阴茎延长术延长长度的个体化预测及阴茎勃起角度形成机制的相关研究
|
摘要
研究背景
阴茎的长度在男性的生理及心理上都占有十分重要的地位，临床上各种原因引起的阴茎短小病例，甚至一部分阴茎尺寸正常的男性都希望通过一定的方式谋求阴茎增大。悬韧带松解术最初应用于先天性尿道上裂或膀胱外翻的矫正，随着对阴茎悬韧带及周围结构研究的深入，其手术适应症逐渐扩展至各种原因引起的先天性或后天性的阴茎短小（如阴茎发育不良、外伤缺损、阴茎癌切除术后等）。因其方法简单、对勃起功能影响小、术后恢复快等优点，最易被医生和患者所接受。在悬韧带松解阴茎延长术（简称为阴茎延长术）的临床应用中，最重要的两个问题是该手术的有效性及安全性。具体来说，即该手术的效果及该手术对阴茎勃起的影响。
目前医学界对于该手术的效果尚存在较大的争议。一方面，该手术的确切效果尚未达成统一意见。普遍的观点认为该术式通常可以获得1~2cm的延长效果，但各文献报道的数据之间存在明显的差异，对于接受相同手术方式的同种病例，个体之间的延长效果差别较大。另一方面，该术式的术后患者满意程度普遍不高。因为通常该手术对与大部分患者的延长效果有限，但患者在接受手术前却往往对自身的手术效果有较高的期望。此外，临床上该手术的适应症较为混乱。Mondaini等报道，临床上谋求行该延长手术的男性中，大部分人的阴茎尺寸实际上在正常范围内。这些人对手术的期望普遍较高，该术式的平均延长效果很难令其满意，不能达到治疗目的。总之，许多研究者对该手术开展持保留的态度，认为该手术应避免过度开展，尤其对于阴茎尺寸接近或达到正常范围的男性。实际上，严格控制适应症并不能很好的改善术后患者满意度，关键的问题是使患者的期望与其实际能获得的效果相符合。因此，一个针对个体的手术效果的预测方法对于解决上述诸多争议将是非常有裨益的。精确的个体化预测必须掌握该手术对阴茎背根部结构的精确影响。然而，由于缺乏精确而有效的研究方法，目前研究对于该手术原理的认识还过于粗略，难以满足个体化预测的需要。因此，寻找一种能够揭示该手术对阴茎背根部结构的精确影响的研究方法，对于该手术深入研究和临床推广十分重要。
阴茎延长术是以破坏阴茎背根部悬吊系统为代价而达到延长阴茎的目的，这不可避免的或多或少会影响悬吊系统的生理功能。阴茎背根部悬吊系统包括阴茎系韧带、悬韧带和耻骨弓状韧带。其主要生理功能是将阴茎体悬吊、固定于耻骨联合之下，并参与了维持阴茎“上举”的勃起状态。目前普遍的观点认为阴茎延长术对于阴茎勃起时的“稳定性”的影响不显著，但该观点尚未经过严格的实验加以证明，因此其正确性值得怀疑。实际上，传统的泌尿外科学领域对这种通俗意义上阴茎勃起“稳定性”并无针对性的研究，甚至对该概念都没有明确的定义。整形外科领域对阴茎延长术后所谓的阴茎勃起的“稳定性”的理解更倾向于阴茎勃起时是否出现明显的摆动或下垂。从该角度来说，我们认为阴茎勃起角度可以作为反映阴茎勃起“稳定性”的指标。遗憾的是，目前泌尿外科学及男科学相关专著及论著对于阴茎勃起角度的研究也十分有限。因此，为了研究阴茎延长术对阴茎勃起结构稳定性的影响，首先需要对阴茎勃起角度的形成机制及其与阴茎勃起结构稳定性的关系进行初步的研究。
方法
本研究分为三部分。
1、我们选取了第三军医大学第西南医院整形美容科1988年至2011年行阴茎延长术的先天性阴茎发育不良病例322例，随机分为建模组（200例）与验证组（122例），将建模组手术前、后的常态与勃起状态阴茎长度等指标进行相关性和线性回归分析，拟揭示该手术前后阴茎长度的变化规律，并由此推导预测公式，通过建模组与验证组中预测结果与实际结果的一致性来评价预测效果。
2、我们对3例先天性阴茎短小患者于手术前、后行阴茎背根部超声及MRI检查，对比两种检查结果，考察超声对阴茎背根部结构的显示情况，根据手术前后超声图像对比获得该手术对阴茎背根部结构的精确影响，并由此总结该手术的精确原理。
3、我们从阴茎勃起角度形成的力学和结构因素出发，根据既往文献研究归纳了阴茎勃起角度的形成机制，并根据该机制及相关物理学原理建立了阴茎勃起角度的数学模型。最后通过新鲜尸体标本实验测量并计算相关参数。
结果
1、患者术后常态与勃起状态的延长长度、手术前后的阴茎勃起长度与常态长度的比值、术前常态长度与术前阴茎勃起长度与常态长度的比值存在显著的相关性（相关系数分别为0.921、0.803、-0.803，P＜0.01）。由此可推导出延长长度的预测公式，通过对建模组与验证组的数据进行检验，预测误差在±1.5cm以内时其有效预测率分别为84.5%和87.7%。
2、超声检查可以显示阴茎背根部除悬韧带以外的主要结构的位置，包括阴茎海绵体、尿道海绵体、耻骨联合前下缘、阴茎背动脉等。手术后，被释放的固定段海绵体会有一个向下和沿长轴的位移，这段被释放的海绵体一部分仍隐藏域体内，另一部分则转化为游离段海绵体从而增加了游离段阴茎的长度。固定段海绵体的减少对常态延长长度的贡献约占1/4，被释放的海绵体沿长轴的伸长对常态延长长度的贡献约占3/4。
3、阴茎勃起角度主要由阴茎海绵体内压力、游离段阴茎干尺寸、海绵体白膜的纤维分布以及阴茎固定段海绵体与水平面的夹角共同决定。其中阴茎海绵体内压力和游离段阴茎干尺寸分别是阴茎勃起角度形成的内在动力和主要阻力因素，而海绵体白膜的纤维分布以及阴茎固定段海绵体角度与水平面的夹角是其重要的结构基础。所建立的数学模型可以反映阴茎勃起角度、长度、海绵体内压力以及阴茎固定段与水平面的夹角之间的数学关系。
结论
1、根据既往手术资料统计分析所得的线性回归方程较以往的单纯的延长长度更能反映手术前后阴茎长度的变化规律，由其推导的预测公式可用于阴茎延长术后延长长度的初步的个体化预测，但其精确性有限。更为精确的预测需要从患者阴茎背根部的个体化结构着手。
2、我们所建立的超声检查和分析方法可以应用于的阴茎延长手术病例的相关研究，其方法和结论可以为该手术延长效果的个体化预测提供必要的理论和方法支持。
3、本研究结论，在理论上可以通过海绵体内压力将阴茎勃起角度等形态学指标与血流动力学、结构动力学指标统一起来，从而完善了阴茎勃起机制相关理论；在临床上可以指导阴茎勃起角度异常病例的治疗方法的选择，也可以实现通过形态学数据估算海绵体内压力，从而利于临床上更简便、科学地对阴茎勃起状态进行评估，此外，还可以用于指导阴茎延长手术个体化手术方案的设计，具有一定的实用价值。
Background
Penis is an important urinary and reproductive organ, and the size of which plays aspecial role in male’s physiology and psychology. People usually believe that “bigger isbetter”, and many males with a short penis, even normal size, hope to enlarge their penisesthough any surgical or non-surgical approaches. Suspensory ligament dissecting penilelengthening was reported firstly in rectification of congenital epispadias and bladderexstrophy. As further studies in penile suspensory ligament and surrounding structures, theindication of this operation gradually expanded to short penis caused by various congenitalor acquired reasons, such as penile dysplasia, trauma and operations after penile carcinoma.The suspensory ligament dissecting is the more acceptable approach by doctors and patientsbecause of its simple method, lower influence to erection and faster postoperative recovery.Actually, the efficacy and safety of this operation, specifically the operation effect and theinfluence to erection, were the most concerned issues in clinic.
