penis examination

The penis, also known as the penis, refers to the external reproductive organs of male animals, which can be erect and have sexual intercourse. Penis examination is an examination to check whether the penile erection and penis function are normal. Penile examination mainly includes SW penile ultrasonic blood flow test, penile blood flow index, penile artery blood pressure, penile night erection test, foreskin phimosis and so on. A comprehensive physical examination is also necessary for the diagnosis of ED. The purpose is to discover defects and abnormalities in the nervous, endocrine, cardiovascular and reproductive organs associated with ED. Basic Information Specialist classification: male examination inspection classification: physical examination Applicable gender: whether the male is fasting: not fasting Tips: Maintain a normal diet and schedule before checking. People who are allergic to vasoactive substances (prostaglandin E1) should not be examined. Normal value The penis is divided into roots, bodies and heads. It consists of two corpus cavernosums on the dorsal side and one urethral cavernous body on the ventral side. The corpus cavernosum is a round blunt body with pointed ends, and the corpus cavernosum on both sides is in the pubic symphysis. The front lower part begins to merge into one. The urethral sponge body is slender and round and blunt. The front end is called the glans, and the cap is placed at the tip of the two corpus cavernosum. Clinical significance Abnormal result 1, corpus cavernosum angiography: X-ray can be seen on the penis foot and the lower part of the ischial branch "separation", to observe the development of the penile vein system. If the penile vein is developed, there are common penile venous leaks, penile foot leaks, cavernous septal leaks, ectopic venous leaks, spongiforms, and mixed types. 2. Penile artery blood pressure: When the penile artery blood pressure is lower than the systemic mean arterial blood pressure by 30 mmHg (4.0 kPa), or the penile artery index is lower than 0.6, it is abnormal. The measurement of penile artery blood pressure is often not constant, which is due to both technical limitations and the effects of penile vascular response on the environment and mood. Therefore, if an abnormal result is measured, it is necessary to repeatedly measure and verify that the penile artery index abnormality may be made. Penile artery blood pressure measurement may be helpful in diagnosing arterial insufficiency, but it is not very reliable to use this test to exclude arterial insufficiency as the cause of impotence. Moreover, it does not clarify any condition of blood flow, and it is even less able to detect penile artery function in an erect state. 3, foreskin phimosis inspection: If the phimosis or foreskin is too long, it may be because the foreskin is long wrapped in the glans, the temperature and humidity inside the foreskin is increased, easy to grow and multiply and inflammation occurs. Over time, can form the foreskin and glans adhesion, can cause sexual intercourse pain. In addition, the smegma secreted by the foreskin sebaceous glands has a penile cancer effect. Due to the large number of items in the penis examination, only three of them are listed here, and the detailed examination items of the penis examination can be browsed in detail. People who need to be examined: patients with impotence and penis at night with poor erection or erection. Precautions 1. Taboo before examination: Maintain normal diet and schedule. 2, inspection requirements: actively cooperate with the doctor's work. Inspection process 1. Physical examination: A comprehensive physical examination is also necessary for the diagnosis of ED. The purpose is to discover defects and abnormalities in the nervous, endocrine, cardiovascular and reproductive organs associated with ED. (1) General situation: attention should be paid to body shape, hair and subcutaneous fat distribution, muscle strength, secondary sexual characteristics, and the presence or absence of male breasts. This is related to the presence or absence of cortical dysfunction, such as cortisol, thyroid disease, hyperprolactin, and testis. (2) Cardiovascular system: blood pressure and limb pulse are measured. Loss or weakening of the femoral artery or radial artery may indicate abdominal aorta, radial artery embolization or stenosis. In addition to special examinations, the blood supply to the penis can be gently pressed and relaxed with the fingers to observe the blood filling and reflow of the penis glans. (3) nervous system: pay attention to the pain, touch and temperature difference of the lower back, lower limbs, perineum and penis, the vibration of the penis and toes, the ball sponge reflection (when stimulating the penis glans, the fingers should feel the anal sphincter when inserted into the anus Contraction) and other changes in the nervous system. (4) Abdomen: Whether there is hepatosplenomegaly, with or without ascites. (5) external genitalia 1 The size, shape and foreskin of the penis are abnormal. The corpus cavernosum should be carefully touched, and if there is a fibrous plaque, it suggests a penile cavernous insufficiency (Peyronie's disease). Phimosis, foreskin balanitis, foreskin adhesion or foreskin ligaments are too short to affect normal erectile function. 