Malignant priapism: an unexpected response to local anaesthetic infiltration of the dorsal nerves of the penis

Priapism: pathophysiology and the role of the radiologist

Priapism is defined as a penile erection that persists for 4 h or longer and is unrelated to sexual activity. Its identification is important as lack of timely treatment (particularly of the low flow/ischaemic subgroup) can result in persisting erectile dysfunction as a consequence of irreversible corporal fibrosis. This review describes the physiology and anatomy of the normal erection, the aetiology and pathophysiology of the different types of priapism, and the role of the radiologist in the management of the condition. The treatment of iatrogenic priapism following intracavernosal injection of pharmacostimulant is discussed.

Priapism

Priapism is a relatively uncommon condition that may present as a medical emergency associated with significant pain and anxiety in the veno-occlusive or low-flow variant. Pharmacologic advances and, specifically, the availability of intracavemosal alpha-agonist therapy have dramatically improved the prospects of resolution for patients with low-flow priapism presenting within the first few hours of the acute episode. High-flow priapism is not considered an emergency and treatment measures are typically conservative aimed at preservation of potency. Urologists, radiologists, and other health care personnel caring for the patient with priapism must be familiar with various etiologic factors implicated in low-flow and high-flow priapism to formulate a logical step-care approach. Differentiation of the low-flow from the high-flow state is perhaps the most critical initial diagnostic challenge that determines the sequence of further interventions including surgical shunts in low-flow priapism refractory to medical therapy.

The etiology, diagnosis, and treatment of priapism: review of the American Foundation for Urologic Disease Consensus Panel Report

Priapism is an important medical condition that requires immediate evaluation, and depending on etiology, may require emergency management. Based on the classification scheme offered by a recent consensus panel, priapism can be subdivided into ischemic and nonischemic types. The nonischemic type, usually the result of perineal trauma, can be treated with conservative therapy, whereas the nonischemic type, which arises from many varied causes, mandates immediate intervention. Corporal fibrosis and permanent erectile dysfunction can result from ischemic priapism that fails to resolve with therapy.

Priapism secondary to penile metastasis: a report of two cases and a review of the literature

Malignancy metastasis to the penis is an uncommon clinicopathological entity. We present two cases of malignant priapism following penile metastasis, in which the diagnosis was established by core needle biopsy of the corpus cavernosum. Primary tumors were urothelial carcinoma of the urinary bladder in one case (the patient having concomitant high-grade prostatic adenocarcinoma) and prostatic adenocarcinoma in the other. The clinicopathological features of 51 previously reported cases of penile metastasis in the recent literature are reviewed.

Cancer metastatic to the penis: treatment with hyperthermia and radiation therapy and review of the literature

Metastatic cancer to the penis is rare, its optimum treatment remains poorly defined and the outcome of patients with such metastases is poor. Hyperthermia in conjunction with radiation therapy has been shown to be an effective modality in the treatment of locally advanced or recurrent cancer and hyperthermia alone is under evaluation in treating benign disorders, such as hypertrophy of the prostate. Recently, 4 patients with symptomatic metastatic lesions to the penis (3 had primary prostatic cancer and 1 had rectal cancer) were treated with radiation therapy and hyperthermia. Treatment was well tolerated except for pain during hyperthermia, which limited the temperatures that could be obtained. All of the patients improved symptomatically, 1 achieved a complete response and 2 had partial responses. No significant complications were noted. Symptomatic control was maintained in all patients for the duration of their survival. This limited series suggests the possible role of local hyperthermia as an adjunct to radiation therapy in the treatment of metastases to the penis.

Cavernosography in diagnosis of metastatic tumors of the penis: 5 new cases and a review of the literature

Secondary tumors of the penis are rare, with 266 cases having been reported. We describe 5 new cases studied by cavernosography. The primary tumors were bladder cancer in 3 patients and prostatic cancer in 2. Cavernosography suggested the diagnosis, which was confirmed by a guided biopsy or fine needle aspiration biopsy. The prognosis has been poor, with the average survival being less than 9 months.

Involvement of the penis by rectocolic adenocarcinoma. Report of a case and review of the literature

A case report of a rectal carcinoma metastasizing to the penis is reviewed along with a total of 44 similar cases reported in the world literature. Pertinent arguments are presented in favor of yet another possible route of metastases, namely the perineural route, which has not been considered previously. Cavernosography provides valuable information about the extent of tumor spread; used more often, it would lead to recognition of the rare opportunity when an aggressive surgical approach might achieve prolonged survival.

Four cases of metastases to the penis and a review of the literature

Penile metastases are rare and usually are secondary to other genitourinary primaries. Approximately 200 cases have been reported. Survival for more than 1 year is unusual, and multiple metastases have been present in all autopsied cases. Occasional survival longer than 5 years has occurred with surgical excision, suggesting the possibility of cure for those patients in whom control of the primary has been achieved and who show no other clinical metastatic lesions.