In recent years, there were some of disputes in operation effect. Firstly, the actualextended effect of the operation had not reached a consensus. The universal viewpointconsidered that this operation could obtain1~2cm in extended length, but the data indifferent reports existed obvious difference. Secondly, the postoperative satisfaction wasgenerally low in this operation. The reasons were that the patients usually had a higherexpectation preoperatively, but the extended lengths were usually very limited in most cases.Thirdly, the indications of this operation were unclear in clinic. Mondaini et al. reportedthat the men who sought penis lengthening in clinic mostly had a normal penile size. Thesemales usually had a higher expectation in extended length, and the operation effect usuallywould not satisfy them. For these reasons, many researches had conservative attitudes tothis operation. They thought this operation should not be operated extensively, especially tomales with a normal penile size. Actually, it might be helpless to improve the postoperative satisfaction by limiting the indications strictly. The key problem was to make patients’expectation correspond to the actual effect. Thus, an individual forecasting method wouldbe very useful to solve the disputes above-mentioned. An individual forecasting methodneeded a precise prehension of the influence of the regional structures caused by theoperation. However, current researches in the mechanism of the operation were too rough tosatisfy it, because there was lacking of effective study methods yet. Therefore, it wasimportant and urgent to find an effective and precise study method to investigate the precisemechanism for clinical extending and thorough researches of this operation.
The penile lengthening procures the extended length through destroying the suspensionsystem of penis, so it is inevitable to influence the physiological function of this systemmore or less. The suspension system of penis contains the fundiform ligament, suspensoryligament and arcuate subpubic ligament, which fixes the corpus penis to the pubicsymphysis and maintains the superducting status in erection. The universal idea of thesuspension system affected by penile lengthening was that the operation brought littleinfluence to the “stability of penile erection”, but there was lacking of strict experimentalevidences to support it. Actually there was not related research in the “stability of penileerection” in traditional uronology, even a definite concept. In plastic surgery, the “stabilityof penile erection” in penile lengthening usually was used to indicate whether there was avisible swing or drooping of penis during erection. In this point of view, we suggested thatthe erection angle of penis might be a potential index representing this “stability of penileerection”. In order to distinguish with the hemodynamic stability of penile erection, we putforward a concept of “structural stability of penile erection” to represent the previous“stability of penile erection” in penile lengthening. However, there were limited literaturesreferring to erection angle in uronology and andriatria as well. Thus, we firstly had toinvestigate the formation mechanism of erection angle and the relationship of the erectionangle and structural stability of penile erection, in order to study the influence of thesuspension system affected by penile lengthening.
Method
This research consist three parts as follow:
1. A total of322patients were diagnosed congenital penile shortness and receivedpartial suspensory ligament release in our department since1988. Firstly all the patients were divide into two groups, named the Modeling Group (200patients) and the CheckingGroup (122patients). Then a two-dimensional model of the suspensory-ligament-releasepenis lengthening was established. For the Modeling Group, a statistical analysis of thepenile length in flaccid and erectile state before and after penis lengthening was carried out,and a forecasting predictive function of increased penile length was derived. At last, theforecasting error of the Modeling Group and the Checking Group were compared.
2. The ultrasonograph and MRI were firstly examined in3patients preoperatively andpostoperatively. Then, the corresponding images of ultrasonograph and MRI werecontrasted to investigate the displaying status of dorsal root of penis in ultrasonograph.Finally, the preoperative and postoperative ultrasonograph images were contrasted toinvestigate the precise changes of regional structures caused by the operation.
3. The formation mechanism of erection angle was discussed through literature review.Based on the mechanism, a mathematic model of erection angle was established. Then, theintracavernous pressure, erectile angle and length on ex vivo fresh corpse were measured,and the parameter of the model was computed from those measured data.
Results
1. There is a significant linear correlation between the increased length in flaccid anderectile state (R=0.921, P <0.01), a similar relationship between the extension rate oferection before and after the operation (R=0.803, P <0.01), as well as preoperative flaccidlength and extension rate of erection (R=-0.803, P <0.01). According to the significantlinear correlations shown above, two regression forecasting models are established. Apredictive function of increased flaccid length is derived from the two regressionforecasting models. The effectively forecasting rate is84.5%(the Modeling Group) and87.7%(the Checking Group) when the absolute value of forecasting error is less than1.5cm.
2. The ultrasonograph could display the major structures of dorsal root of penis. Afterthe operation, the released corpus cavernosum usually would have a downward (leg side)displacement and an axial prolongation. But a part of released corpus cavernosum washidden in corpore again because of the thickening of presymphysial soft tissue. Thecontributions of the decrease of fixed segment of penis and the axial prolongation ofreleased corpus cavernosum were about1/4and3/4of flaccid absolute extended length respectively.
3. The formation mechanism of erection angle mainly depended on the intracavernouspressure, the size of free segment of penis, the distribution of elastic fiber in tunicaalbuginea and the angle between fixed segment of cavernosum and horizontal plane. Theconstructed mathematic model of erection angle could reflect the functional relation of thedeterminative factors shown above. And the parameter of the model could be calculated bythe measured data.
Conclusions
1. The discovered significant correlation and the established forecasting functionprovide us a model of roughly and individually forecasting the feasible extended penilelength before penis lengthening. But the accuracy of the forecasting model is limited.
2. This study is useful to prehension the mechanism and significance of the operation,and might provide some supports in theory and method for forecasting the extended lengthprecisely and individually. In addition, it might degrade the blindness and risk of operativeprocedure.
3. The formation mechanism and mathematic model of erection angle we worked couldenrich the theory of penile erection mechanism. Besides, it could be referred for choosing aright treatment for penile lengthening, abnormal erection angle and an evaluation oferection state conveniently and scientifically in clinical practice.
阴茎的长度在男性的生理及心理上都占有十分重要的地位，临床上各种原因引起的阴茎短小病例，甚至一部分阴茎尺寸正常的男性都希望通过一定的方式谋求阴茎增大。悬韧带松解术最初应用于先天性尿道上裂或膀胱外翻的矫正，随着对阴茎悬韧带及周围结构研究的深入，其手术适应症逐渐扩展至各种原因引起的先天性或后天性的阴茎短小（如阴茎发育不良、外伤缺损、阴茎癌切除术后等）。因其方法简单、对勃起功能影响小、术后恢复快等优点，最易被医生和患者所接受。在悬韧带松解阴茎延长术（简称为阴茎延长术）的临床应用中，最重要的两个问题是该手术的有效性及安全性。具体来说，即该手术的效果及该手术对阴茎勃起的影响。
目前医学界对于该手术的效果尚存在较大的争议。一方面，该手术的确切效果尚未达成统一意见。普遍的观点认为该术式通常可以获得1~2cm的延长效果，但各文献报道的数据之间存在明显的差异，对于接受相同手术方式的同种病例，个体之间的延长效果差别较大。另一方面，该术式的术后患者满意程度普遍不高。因为通常该手术对与大部分患者的延长效果有限，但患者在接受手术前却往往对自身的手术效果有较高的期望。此外，临床上该手术的适应症较为混乱。Mondaini等报道，临床上谋求行该延长手术的男性中，大部分人的阴茎尺寸实际上在正常范围内。这些人对手术的期望普遍较高，该术式的平均延长效果很难令其满意，不能达到治疗目的。总之，许多研究者对该手术开展持保留的态度，认为该手术应避免过度开展，尤其对于阴茎尺寸接近或达到正常范围的男性。实际上，严格控制适应症并不能很好的改善术后患者满意度，关键的问题是使患者的期望与其实际能获得的效果相符合。因此，一个针对个体的手术效果的预测方法对于解决上述诸多争议将是非常有裨益的。精确的个体化预测必须掌握该手术对阴茎背根部结构的精确影响。然而，由于缺乏精确而有效的研究方法，目前研究对于该手术原理的认识还过于粗略，难以满足个体化预测的需要。因此，寻找一种能够揭示该手术对阴茎背根部结构的精确影响的研究方法，对于该手术深入研究和临床推广十分重要。