2 testicular size, texture, with or without hydrocele, epididymal cysts and varicocele. Huge hydrocele and hernia also affect normal sexual intercourse. 3 anal finger examination prostate size, texture, with nodules and tenderness, anal sphincter tension, etc., more than 50 years old ED patients should pay more attention to anal finger examination. 2, laboratory inspection (1) blood, urine routine, fasting blood glucose, high and low density lipoprotein and liver and kidney function tests are necessary for the discovery of diabetes, abnormal lipid metabolism and chronic liver and kidney disease. (2) Whether the determination of hormone levels should be used as a routine examination is still controversial. 1 Testosterone: There is a 24h rhythm change in testosterone levels in men, which is usually highest in the morning and 30% in the afternoon. Testosterone levels should be determined if suspected testosterone secretion is low. Only 2% to 20% of ED patients have a decrease in testosterone levels. However, the relationship between testosterone levels and erectile function remains unclear, and the value of ED for testosterone replacement therapy remains controversial. 2 prolactin: Any loss of sexual desire and erectile function, especially young people should suspect high prolactinosis, often caused by pituitary tumors. Taking estrogen, cimetidine, clomiphene, methyldopa, phenothiazine, etc. can also cause an increase in prolactin. Among patients with ED, elevated prolactin accounted for about 1% to 6%, but only 0.1% of those with pituitary adenoma were found. Prolactinoma should be suspected when the prolactin is 20 ng/ml. 3 thyroxine: abnormal thyroid function can cause ED. Anyone suspected of hyperthyroidism or hypothyroidism should be tested for thyroxine levels. Determination of 4 catecholamines and their metabolites: Determination of blood urinary catecholamines and their metabolites is helpful in the diagnosis of adrenal dysfunction. Combined with physical signs and imaging examinations, it is often clear. Because of the high cost of hormone testing and the 2.6% efficiency of testosterone replacement therapy, ED patients do not need routine serotonic screening. Corresponding hormones are measured only when the patient has significant loss of libido and hypogonadism. 3, special examination: a small number of patients with erectile dysfunction (about 15%) due to non-invasive treatment, in order to further understand the exact pathogenesis or mechanism of erectile dysfunction, in order to discuss further invasive treatment, need to choose a treatment The ground is used for some inspections in the following items. (1) Nocturnal penile tumescence (NPT): clinically can help distinguish between psychological or organic ED. However, in patients with organic ED, there may still be penile erection in the early stage. In addition, psychological ED caused by anxiety and depression may also affect the quality of sleep and abnormal penile erection. Therefore, the results of clinical interpretation of NPT should be comprehensively analyzed. . (2) Intracavernous injection (ICI): Intracavernous injection of vasoactive drugs began in the 1980s. The first vasoactive drug used was papaverine. Later, intracavernous injection of phenol was discovered. Tolamin, phenoxybenzamine, prostaglandin E1, etc. can also induce human penile erection. Different drugs have different mechanisms of action, but eventually lead to relaxation of the cavernous arteries and cavernous sinus smooth muscles, reduced blood flow resistance, increased perfusion of the cavernous arteries, enlargement of the cavernous sinus, compression of the reflux veins, and reduction of venous return of the cavernous sinus, resulting in erection . Currently commonly used drugs are: a single dose of papaverine in 10 ~ 30mg, prostaglandin E1 is 5 ~ 40μg. The triple mixed preparation was papaverine 30 mg/ml, phentolamine 0.5 mg/ml and prostaglandin E 110 μg/ml. The two mixed preparations were papaverine 30 mg/ml and phentolamine 0.5 mg/ml, or phentolamine 0.5 mg/ml and prostaglandin E 110 μg/ml. The dosage of the mixed preparation