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CC BY-NC-ND 4.0 · Revista Urología Colombiana / Colombian Urology Journal 2018; 27(02): 156-166
DOI: 10.1016/j.uroco.2017.02.001
Original Article | Artículo Original
Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Cavernosopatía traumática crónica. Un nuevo síndrome de fibrosis peneana

Chronic Traumatic Cavernopathy. A New Syndrome of Penile Fibrosis
Juan F. Uribe A
1   Servicio de Urología, Hospital Pablo Tobón Uribe, Medellín, Colombia
,
Alejandro Vélez H
2   Servicio de Patología, Hospital Pablo Tobón Uribe, Medellín, Colombia
,
John J. Zuleta T
3   Servicio de Epidemiología, Hospital Pablo Tobón Uribe, Medellín, Colombia
,
Carlos A. Uribe T
4   Servicio de Medicina Sexual, Hospital Pablo Tobón Uribe, Medellín, Colombia
› Institutsangaben
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04. September 2016

02. Februar 2017

Publikationsdatum:
10. Januar 2018 (online)

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Resumen

Introdución La llamada genéricamente «enfermedad de Peyronie» es un diagnóstico que explica un porcentaje de ciertos estados de fibrosis peneana grave, pero se queda corta para abarcar la amplia gama de grises de la fibrosis peneana secundaria a microtrauma sexual repetido.

Objectivo Describir un nuevo síndrome por trauma repetido en el pene al que se propone denominar «cavernosopatía traumática crónica» (CTC), con 4 componentes: fibrosis (leve, moderada o grave), disfunción eréctil, curvatura y fugas venosas peneanas.

Materiales y métodos Se realizó un estudio de corte transversal en una base de datos de 128 pacientes que tenían al menos una ecografía de pene con vasoactivo y en los que se había detectado algún grado de fibrosis cavernosa según la clasificación de Levine. Se evaluó la presencia de disfunción eréctil, curvas y fugas venosas según el grado de fibrosis. El estudio contó con la aprobación del Comité de Ética en Investigación.

Resultados Se estudió a 128 pacientes con fibrosis, con 51,3 años de edad promedio (DE = 13). El grado de fibrosis fue leve (Levine 1) en 30 (23,43%), moderado (Levine 2) en 23 (17,96%) y grave (Levine 3) en 75 (58,6%). Se demostró que, a mayor fibrosis, mayor disfunción eréctil, 66,6; 83,6 y 96% para Levine 1, 2 y 3, respectivamente (p ≤ 0,0001). La frecuencia de curvatura secundaria (n = 71) fue de 0; 4,2 y 95,7% para Levine 1, 2 y 3, respectivamente (p ≤ 0,0001). La frecuencia en los 44 pacientes con fugas cavernosas fue de 9; 20,4 y 70,4% (p = 0,0060) y en los 15 de fugas dorsales fue de 80; 13,3 y 6,6% (p < 0,0001) para Levine 1, 2 y 3 respectivamente. El grupo de 79 pacientes (64,03%) con mayor posibilidad de CTC, con presencia de 3 o 4 criterios que incluyeran curvatura secundaria y fuga cavernosa, tuvo un promedio de edad de 59,2 años (DE = 8,7), comparado con 41,7 años (DE = 11,7) en el grupo de menor posibilidad, diferencia estadísticamente significativa (p ≤ 0,0001).

Conclusiones Proponemos que existe un síndrome de microtrauma repetido en el pene, que puede denominarse CTC, análogo a la encefalopatía traumática crónica, con 4 componentes: fibrosis cavernosa, disfunción eréctil, curvatura peneana y fugas venosas. La fibrosis es un continuum que el paciente recorre por fases leves y moderadas, a menudo inapreciables para los clínicos. Las curvaturas secundarias y las fugas cavernosas están relacionadas directamente con el grado de fibrosis y con mayor riesgo de disfunción eréctil. La edad empeora algunos factores de la CTC.

Abstract

Introduction The condition called “Peyronie's disease” is a diagnosis that explains a percentage of the states of severe penile fibrosis, but not enough to cover the wide grey range of penile fibrosis secondary to repeated sexual micro-trauma.

Purpose To describe a new syndrome due to repeated trauma to the penis, which is proposed to be called “Chronic traumatic cavernopathy” (CTC), with 4 components: fibrosis, erectile dysfunction, curvature and penile venous leakage.

Materials and Methods A cross-sectional study was conducted on a database of 128 patients who had at least one penis ultrasound performed with a vasoactive, and had some degree of cavernous fibrosis according to Levine classification. An evaluation was made on the presence of erectile dysfunction, curvature, and venous leakage depending on the degree of fibrosis. The study was approved by the Research Ethics Committee.

Results The study included 128 patients with penile fibrosis, and a mean age of 52.9 years (SD = 13). The degree of fibrosis was mild (Levine 1) in 30 (23.43%), moderate (Levine 2) in 23 (17.96%), and severe (Levine 3) in 75 (58.6%). It was shown that the higher the fibrosis, the more erectile dysfunction (ED), with 66.6%, 83.6%, and 96% for Levine 1, 2, and 3 respectively (P ≤ 0.0001). Frequency of secondary curvature (n = 71) was 0%, 4.2%, and 95.7% for Levine 1, 2, and 3, respectively (P ≤ 0.0001). The frequency in 44 cavernous patients with venous leakages was 9%, 20.4%, and 70.4% (P = 0.0060), and with 15 dorsal leakages it was 80%, 13.3%, and 6.6% (P < 0.0001) for Levine 1, 2, and 3, respectively. The group of 79 (64.03%) patients with increased possibility of CTC, and who met the 4 criteria, or the 3 criteria including secondary curvature and cavernous venous leakage, had a mean age of 59.2 years (SD = 8.7), compared to 41.7 years (SD = 11.7) in the other group with less possibility, which had a statistically significant difference (P ≤ 0.0001).

Conclusions We propose that there is a syndrome of repeated micro-trauma in penis, which can be called CTC, analogous to chronic traumatic encephalopathy, with 4 components: cavernous fibrosis, erectile dysfunction, penile curvature, and venous leak. Fibrosis is a continuum that, in the patient goes through mild and moderate stages, and often goes unnoticed by clinicians. Secondary curvatures and cavernous leaks are directly related to the degree of fibrosis and increased risk of erectile dysfunction. Age aggravates some factors of CTC.

Palabras Clave

enfermedad peneana - peyronie - induración peneana - traumas de pene - disfunción eréctil - fibrosis - ultrasonografía

Keywords

penile disease - peyronie's disease - penile induration - penile injuries - erectile dysfunction - fibrosis - ultrasound
 

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