阴茎延长术是以破坏阴茎背根部悬吊系统为代价而达到延长阴茎的目的，这不可避免的或多或少会影响悬吊系统的生理功能。阴茎背根部悬吊系统包括阴茎系韧带、悬韧带和耻骨弓状韧带。其主要生理功能是将阴茎体悬吊、固定于耻骨联合之下，并参与了维持阴茎“上举”的勃起状态。目前普遍的观点认为阴茎延长术对于阴茎勃起时的“稳定性”的影响不显著，但该观点尚未经过严格的实验加以证明，因此其正确性值得怀疑。实际上，传统的泌尿外科学领域对这种通俗意义上阴茎勃起“稳定性”并无针对性的研究，甚至对该概念都没有明确的定义。整形外科领域对阴茎延长术后所谓的阴茎勃起的“稳定性”的理解更倾向于阴茎勃起时是否出现明显的摆动或下垂。从该角度来说，我们认为阴茎勃起角度可以作为反映阴茎勃起“稳定性”的指标。遗憾的是，目前泌尿外科学及男科学相关专著及论著对于阴茎勃起角度的研究也十分有限。因此，为了研究阴茎延长术对阴茎勃起结构稳定性的影响，首先需要对阴茎勃起角度的形成机制及其与阴茎勃起结构稳定性的关系进行初步的研究。
方法
本研究分为三部分。
1、我们选取了第三军医大学第西南医院整形美容科1988年至2011年行阴茎延长术的先天性阴茎发育不良病例322例，随机分为建模组（200例）与验证组（122例），将建模组手术前、后的常态与勃起状态阴茎长度等指标进行相关性和线性回归分析，拟揭示该手术前后阴茎长度的变化规律，并由此推导预测公式，通过建模组与验证组中预测结果与实际结果的一致性来评价预测效果。
2、我们对3例先天性阴茎短小患者于手术前、后行阴茎背根部超声及MRI检查，对比两种检查结果，考察超声对阴茎背根部结构的显示情况，根据手术前后超声图像对比获得该手术对阴茎背根部结构的精确影响，并由此总结该手术的精确原理。
3、我们从阴茎勃起角度形成的力学和结构因素出发，根据既往文献研究归纳了阴茎勃起角度的形成机制，并根据该机制及相关物理学原理建立了阴茎勃起角度的数学模型。最后通过新鲜尸体标本实验测量并计算相关参数。
结果
1、患者术后常态与勃起状态的延长长度、手术前后的阴茎勃起长度与常态长度的比值、术前常态长度与术前阴茎勃起长度与常态长度的比值存在显著的相关性（相关系数分别为0.921、0.803、-0.803，P＜0.01）。由此可推导出延长长度的预测公式，通过对建模组与验证组的数据进行检验，预测误差在±1.5cm以内时其有效预测率分别为84.5%和87.7%。
2、超声检查可以显示阴茎背根部除悬韧带以外的主要结构的位置，包括阴茎海绵体、尿道海绵体、耻骨联合前下缘、阴茎背动脉等。手术后，被释放的固定段海绵体会有一个向下和沿长轴的位移，这段被释放的海绵体一部分仍隐藏域体内，另一部分则转化为游离段海绵体从而增加了游离段阴茎的长度。固定段海绵体的减少对常态延长长度的贡献约占1/4，被释放的海绵体沿长轴的伸长对常态延长长度的贡献约占3/4。
3、阴茎勃起角度主要由阴茎海绵体内压力、游离段阴茎干尺寸、海绵体白膜的纤维分布以及阴茎固定段海绵体与水平面的夹角共同决定。其中阴茎海绵体内压力和游离段阴茎干尺寸分别是阴茎勃起角度形成的内在动力和主要阻力因素，而海绵体白膜的纤维分布以及阴茎固定段海绵体角度与水平面的夹角是其重要的结构基础。所建立的数学模型可以反映阴茎勃起角度、长度、海绵体内压力以及阴茎固定段与水平面的夹角之间的数学关系。
结论
1、根据既往手术资料统计分析所得的线性回归方程较以往的单纯的延长长度更能反映手术前后阴茎长度的变化规律，由其推导的预测公式可用于阴茎延长术后延长长度的初步的个体化预测，但其精确性有限。更为精确的预测需要从患者阴茎背根部的个体化结构着手。
2、我们所建立的超声检查和分析方法可以应用于的阴茎延长手术病例的相关研究，其方法和结论可以为该手术延长效果的个体化预测提供必要的理论和方法支持。
3、本研究结论，在理论上可以通过海绵体内压力将阴茎勃起角度等形态学指标与血流动力学、结构动力学指标统一起来，从而完善了阴茎勃起机制相关理论；在临床上可以指导阴茎勃起角度异常病例的治疗方法的选择，也可以实现通过形态学数据估算海绵体内压力，从而利于临床上更简便、科学地对阴茎勃起状态进行评估，此外，还可以用于指导阴茎延长手术个体化手术方案的设计，具有一定的实用价值。
Background
Penis is an important urinary and reproductive organ, and the size of which plays aspecial role in male’s physiology and psychology. People usually believe that “bigger isbetter”, and many males with a short penis, even normal size, hope to enlarge their penisesthough any surgical or non-surgical approaches. Suspensory ligament dissecting penilelengthening was reported firstly in rectification of congenital epispadias and bladderexstrophy. As further studies in penile suspensory ligament and surrounding structures, theindication of this operation gradually expanded to short penis caused by various congenitalor acquired reasons, such as penile dysplasia, trauma and operations after penile carcinoma.The suspensory ligament dissecting is the more acceptable approach by doctors and patientsbecause of its simple method, lower influence to erection and faster postoperative recovery.Actually, the efficacy and safety of this operation, specifically the operation effect and theinfluence to erection, were the most concerned issues in clinic.
In recent years, there were some of disputes in operation effect. Firstly, the actualextended effect of the operation had not reached a consensus. The universal viewpointconsidered that this operation could obtain1~2cm in extended length, but the data indifferent reports existed obvious difference. Secondly, the postoperative satisfaction wasgenerally low in this operation. The reasons were that the patients usually had a higherexpectation preoperatively, but the extended lengths were usually very limited in most cases.Thirdly, the indications of this operation were unclear in clinic. Mondaini et al. reportedthat the men who sought penis lengthening in clinic mostly had a normal penile size. Thesemales usually had a higher expectation in extended length, and the operation effect usuallywould not satisfy them. For these reasons, many researches had conservative attitudes tothis operation. They thought this operation should not be operated extensively, especially tomales with a normal penile size. Actually, it might be helpless to improve the postoperative satisfaction by limiting the indications strictly. The key problem was to make patients’expectation correspond to the actual effect. Thus, an individual forecasting method wouldbe very useful to solve the disputes above-mentioned. An individual forecasting methodneeded a precise prehension of the influence of the regional structures caused by theoperation. However, current researches in the mechanism of the operation were too rough tosatisfy it, because there was lacking of effective study methods yet. Therefore, it wasimportant and urgent to find an effective and precise study method to investigate the precisemechanism for clinical extending and thorough researches of this operation.
The penile lengthening procures the extended length through destroying the suspensionsystem of penis, so it is inevitable to influence the physiological function of this systemmore or less. The suspension system of penis contains the fundiform ligament, suspensoryligament and arcuate subpubic ligament, which fixes the corpus penis to the pubicsymphysis and maintains the superducting status in erection. The universal idea of thesuspension system affected by penile lengthening was that the operation brought littleinfluence to the “stability of penile erection”, but there was lacking of strict experimentalevidences to support it. Actually there was not related research in the “stability of penileerection” in traditional uronology, even a definite concept. In plastic surgery, the “stabilityof penile erection” in penile lengthening usually was used to indicate whether there was avisible swing or drooping of penis during erection. In this point of view, we suggested thatthe erection angle of penis might be a potential index representing this “stability of penileerection”. In order to distinguish with the hemodynamic stability of penile erection, we putforward a concept of “structural stability of penile erection” to represent the previous“stability of penile erection” in penile lengthening. However, there were limited literaturesreferring to erection angle in uronology and andriatria as well. Thus, we firstly had toinvestigate the formation mechanism of erection angle and the relationship of the erectionangle and structural stability of penile erection, in order to study the influence of thesuspension system affected by penile lengthening.
Method
This research consist three parts as follow:
1. A total of322patients were diagnosed congenital penile shortness and receivedpartial suspensory ligament release in our department since1988. Firstly all the patients were divide into two groups, named the Modeling Group (200patients) and the CheckingGroup (122patients). Then a two-dimensional model of the suspensory-ligament-releasepenis lengthening was established. For the Modeling Group, a statistical analysis of thepenile length in flaccid and erectile state before and after penis lengthening was carried out,and a forecasting predictive function of increased penile length was derived. At last, theforecasting error of the Modeling Group and the Checking Group were compared.
2. The ultrasonograph and MRI were firstly examined in3patients preoperatively andpostoperatively. Then, the corresponding images of ultrasonograph and MRI werecontrasted to investigate the displaying status of dorsal root of penis in ultrasonograph.Finally, the preoperative and postoperative ultrasonograph images were contrasted toinvestigate the precise changes of regional structures caused by the operation.
3. The formation mechanism of erection angle was discussed through literature review.Based on the mechanism, a mathematic model of erection angle was established. Then, theintracavernous pressure, erectile angle and length on ex vivo fresh corpse were measured,and the parameter of the model was computed from those measured data.