is 0.1~2ml, and gradually increases from the small dose to the optimal dose, and the usual dose is 0.25~1ml. Injection of vasoactive drugs into the corpus cavernosum can induce penile erection in patients with psychotic, neurological, hormonal, and mild vascular ED, especially in patients with neurological ED. (3) Colour duplex ultrasonography (CDU): This test is non-invasive and can be performed in an outpatient setting. The high-frequency probe shows the corpus cavernosum, corpus cavernosum and white membrane, providing real-time images, observing whether the penis has pathological changes, and obtaining high-resolution images of penile vessels. The inner diameter of the blood vessel was measured, and the diameter and blood flow rate of the penile artery under the weak state were recorded. If the vasoactive substance (such as PGE1) was injected into the corpus cavernosum to observe the blood flow of the penis before and after the injection, the mechanism of blood supply and venous closure of the penile artery was understood. Have helped. Common parameters for evaluating vascular function in the penis include arterial systolic maximum blood flow rate (PSV), end-diastolic blood flow rate (EDV), and resistance index (RI), of which PSV is the main indicator for evaluating penile artery blood supply function. Domestic Lu Shukun and others used dual-function color Doppler ultrasound to study normal people and patients with vascular erectile dysfunction. It was found that the vascular diameter of the corpus cavernosum was increased by more than 80% after the injection, and the blood flow rate was greater than or equal to 29 cm/s, and the resistance index was greater than or equal to 0.93. In patients with arterial ED, the diameter of the cavernous artery of the corpus cavernosum is smaller than normal, the maximum blood flow rate is low, and the resistance index is normal. After injection of venous ED patients, the diameter of the cavernous artery of the penis increased and the maximum blood flow rate was normal, and the resistance index was significantly lower than normal. Yao Dehong et al found that the resistance index of patients with venous erectile dysfunction is less than 1, and the end-diastolic blood flow rate is greater than 10ml/s. (4) Cavernosometry (CM): This method is an effective method for diagnosing venous erectile dysfunction. In 1981, vasoactive drugs (such as papaverine or prostaglandin E1) were used to induce post-erection pressure measurement. Wespes et al. found that the average perfusion flow rate after injection of papaverine into the corpus cavernosum was reduced from about 120 ml/min to 35 ml/min. There was also a corresponding decrease in the average perfusion flow rate for maintaining erection after injection. Diagnostic indicators for penile cavernous pressure measurement include perfusion flow rate (IF) for inducing erection, perfusion flow rate (MF) for maintaining erection, IF/IM, and pressure drop (PLC). In the early days, some people used IF for diagnosis. Currently, MF and PLC are used as diagnostic indicators. Under normal conditions, when the smooth muscle is completely relaxed, the perfusion flow rate that maintains a complete erection is below 10 ml/min, usually below 5 ml/min. Within 30 s after stopping the perfusion, the intracavernous pressure was reduced from 150 mmHg to below 45 mmHg. If the intracavernous pressure cannot reach the average systolic pressure during perfusion, the MF exceeds 10 ml/min or the intracavernous pressure drops rapidly after stopping the perfusion, the venous insufficiency is indicated. Significant venous insufficiency should be considered for MF over 40 ml/min. Payau et al believe that if IF>120ml/min, MF>50ml/min, it can be diagnosed as venous leak. (5) Cavernosography: In 1981, Wespes et al first used corpus cavernosum angiography for clinical use, which improved the understanding of venous ED and also provided a basis for the treatment of venous ED. In patients with venous leakage in the sphincter injection vasoactive drug test, the venous leak can be further confirmed by corpus cavernosum. The X-ray of venous leaks showed: 1 development of deep veins and peri-peripheral venous plexus; 2 development of internal and external venous system of the genitals; 3 visualization of superficial veins of the penis; 4 visualization of corpus cavernosum; 5 a small number of patients showed perineal plexus development. Lue and Rajfer et al. found that cavernosal angiography showed that there were more than two venous leaks in most patients. (6) Selective penile angiography: Arteriography is still the main method for assessing the location and characterization of penile blood supply abnormalities. Generally, erectile