernous electrical activity.Urol Res,1991,19(5):277-280.
[40] Truss MC,Djamilian MH,Tan HK,et al.Single potential analysis of cavernous electrical activity.Four years' experience in more than 500 patients with erectile dysfunction.Eur Urol,1993,24(3):358-365.
[41] 马永江,陈凯,王家华.阴茎海绵体肌电图仪临床应用的初步报告.男性学杂志,1994,8(3):167-168.
[42] 胡剑麟,陈斌,徐杰,等.101例ED患者阴茎海绵体肌电图检测结果分析.中国男科学杂志,2010,24(1):54-57,59.
[43] Jiang XG,Holsheimer J,Mano L,et al.Application of correlation techniques in the analysis of corpus cavernosum electromyographic signals.Asian J Androl,2007,9 (3):369-376.