Results
1. There is a significant linear correlation between the increased length in flaccid anderectile state (R=0.921, P <0.01), a similar relationship between the extension rate oferection before and after the operation (R=0.803, P <0.01), as well as preoperative flaccidlength and extension rate of erection (R=-0.803, P <0.01). According to the significantlinear correlations shown above, two regression forecasting models are established. Apredictive function of increased flaccid length is derived from the two regressionforecasting models. The effectively forecasting rate is84.5%(the Modeling Group) and87.7%(the Checking Group) when the absolute value of forecasting error is less than1.5cm.
2. The ultrasonograph could display the major structures of dorsal root of penis. Afterthe operation, the released corpus cavernosum usually would have a downward (leg side)displacement and an axial prolongation. But a part of released corpus cavernosum washidden in corpore again because of the thickening of presymphysial soft tissue. Thecontributions of the decrease of fixed segment of penis and the axial prolongation ofreleased corpus cavernosum were about1/4and3/4of flaccid absolute extended length respectively.
3. The formation mechanism of erection angle mainly depended on the intracavernouspressure, the size of free segment of penis, the distribution of elastic fiber in tunicaalbuginea and the angle between fixed segment of cavernosum and horizontal plane. Theconstructed mathematic model of erection angle could reflect the functional relation of thedeterminative factors shown above. And the parameter of the model could be calculated bythe measured data.
Conclusions
1. The discovered significant correlation and the established forecasting functionprovide us a model of roughly and individually forecasting the feasible extended penilelength before penis lengthening. But the accuracy of the forecasting model is limited.
2. This study is useful to prehension the mechanism and significance of the operation,and might provide some supports in theory and method for forecasting the extended lengthprecisely and individually. In addition, it might degrade the blindness and risk of operativeprocedure.
3. The formation mechanism and mathematic model of erection angle we worked couldenrich the theory of penile erection mechanism. Besides, it could be referred for choosing aright treatment for penile lengthening, abnormal erection angle and an evaluation oferection state conveniently and scientifically in clinical practice.
引文
[1]龙道畴,陕声国,罗定安,等.阴茎延长术的临床研究.中华整形烧伤外科杂志,1990,6(1):17-19.
[2]林子豪,李世荣,吴宏,等.阴茎延长术//李世荣.现代美容整形外科学.北京:人民军医出版社,2006:1398-1403.
[3] Vardi Y, Har-Shai Y, Gil T, et al. A critical analysis of penile enhancement proceduresfor patients with normal penile size: surgical techniques, success, and complications.Eur Urol,2008,54(5):1042-1050.
[4]李俊,黄健,虞湘才.阴茎悬韧带及其周围组织器官的局部解剖.临床泌尿外科杂志,2008,6(23).409-411.
[5]丁自海,张巧德,高承文.阴茎延长术的解剖学基础.中国临床解剖学杂志,1993,11(1):44-46.
[6] Shirong L, Xuan Z, Zhengxiang W, et al. Modified penis lengthening surgery: review of52cases. Plast Reconstr Surg,2000,105(2):596-599.
[7] Zhuo Q, Li S, Wu J, et al. Clinical application of scrotal flap on penis lengthening.Saudi Med,2009,30(3):418-421.
[8]陈华,李世荣,张绍祥,等.成人阴茎整形修复的3D手术仿真研究.中国美容医学,2006,15(9):1038-1039.
[1] Vardi Y. Is penile enlargement an ethical procedure for patients with a normal-sizedpenis? Eur Urol,2006,49(4):609-611.
[2] Austoni E, Guarneri A, Gatti G. Penile elongation and thickening--a myth? Is there acosmetic or medical indication? Andrologia,1999,31(Suppl1):45-51.
[3] Johnston JH. Lengthening of the congenital or acquired short penis. Br JUrol,1974,46(6):685-688.
[4] Kelley JH, Eraklis AJ. A procedure for lengthening the phallus in boys with exstrophyof the bladder.J Pediatr Surg,1971,6(5):645-649.
[5] Vardi Y, Harshai Y, Gil T, et al. A Critical Analysis of Penile Enhancement Proceduresfor Patients with Normal Penile Size: Surgical Techniques, Success, and Complications.Eur Urol,2008,54(5):1042-1050.
[6] Xie WG, Long DC, Zhu H, et al. Repair and reconstruction of penile defects due todevastating deep burn. Zhonghua Shao Shang Za Zhi,2009,25(6):407-410.
[7] Donnellan SM, Webb DR. Management of invasive penile cancer by synchronous penilelengthening and radical tumour excision to avoid perineal urethrostomy. Aust N Z JSurg,1998,68(5):369-370.
[8] Colombo F, Casarico A. Penile enlargement. Curr Opin Urol,2008,18(6):583-588.
[9] Mondaini N, Ponchietti R, Gontero P, et al. Penile length is normal in most men seekingpenile lengthening procedures. Int J Impot Res,2002,14(4):283-286.
[10] Nugteren HM, Balkema GT, Pascal AL, et al.18-year experience in the management ofmen with a complaint of a small penis. J Sex Marital Ther,2010,36(2):109-117.
[11] Wang HY, Tao L, Chen L, et al. A model of individually forecasting the penile lengthgained after penis lengthening. Zhonghua Zheng Xing Wai Ke Za Zhi,2011,27(6):427-431.
[12] Shirong L, Xuan Z, Zhengxiang W, et al. Modified penis lengthening surgery: reviewof52cases. Plast Reconstr Surg,2000,105(2):596-599.
[13] Aversa A, Sarteschi LM. The role of penile color-duplex ultrasound for the evaluationof erectile dysfunction.J Sex Med,2007,4(5):1437-1447.
[14] Protogerou V, Anagnostopolou S, Venierates D, et al. Penis ligaments: their use in
"increasing" the size of the penis in penile augmentation procedures. Anatomical
description in human cadavers and clinical results of a phalloplasty series.Ann Ital
Chir,2010,81(3):199-204.
[1] Li CY, Agrawal V, Minhas S, et al. The penile suspensory ligament: abnormalities andrepair. BJU Int,2007,99(1):117-120.
[2] Nugteren HM, Pascal AL, Weijmar Schultz WCM, et al. Surgery for an “acute erectileangle,” when counseling fails. J Sex Med,2010,7(3):1311-1314.
[3] Wespes E, Delcour C, Rondeux C, et al. The erectile angle: Objective criterion toevaluate the papaverine test in impotence. J Urol,1987,138(5):1171-1173.
[4] Viswaroop B, B A, Gopalakrishnan G. Evaluating erectile dysfunction: oral sildenafilversus intracavernosal injection of papaverine. Natl Med J India,2005,18(6):299-301.
[5] Sparling J. Penile erections: shape, angle, and length. J Sex Marital Ther,1997,23(3):195-207.
[6] Deysach LJ. The comparative morphology of the erectile tissue of the penis withespecial emphasis on the probable mechanism of erection. Am. J. Anat,1939,64(1):111-131.
[7] Da Silva EA, Sampaio FJB. Urethral extensibility applied to reconstructive surgery. JUrol,2002,167(5):2042-2045.
[8] Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectiledysfunction. Urol Clin North Am,2005,32(4):379–395.
[9] Granton PV, Norley CJD, Umoh J, et al. Rapid in vivo whole body composition ofrats using cone beam μCT. J Appl Physiol,2010,109(4):1162-1169.
[10] Barendregt JNM, Kooman JP, Van Der Sande FM, et al. The effect of dialysatetemperature on energy transfer during hemodialysis (HD). Kidney Int,1999,55(6):2598-2608.
[11] Brock G, Hsu GL, Nunes L, et al. The anatomy of the tunica albuginea in the normalpenis and Peyronie's disease. J Urol,1997,157(1):276-281.
[12] Kelly DA. Axial orthogonal fiber reinforcement in the corpus cavernosum of thenine-banded armadillo (Dasypus novemcinctus). J. Morphol,1997,233(3):249-255.
[13] Kelly DA. Expansion of the tunica albuginea during penile inflation in thenine-banded armadillo (Dasypus novemcinctus). J Exp Biol,1999,202(Pt3):253-265.
[14] Darewicz B, Kudelski J, Szynaka B, et al. Ultrastructure of the tunica albuginea incongenital penile curvature. J Urol,2001,166(5):1766-1768.
[15] Aboyan IA, Shestel AN, Pavlov SV, et al. Mathematical modelling of the results oftunica albuginea plasty at various forms of penile deviation. J Sex Med,2009,6(suppl2):139.
[16] Hoznek A, Rahmouni A, Abbou C, et al. The suspensory ligament of the penis: ananatomic and radiologic description. Surg Radiol Anat,1998,20(6):413-417.