dysfunction occurs after pelvic fracture. Young people with primary erectile dysfunction suspected genital vascular malformation, aortic or radial artery stenosis, obstructive lesions, and confirmed penile insufficiency by NPT, Doppler ultrasound, etc. Penile arterial angiography can be performed before surgery. (7) Neurological detection of erectile dysfunction: The autonomic nervous system plays an important role in the nerve conduction process of the erectile response. The efferent pathway composed of the autonomic nervous system triggers penile erection and maintains an erection, while the somatic nervous system is required for sensing stimulation signals, afferent signals, and increasing penile stiffness. 1 autonomic nerve detection: there is no direct detection method, and the functional status of the autonomic nervous system (including sympathetic and parasympathetic nerves) can only be indirectly understood through the organs, systemic functional status and neural distribution involved in autonomic neuropathy and their relationship with autonomic nerves. . Including heart rate control test, cardiovascular reflex test, sympathetic skin reaction, cavernous EMG, temperature domain value detection, urinary anal reflex and so on. 2 physical nervous system examination: including penile biological threshold measurement test, sacral nerve stimulation response, vaginal nerve conduction velocity, somatosensory nerve evoked potential. Due to the lack of effective treatments for the vast majority of existing neuropathies, ED neurological testing is generally only applicable to clinical studies or to patients with clear benefits. (8) Cavernous biopsy: pathological changes of cavernous smooth muscle cells and cavernous cavities such as reduced number of smooth muscles, ultrastructural changes of cells and a large number of fibrous tissue proliferation can reduce the compliance and elasticity of smooth muscle cells and cavernous sinus, resulting in arterial filling Insufficient and venous insufficiency, which leads to erection. The corpus cavernosum biopsy can directly evaluate the cavernous function and is necessary in the etiology diagnosis of some impotence patients. The cavernous smooth muscle biopsy is often performed using the Trucut needle puncture method. The tissue was taken out for microscopic and computer image analysis by sectioning, and the smooth muscle density was analyzed. If the density of the smooth muscle of the cavernous body was found to be reduced, the impotence could be diagnosed. The cavernous biopsy should be based on the premise of not damaging the structure of the cavernous body, and the tissue removed can be representative and reflect the entire structure of the cavernous body. For some impotence patients who are scheduled to undergo surgical treatment of venous insufficiency, preoperative cavernous biopsy can help determine prognosis. Wespes et al found a correlation between the smooth muscle fiber content of the cavernous body and the surgical outcome, and the penile smooth muscle content was >29%, which was good after surgery. Because the cavernous biopsy is invasive, it is easy to cause complications such as hematoma, infection, scar, etc., so it should be cautious in clinical application. 4. Patient-oriented erectile dysfunction diagnosis Because erectile dysfunction treatment has its own particularity, most patients prefer non-invasive or minimally invasive treatment, rather than choosing a treatment that is prone to complication. . In the past 10 years, with the continuous development of erectile mechanism research, the introduction of new non-invasive or invasive treatment methods, the patient's above wishes have been realized, so the diagnosis of erectile dysfunction should be the least invasive and the most cost-effective. The method begins. A detailed medical history, a comprehensive physical examination, and the necessary tests are the most basic diagnostic steps. Then, based on the positive findings and the selected treatments in the above basic diagnosis, the corresponding special examination items can be recommended if necessary. Such as oral medication, vacuum narrowing device (VCD) or MUSE, unless the patient asks to know the exact cause of erectile dysfunction, there is no need to do further costly and painful examination. Not suitable for the crowd Allergic to vasoactive substances (prostaglandin E1), patients with sickle cell anemia, multiple myeloma, leukemia and easy to induce abnormal erection, patients with penile cavernous fibrosis, penile prosthesis, severe cardiovascular disease, severe People with heart rhythm disorder, hypotension, and old age should be banned or used with caution. Adverse reactions and risks No complications.