[17] Vardi Y, Harshai Y, Gil T, et al. A Critical Analysis of Penile Enhancement Proceduresfor Patients with Normal Penile Size: Surgical Techniques, Success, andComplications. Eur Urol.2008,54(5):1042-1050.
[18] Barnea O, Hayun S, Gillon G. A mathematical model of penile vascular dysfunctionand its application to a new diagnostic technique. Ann N Y AcadSci,2007,1101:439-452.
[19] Timm GW, Elayaperumal S and Hegrenes J. Biomechanical analysis of penileerections: penile buckling behaviour under axial loading and radial compression. BJUInt,2008,102(1):76-84.
[20] Kelly DA. Penises as Variable-Volume Hydrostatic Skeletons. Ann N Y AcadSci,2007,1101:453-463.
[21] Udelson D, Nehra A, Hatzichristou DG, et al. Engineering analysis of penilehemodynamic and structural-dynamic relationships: Part I—clinical implications ofpenile tissue mechanical properties. Int J Impot Res,1998,10(1):15-24.
[22] Udelson D, Nehra A, Hatzichristou DG, et al. Engineering analysis of penilehemodynamic and structural-dynamic relationships: Part II—Clinical implications ofpenile buckling. Int J Impot Res,1998,10(1):25-35.
[23] Udelson D, Nehra A, Hatzichristou DG, et al. Engineering analysis of penilehemodynamic and structural-dynamic relationships: Part III—Clinical considerations ofpenile hemodynamic and rigidity erectile responses. Int J Impot Res,1998,10(2):89-99.
[24] Hatzichristou DG, Hatzimouratidis K, Tzortzis V, et al. Normal hemodynamicparameters do not always predict the presence of a rigid erection: a quantitativeassessment of functional erectile impairment. Int J Impot Res,2003,15(2):99-104.
[1] Vardi Y. Is penile enlargement an ethical procedure for patients with a normal-sizedpenis? Eur Urol,2006,49(4):609-611.
[2] Austoni E, Guarneri A, Gatti G. Penile elongation and thickening--a myth? Is there acosmetic or medical indication? Andrologia,1999,31(Suppl1):45-51.
[3]龙道畴,陕声国,罗定安,等.阴茎延长术的临床研究.中华整形烧伤外科杂志,1990,6(1):17-19.
[4]李世荣,樊东力,梁昭华,等.烧伤后阴茎短小畸形及先天性小阴茎的临床治疗.实用美容整形外科杂志,1991,2,(4):24-25.
[5] Kelley JH, Eraklis AJ. A procedure for lengthening the phallus in boys with exstrophyof the bladder. J Pediatr Surg,1971,6(5):645-649.
[6] Johnston JH. Lengthening of the congenital or acquired short penis. Br JUrol,1974;46(6):685-688.
[7] Vardi Y, Harshai Y, Gil T, et al. A Critical Analysis of Penile Enhancement Proceduresfor Patients with Normal Penile Size: Surgical Techniques, Success, andComplications. Eur Urol,2008,54(5):1042-1050.
[8] Xie WG, Long DC, Zhu H, et al. Repair and reconstruction of penile defects due todevastating deep burn. Zhonghua Shao Shang Za Zhi,2009,25(6):407-410.
[9] Donnellan SM, Webb DR. Management of invasive penile cancer by synchronouspenile lengthening and radical tumour excision to avoid perineal urethrostomy. Aust NZ J Surg,1998,68(5):369-370.
[10]胡清,郑刚.阴茎延长术治疗隐匿阴茎(附18例报告).中华男科学杂志,2004,10(9):695-696.
[11] Borsellino A, Spagnoli A, Vallasciani S, et al. Surgical approach to concealed penis:technical refinements and outcome. Urology,2007,69(6):1195-1198.
[12] Mondaini N, Ponchietti R, Gontero P, et al. Penile length is normal in most menseeking penile lengthening procedures. Int J Impot Res,2002,14(4):283-286.
[13] Awwad Z, Abu-Hijleh M, Basri S, et al. Penile measurements in normal adultJordanians and in patients with erectile dysfunction. Int J of Impot Res,2005,17(2):191-195.
[14]王润,李俊悦.男性青年性器官的调查分析.中国临床解剖学杂志,1989,7(1):44-46.
[15] Wessells H, Lue TF, McAninch JW. Penile length in the flaccid and erect states:guidelines for penile augmentation. J Urol,1996,156(3),995-997.
[16]都培砖.维吾尔族、汉族妇女阴道长度的比较.中国临床解剖学杂志,1988,6(1):45.
[17]李少兰,曹群朵.40例阴茎延长术患者的围手术期护理.山东医药,2003,43(17):56-57.
[18]林子豪,李世荣,吴宏,等.阴茎延长术//李世荣.现代美容整形外科学.北京:人民军医出版社,2006:1398-1403.
[19] Hoznek A, Rahmouni A, Abbou C, et al. The suspensory ligament of the penis: ananatomic and radiologic description. Surg Radiol Anat,1998,20(6):413-417.
[20]朱辉,龙云,崔永言,等.阴茎部整形术的应用解剖学研究.中华整形外科杂志,2005,2l(4):274-277.
[21]汪灏,李森恺,杨明勇,等.经包皮内板切口阴茎延长增粗术的研究.中国实用美容整形外科学杂志,2006,17(1):21-23.
[22] Zhuo Q, Li S, Wu J, et al. Clinical application of scrotal flap on penis lengthening.Saudi Med J,2009,30(3):418-421.
[23]张明利,郭恩覃,卢范.短小阴茎的延长整复治疗.中华整形烧伤外科杂志,1992,8(3):188-189.
[24]潘斯俭,赵亚南,李允怡,等.两种手术方法在阴茎延长术中的应用.云南医药,2004,25(2):104-106.
[25]潘连军,祝黎洁,王忠,等.连续Z形阴茎延长术的临床应用.中华男科学杂志,2008,14(4):317-320.
[26]李战松.耻骨下区V-Y成形阴茎延长术(附85例临床报告).中国性科学,2007,16(4):14-17.
[27]霍然,李森恺,李养群,等.下腹部轴型皮瓣在阴茎延长术的应用.中华整形外科杂志,2001,17(3):144-146.
[28]刘元波,李森恺,李养群,等.应用阴囊肉膜平滑肌肌皮瓣修复阴茎延长术中的阴茎创面.中华整形外科杂志,2002,18(4):206-208.
[29]李迎斋,李相如,陈学军.勃起状态下阴茎延长术12例报告.中国男科学杂志,2005,19(5):8.
[30]陈建军,殷国前.阴茎延长术的临床应用及进展.中外医疗,2009,28(20):170-172.
[31] Protogerou V, Anagnostopolou S, Venierates D, et al. Penis ligaments: their use in"increasing" the size of the penis in penile augmentation procedures. Anatomicaldescription in human cadavers and clinical results of a phalloplasty series. Ann ItalChir,2010,81(3):199-204.
[32]丁自海,张巧德,高承文,等.阴茎延长术的解剖学基础.中国临床解剖学杂志,1993,11(1):44-46.
[33]陈华,李世荣.计算机可视化技术应用在成年男性生殖器官整形修复中的研究进展.中国美容医学,2006,15(3):344-346.
[34]陈华,李世荣,张绍祥,等.成人阴茎整形修复的3D手术仿真研究.中国美容医学,2006,15(9):1038-1039.
[35]王洪一,陶灵,陈亮,等.悬韧带松解阴茎延长术后延长长度预测模型的建立和验证.中华整形外科杂志,2011,27(6):427-431.
[36] Chen J, Gefen A, Greenstein A, et al. Predicting penile size during erection. Int JImpot Res,2000,12(6):328-333.
[37]仝润泽,吕启凤,冯辉利.海绵体释放阴茎延长术84例临床分析.实用医院临床杂志,2005,2(2):50-51.
[38] Shirong L, Xuan Z, Zhengxiang W, et al. Modified penis lengthening surgery: reviewof52cases. Plast Reconstr Surg,2000,105(2):596-599.
[39] Li CY, Kayes O, Kell PD, et al. Penile suspensory ligament division for penileaugmentation: indications and results. Eur Urol,2006,49(4):729-733.
[40]姜立仁.阴茎延长术的手术适应证及手术方法.哈尔滨医药,2009,29(1):29.
[41]陶灵,李世荣,孙建森,等.成人尸体阴茎延长长度的测量及其静脉淋巴管的解剖学观察.第三军医大学学报,2005,27(10):997-999.
[42]陶灵,李世荣.改良的阴茎延长手术方法及其术后并发症的观察.中国修复重建外科杂志,2008,22(12):1409-1411.
[43] Li S, Tao L, Wang Z, et al. Postoperative hydrophallus after penile lengthening: anexperimental and clinical study. Plast Reconstr Surg,2007,119(2):768-770.
[44] Nugteren HM, Pascal AL, Weijmar Schultz WCM, et al. Surgery for an “acute erectileangle,” when counseling fails. J Sex Med,2010,7(3):1311-1314.
[1]龙道畴,陕声国,罗定安,等.阴茎延长术的临床研究.中华整形烧伤外科杂志,1990,6(1):17-19.
[2]李世荣,樊东力,梁昭华,等.烧伤后阴茎短小畸形及先天性小阴茎的临床治疗.实用美容整形外科杂志,1991,2,(4):24-25.
[3]张明利,郭恩覃,卢范.短小阴茎的延长整复治疗.中华整形烧伤外科杂志,1992,8(3):188-189.
[4]徐正新,郭仲武,常金枝.阴茎延长术35例体会.中国美容医学,2006,15(1):41.
[5]刘元波,李森恺,李养群,等.应用阴囊肉膜平滑肌肌皮瓣修复阴茎延长术中的阴茎创面.中华整形外科杂志,2002,18(4):206-208.
[6]周宏礽,杨定文,李宁生,等.改良的阴茎延长术(附6例报告).中国厂矿医学,2003,l6(6):449-450.
[7]蔡志明,朱辉,冯子毅,等.保留感觉与勃起功能的阴茎再造术.中华整形外科杂志,2003,19(6):423-426.
[8]潘斯俭,赵亚南,李允怡,等.两种手术方法在阴茎延长术中的应用.云南医药,2004,25(2):104-106.
[9]周少虎,张怀树,施广祥.阴茎悬韧带松解术.中华男科学杂志,2004;10(10):781-782.
[10]胡清,郑刚.阴茎延长术治疗隐匿阴茎(附18例报告).中华男科学杂志,2004,10(9):695-696.
[11]张金明,陈小萱,崔永言,等.大隐静脉移植加大阴茎海绵体的一期阴茎延长术.中国修复重建外科杂志,2005,19(1):82-83.
[12]吴小蔚,龙道畴,程邦昌,等.残余阴茎的修复(附52例报告).中华男科学杂志,2005,11(3):198-200.
[13]仝润泽,吕启凤,冯辉利.海绵体释放阴茎延长术84例临床分析.实用医院临床杂志,2005,2(2):50-51.
[14]李迎斋,李相如,陈学军.勃起状态下阴茎延长术12例报告.中国男科学杂志,2005,19(5):8.
[15]汪灏,李森恺,杨明勇,等.经包皮内板切口阴茎延长增粗术的研究.中国实用美容整形外科学杂志,2006,17(1):21-23.
[16]高锦彪,王莉莉,孙玉梅.“V-Y”成形微创阴茎延长术1200例.中国实用美容整形外科杂志,2006,17(1):32-33.
[17]杨晓林,赵绍明,饶颖慧,等.肥胖成年阴茎延长术的临床体会.中国美容整形外科杂志,2006,17(5):372-373.
[18]徐正新,郭仲武,常金枝.阴茎延长术35例体会.中国美容医学,2006,15(1):41-41.
[19]李战松.耻骨下区V-Y成形阴茎延长术(附85例临床报告).中国性科学,2007,16(4):14-17.
[20]张革军,田浩亮,顾国君,等.“V”形切口行阴茎延长术的手术体会(附27例报告).齐齐哈尔医学院学报,2007,28(24):2987.
[21]陈建军.阴茎延长术合并包皮环切术58例.广西医科大学学报,2008,25(4):645.
[22]潘连军,祝黎洁,王忠,等.连续Z形阴茎延长术的临床应用.中华男科学杂志,2008,14(4):317-320.
[23]王传家,陈茵,关魁,等.改良阴茎延长加增粗术临床应用分析.中国美容医学,2008,l7(7):966-967.
[24] Zhuo Q, Li S, Wu J, et al. Clinical application of scrotal flap on penis lengthening.Saudi Med J,2009,30(3):418-421.
[25]谢卫国,龙道畴,朱辉,等.阴茎毁损性烧伤的修复与重建.中华烧伤杂志,2009,25(6):407-410.
[26]陈建军,曾田青,谭勇明,等.阴茎延长术阴茎长度的测量方法.华夏医学,2009,22(3):454-456.
[27]黄威,刘晓燕.连续Z改形阴茎延长术的临床应用.中国美容整形外科杂志,2009,20(9):521-523.
[28]张倩,李卫贤.阴茎延长术治疗小阴茎105例分析.河南职工医学院学报,2009,21(2):162-163.
[29]丁健,李强,李森恺,等.正常男性的阴茎延长术.中国美容医学,2010,19(6):805-807.
[30]龙云,朱辉,崔永言,等.改良阴茎延长术的解剖学研究和临床应用.2010,26(2):116-119.
[31]龙云,朱辉,崔永言,等.阴囊皮瓣结合阴茎延长术修复阴茎部分缺损.中华医学杂志.2010,90(20):1408-1410.
[32]颜贵江,刘会红,孙承恕,等.舌形皮瓣阴茎延长术56例临床分析.中外医疗,2010,29(36):51-51.
[2]林子豪,李世荣,吴宏,等.阴茎延长术//李世荣.现代美容整形外科学.北京:人民军医出版社,2006:1398-1403.
[3] Vardi Y, Har-Shai Y, Gil T, et al. A critical analysis of penile enhancement proceduresfor patients with normal penile size: surgical techniques, success, and complications.Eur Urol,2008,54(5):1042-1050.
[4]李俊,黄健,虞湘才.阴茎悬韧带及其周围组织器官的局部解剖.临床泌尿外科杂志,2008,6(23).409-411.
[5]丁自海,张巧德,高承文.阴茎延长术的解剖学基础.中国临床解剖学杂志,1993,11(1):44-46.
[6] Shirong L, Xuan Z, Zhengxiang W, et al. Modified penis lengthening surgery: review of52cases. Plast Reconstr Surg,2000,105(2):596-599.
[7] Zhuo Q, Li S, Wu J, et al. Clinical application of scrotal flap on penis lengthening.Saudi Med,2009,30(3):418-421.
[8]陈华,李世荣,张绍祥,等.成人阴茎整形修复的3D手术仿真研究.中国美容医学,2006,15(9):1038-1039.
[1] Vardi Y. Is penile enlargement an ethical procedure for patients with a normal-sizedpenis? Eur Urol,2006,49(4):609-611.
[2] Austoni E, Guarneri A, Gatti G. Penile elongation and thickening--a myth? Is there acosmetic or medical indication? Andrologia,1999,31(Suppl1):45-51.
[3] Johnston JH. Lengthening of the congenital or acquired short penis. Br JUrol,1974,46(6):685-688.
[4] Kelley JH, Eraklis AJ. A procedure for lengthening the phallus in boys with exstrophyof the bladder.J Pediatr Surg,1971,6(5):645-649.
[5] Vardi Y, Harshai Y, Gil T, et al. A Critical Analysis of Penile Enhancement Proceduresfor Patients with Normal Penile Size: Surgical Techniques, Success, and Complications.Eur Urol,2008,54(5):1042-1050.
[6] Xie WG, Long DC, Zhu H, et al. Repair and reconstruction of penile defects due todevastating deep burn. Zhonghua Shao Shang Za Zhi,2009,25(6):407-410.
[7] Donnellan SM, Webb DR. Management of invasive penile cancer by synchronous penilelengthening and radical tumour excision to avoid perineal urethrostomy. Aust N Z JSurg,1998,68(5):369-370.
[8] Colombo F, Casarico A. Penile enlargement. Curr Opin Urol,2008,18(6):583-588.
[9] Mondaini N, Ponchietti R, Gontero P, et al. Penile length is normal in most men seekingpenile lengthening procedures. Int J Impot Res,2002,14(4):283-286.
[10] Nugteren HM, Balkema GT, Pascal AL, et al.18-year experience in the management ofmen with a complaint of a small penis. J Sex Marital Ther,2010,36(2):109-117.
[11] Wang HY, Tao L, Chen L, et al. A model of individually forecasting the penile lengthgained after penis lengthening. Zhonghua Zheng Xing Wai Ke Za Zhi,2011,27(6):427-431.
[12] Shirong L, Xuan Z, Zhengxiang W, et al. Modified penis lengthening surgery: reviewof52cases. Plast Reconstr Surg,2000,105(2):596-599.
[13] Aversa A, Sarteschi LM. The role of penile color-duplex ultrasound for the evaluationof erectile dysfunction.J Sex Med,2007,4(5):1437-1447.
[14] Protogerou V, Anagnostopolou S, Venierates D, et al. Penis ligaments: their use in
"increasing" the size of the penis in penile augmentation procedures. Anatomical
description in human cadavers and clinical results of a phalloplasty series.Ann Ital
Chir,2010,81(3):199-204.
[1] Li CY, Agrawal V, Minhas S, et al. The penile suspensory ligament: abnormalities andrepair. BJU Int,2007,99(1):117-120.
[2] Nugteren HM, Pascal AL, Weijmar Schultz WCM, et al. Surgery for an “acute erectileangle,” when counseling fails. J Sex Med,2010,7(3):1311-1314.
[3] Wespes E, Delcour C, Rondeux C, et al. The erectile angle: Objective criterion toevaluate the papaverine test in impotence. J Urol,1987,138(5):1171-1173.
[4] Viswaroop B, B A, Gopalakrishnan G. Evaluating erectile dysfunction: oral sildenafilversus intracavernosal injection of papaverine. Natl Med J India,2005,18(6):299-301.
[5] Sparling J. Penile erections: shape, angle, and length. J Sex Marital Ther,1997,23(3):195-207.
[6] Deysach LJ. The comparative morphology of the erectile tissue of the penis withespecial emphasis on the probable mechanism of erection. Am. J. Anat,1939,64(1):111-131.
[7] Da Silva EA, Sampaio FJB. Urethral extensibility applied to reconstructive surgery. JUrol,2002,167(5):2042-2045.
[8] Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectiledysfunction. Urol Clin North Am,2005,32(4):379–395.
[9] Granton PV, Norley CJD, Umoh J, et al. Rapid in vivo whole body composition ofrats using cone beam μCT. J Appl Physiol,2010,109(4):1162-1169.
[10] Barendregt JNM, Kooman JP, Van Der Sande FM, et al. The effect of dialysatetemperature on energy transfer during hemodialysis (HD). Kidney Int,1999,55(6):2598-2608.
[11] Brock G, Hsu GL, Nunes L, et al. The anatomy of the tunica albuginea in the normalpenis and Peyronie's disease. J Urol,1997,157(1):276-281.
[12] Kelly DA. Axial orthogonal fiber reinforcement in the corpus cavernosum of thenine-banded armadillo (Dasypus novemcinctus). J. Morphol,1997,233(3):249-255.
[13] Kelly DA. Expansion of the tunica albuginea during penile inflation in thenine-banded armadillo (Dasypus novemcinctus). J Exp Biol,1999,202(Pt3):253-265.
[14] Darewicz B, Kudelski J, Szynaka B, et al. Ultrastructure of the tunica albuginea incongenital penile curvature. J Urol,2001,166(5):1766-1768.
[15] Aboyan IA, Shestel AN, Pavlov SV, et al. Mathematical modelling of the results oftunica albuginea plasty at various forms of penile deviation. J Sex Med,2009,6(suppl2):139.
[16] Hoznek A, Rahmouni A, Abbou C, et al. The suspensory ligament of the penis: ananatomic and radiologic description. Surg Radiol Anat,1998,20(6):413-417.
[17] Vardi Y, Harshai Y, Gil T, et al. A Critical Analysis of Penile Enhancement Proceduresfor Patients with Normal Penile Size: Surgical Techniques, Success, andComplications. Eur Urol.2008,54(5):1042-1050.
[18] Barnea O, Hayun S, Gillon G. A mathematical model of penile vascular dysfunctionand its application to a new diagnostic technique. Ann N Y AcadSci,2007,1101:439-452.
[19] Timm GW, Elayaperumal S and Hegrenes J. Biomechanical analysis of penileerections: penile buckling behaviour under axial loading and radial compression. BJUInt,2008,102(1):76-84.
[20] Kelly DA. Penises as Variable-Volume Hydrostatic Skeletons. Ann N Y AcadSci,2007,1101:453-463.
[21] Udelson D, Nehra A, Hatzichristou DG, et al. Engineering analysis of penilehemodynamic and structural-dynamic relationships: Part I—clinical implications ofpenile tissue mechanical properties. Int J Impot Res,1998,10(1):15-24.
[22] Udelson D, Nehra A, Hatzichristou DG, et al. Engineering analysis of penilehemodynamic and structural-dynamic relationships: Part II—Clinical implications ofpenile buckling. Int J Impot Res,1998,10(1):25-35.
[23] Udelson D, Nehra A, Hatzichristou DG, et al. Engineering analysis of penilehemodynamic and structural-dynamic relationships: Part III—Clinical considerations ofpenile hemodynamic and rigidity erectile responses. Int J Impot Res,1998,10(2):89-99.
[24] Hatzichristou DG, Hatzimouratidis K, Tzortzis V, et al. Normal hemodynamicparameters do not always predict the presence of a rigid erection: a quantitativeassessment of functional erectile impairment. Int J Impot Res,2003,15(2):99-104.
[1] Vardi Y. Is penile enlargement an ethical procedure for patients with a normal-sizedpenis? Eur Urol,2006,49(4):609-611.
[2] Austoni E, Guarneri A, Gatti G. Penile elongation and thickening--a myth? Is there acosmetic or medical indication? Andrologia,1999,31(Suppl1):45-51.
[3]龙道畴,陕声国,罗定安,等.阴茎延长术的临床研究.中华整形烧伤外科杂志,1990,6(1):17-19.
[4]李世荣,樊东力,梁昭华,等.烧伤后阴茎短小畸形及先天性小阴茎的临床治疗.实用美容整形外科杂志,1991,2,(4):24-25.
[5] Kelley JH, Eraklis AJ. A procedure for lengthening the phallus in boys with exstrophyof the bladder. J Pediatr Surg,1971,6(5):645-649.
[6] Johnston JH. Lengthening of the congenital or acquired short penis. Br JUrol,1974;46(6):685-688.
[7] Vardi Y, Harshai Y, Gil T, et al. A Critical Analysis of Penile Enhancement Proceduresfor Patients with Normal Penile Size: Surgical Techniques, Success, andComplications. Eur Urol,2008,54(5):1042-1050.
[8] Xie WG, Long DC, Zhu H, et al. Repair and reconstruction of penile defects due todevastating deep burn. Zhonghua Shao Shang Za Zhi,2009,25(6):407-410.
[9] Donnellan SM, Webb DR. Management of invasive penile cancer by synchronouspenile lengthening and radical tumour excision to avoid perineal urethrostomy. Aust NZ J Surg,1998,68(5):369-370.
[10]胡清,郑刚.阴茎延长术治疗隐匿阴茎(附18例报告).中华男科学杂志,2004,10(9):695-696.
[11] Borsellino A, Spagnoli A, Vallasciani S, et al. Surgical approach to concealed penis:technical refinements and outcome. Urology,2007,69(6):1195-1198.
[12] Mondaini N, Ponchietti R, Gontero P, et al. Penile length is normal in most menseeking penile lengthening procedures. Int J Impot Res,2002,14(4):283-286.
[13] Awwad Z, Abu-Hijleh M, Basri S, et al. Penile measurements in normal adultJordanians and in patients with erectile dysfunction. Int J of Impot Res,2005,17(2):191-195.
[14]王润,李俊悦.男性青年性器官的调查分析.中国临床解剖学杂志,1989,7(1):44-46.
[15] Wessells H, Lue TF, McAninch JW. Penile length in the flaccid and erect states:guidelines for penile augmentation. J Urol,1996,156(3),995-997.
[16]都培砖.维吾尔族、汉族妇女阴道长度的比较.中国临床解剖学杂志,1988,6(1):45.
[17]李少兰,曹群朵.40例阴茎延长术患者的围手术期护理.山东医药,2003,43(17):56-57.
[18]林子豪,李世荣,吴宏,等.阴茎延长术//李世荣.现代美容整形外科学.北京:人民军医出版社,2006:1398-1403.
[19] Hoznek A, Rahmouni A, Abbou C, et al. The suspensory ligament of the penis: ananatomic and radiologic description. Surg Radiol Anat,1998,20(6):413-417.
[20]朱辉,龙云,崔永言,等.阴茎部整形术的应用解剖学研究.中华整形外科杂志,2005,2l(4):274-277.
[21]汪灏,李森恺,杨明勇,等.经包皮内板切口阴茎延长增粗术的研究.中国实用美容整形外科学杂志,2006,17(1):21-23.
[22] Zhuo Q, Li S, Wu J, et al. Clinical application of scrotal flap on penis lengthening.Saudi Med J,2009,30(3):418-421.
[23]张明利,郭恩覃,卢范.短小阴茎的延长整复治疗.中华整形烧伤外科杂志,1992,8(3):188-189.
[24]潘斯俭,赵亚南,李允怡,等.两种手术方法在阴茎延长术中的应用.云南医药,2004,25(2):104-106.
[25]潘连军,祝黎洁,王忠,等.连续Z形阴茎延长术的临床应用.中华男科学杂志,2008,14(4):317-320.
[26]李战松.耻骨下区V-Y成形阴茎延长术(附85例临床报告).中国性科学,2007,16(4):14-17.
[27]霍然,李森恺,李养群,等.下腹部轴型皮瓣在阴茎延长术的应用.中华整形外科杂志,2001,17(3):144-146.
[28]刘元波,李森恺,李养群,等.应用阴囊肉膜平滑肌肌皮瓣修复阴茎延长术中的阴茎创面.中华整形外科杂志,2002,18(4):206-208.
[29]李迎斋,李相如,陈学军.勃起状态下阴茎延长术12例报告.中国男科学杂志,2005,19(5):8.
[30]陈建军,殷国前.阴茎延长术的临床应用及进展.中外医疗,2009,28(20):170-172.
[31] Protogerou V, Anagnostopolou S, Venierates D, et al. Penis ligaments: their use in"increasing" the size of the penis in penile augmentation procedures. Anatomicaldescription in human cadavers and clinical results of a phalloplasty series. Ann ItalChir,2010,81(3):199-204.
[32]丁自海,张巧德,高承文,等.阴茎延长术的解剖学基础.中国临床解剖学杂志,1993,11(1):44-46.
[33]陈华,李世荣.计算机可视化技术应用在成年男性生殖器官整形修复中的研究进展.中国美容医学,2006,15(3):344-346.
[34]陈华,李世荣,张绍祥,等.成人阴茎整形修复的3D手术仿真研究.中国美容医学,2006,15(9):1038-1039.
[35]王洪一,陶灵,陈亮,等.悬韧带松解阴茎延长术后延长长度预测模型的建立和验证.中华整形外科杂志,2011,27(6):427-431.
[36] Chen J, Gefen A, Greenstein A, et al. Predicting penile size during erection. Int JImpot Res,2000,12(6):328-333.
[37]仝润泽,吕启凤,冯辉利.海绵体释放阴茎延长术84例临床分析.实用医院临床杂志,2005,2(2):50-51.
[38] Shirong L, Xuan Z, Zhengxiang W, et al. Modified penis lengthening surgery: reviewof52cases. Plast Reconstr Surg,2000,105(2):596-599.
[39] Li CY, Kayes O, Kell PD, et al. Penile suspensory ligament division for penileaugmentation: indications and results. Eur Urol,2006,49(4):729-733.
[40]姜立仁.阴茎延长术的手术适应证及手术方法.哈尔滨医药,2009,29(1):29.
[41]陶灵,李世荣,孙建森,等.成人尸体阴茎延长长度的测量及其静脉淋巴管的解剖学观察.第三军医大学学报,2005,27(10):997-999.
[42]陶灵,李世荣.改良的阴茎延长手术方法及其术后并发症的观察.中国修复重建外科杂志,2008,22(12):1409-1411.
[43] Li S, Tao L, Wang Z, et al. Postoperative hydrophallus after penile lengthening: anexperimental and clinical study. Plast Reconstr Surg,2007,119(2):768-770.
[44] Nugteren HM, Pascal AL, Weijmar Schultz WCM, et al. Surgery for an “acute erectileangle,” when counseling fails. J Sex Med,2010,7(3):1311-1314.
[1]龙道畴,陕声国,罗定安,等.阴茎延长术的临床研究.中华整形烧伤外科杂志,1990,6(1):17-19.
[2]李世荣,樊东力,梁昭华,等.烧伤后阴茎短小畸形及先天性小阴茎的临床治疗.实用美容整形外科杂志,1991,2,(4):24-25.
[3]张明利,郭恩覃,卢范.短小阴茎的延长整复治疗.中华整形烧伤外科杂志,1992,8(3):188-189.
[4]徐正新,郭仲武,常金枝.阴茎延长术35例体会.中国美容医学,2006,15(1):41.
[5]刘元波,李森恺,李养群,等.应用阴囊肉膜平滑肌肌皮瓣修复阴茎延长术中的阴茎创面.中华整形外科杂志,2002,18(4):206-208.
[6]周宏礽,杨定文,李宁生,等.改良的阴茎延长术(附6例报告).中国厂矿医学,2003,l6(6):449-450.
[7]蔡志明,朱辉,冯子毅,等.保留感觉与勃起功能的阴茎再造术.中华整形外科杂志,2003,19(6):423-426.
[8]潘斯俭,赵亚南,李允怡,等.两种手术方法在阴茎延长术中的应用.云南医药,2004,25(2):104-106.
[9]周少虎,张怀树,施广祥.阴茎悬韧带松解术.中华男科学杂志,2004;10(10):781-782.
[10]胡清,郑刚.阴茎延长术治疗隐匿阴茎(附18例报告).中华男科学杂志,2004,10(9):695-696.
[11]张金明,陈小萱,崔永言,等.大隐静脉移植加大阴茎海绵体的一期阴茎延长术.中国修复重建外科杂志,2005,19(1):82-83.
[12]吴小蔚,龙道畴,程邦昌,等.残余阴茎的修复(附52例报告).中华男科学杂志,2005,11(3):198-200.
[13]仝润泽,吕启凤,冯辉利.海绵体释放阴茎延长术84例临床分析.实用医院临床杂志,2005,2(2):50-51.
[14]李迎斋,李相如,陈学军.勃起状态下阴茎延长术12例报告.中国男科学杂志,2005,19(5):8.
[15]汪灏,李森恺,杨明勇,等.经包皮内板切口阴茎延长增粗术的研究.中国实用美容整形外科学杂志,2006,17(1):21-23.
[16]高锦彪,王莉莉,孙玉梅.“V-Y”成形微创阴茎延长术1200例.中国实用美容整形外科杂志,2006,17(1):32-33.
[17]杨晓林,赵绍明,饶颖慧,等.肥胖成年阴茎延长术的临床体会.中国美容整形外科杂志,2006,17(5):372-373.
[18]徐正新,郭仲武,常金枝.阴茎延长术35例体会.中国美容医学,2006,15(1):41-41.
[19]李战松.耻骨下区V-Y成形阴茎延长术(附85例临床报告).中国性科学,2007,16(4):14-17.
[20]张革军,田浩亮,顾国君,等.“V”形切口行阴茎延长术的手术体会(附27例报告).齐齐哈尔医学院学报,2007,28(24):2987.
[21]陈建军.阴茎延长术合并包皮环切术58例.广西医科大学学报,2008,25(4):645.
[22]潘连军,祝黎洁,王忠,等.连续Z形阴茎延长术的临床应用.中华男科学杂志,2008,14(4):317-320.
[23]王传家,陈茵,关魁,等.改良阴茎延长加增粗术临床应用分析.中国美容医学,2008,l7(7):966-967.
[24] Zhuo Q, Li S, Wu J, et al. Clinical application of scrotal flap on penis lengthening.Saudi Med J,2009,30(3):418-421.
[25]谢卫国,龙道畴,朱辉,等.阴茎毁损性烧伤的修复与重建.中华烧伤杂志,2009,25(6):407-410.
[26]陈建军,曾田青,谭勇明,等.阴茎延长术阴茎长度的测量方法.华夏医学,2009,22(3):454-456.
[27]黄威,刘晓燕.连续Z改形阴茎延长术的临床应用.中国美容整形外科杂志,2009,20(9):521-523.
[28]张倩,李卫贤.阴茎延长术治疗小阴茎105例分析.河南职工医学院学报,2009,21(2):162-163.
[29]丁健,李强,李森恺,等.正常男性的阴茎延长术.中国美容医学,2010,19(6):805-807.
[30]龙云,朱辉,崔永言,等.改良阴茎延长术的解剖学研究和临床应用.2010,26(2):116-119.
[31]龙云,朱辉,崔永言,等.阴囊皮瓣结合阴茎延长术修复阴茎部分缺损.中华医学杂志.2010,90(20):1408-1410.
[32]颜贵江,刘会红,孙承恕,等.舌形皮瓣阴茎延长术56例临床分析.中外医疗,2010,29(36):51-51.