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Salman B, Elsherif E, Elgharabawy M, Badawy A. Early versus delayed penile prosthesis insertion for refractory ischemic priapism. Arab J Urol 2022; 21:76-81. [PMID: 37234682 PMCID: PMC10208160 DOI: 10.1080/2090598x.2022.2135290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/21/2022] [Accepted: 10/09/2022] [Indexed: 11/02/2022] Open
Abstract
Objectives Penile prosthesis insertion is a well-established therapeutic option in refractory ischemic priapism but there is a lack of standardization regarding the timing of surgery, the type of prosthesis (malleable or inflatable), as well as the possible complications. In this study, we retrospectively compared early versus delayed penile prosthesis insertion in patients with refractory ischemic priapism. Methods 42 male patients who presented with refractory ischemic priapism during the period between January 2019 and January 2022 were included in this study. All patients had malleable penile prosthesis insertion by four highly experienced consultants. Patients were divided into two groups based on the time of the prosthesis insertion. 23 patients had immediate insertion of the prosthesis within the first week of the onset of priapism while the remaining 19 patients had delayed prosthesis insertion three months or later after the onset of priapism. The outcome as well as the intra- and the postoperative complications were recorded. Results Postoperative complications such as prosthesis erosion and infection were higher among the early insertion group while the delayed insertion group had higher incidence of intraoperative complications such as corporal perforation and urethral injury. The insertion of the prosthesis was much more difficult among the delayed insertion group due to fibrosis which made dilatation of the corpora very difficult. The length and the width of the penile implant were significantly higher among the early insertion group as compared to the delayed insertion group. Conclusions Early penile prosthesis insertion for refractory ischemic priapism is a safe and effective treatment option as delayed prosthesis insertion is more difficult and challenging due to corporal fibrosis and is associated with higher complication.
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Affiliation(s)
- Baher Salman
- Urology Department, Faculty of Medicine, Menofia University, Shibin Elkoom, Egypt
| | - Eid Elsherif
- Urology Department, Faculty of Medicine, Menofia University, Shibin Elkoom, Egypt
| | - Mohamed Elgharabawy
- Urology Department, Faculty of Medicine, Menofia University, Shibin Elkoom, Egypt
| | - Atef Badawy
- Urology Department, Faculty of Medicine, Menofia University, Shibin Elkoom, Egypt
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Rahoui M, Ouanes Y, Kays C, Mokhtar B, Mrad Dali K, Sellami A, Ben Rhouma S, Nouira Y. Erectile function outcomes following surgical treatment of ischemic priapism. Ann Med Surg (Lond) 2022; 77:103696. [PMID: 35638068 PMCID: PMC9142696 DOI: 10.1016/j.amsu.2022.103696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
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Massenio P, D'Altilia N, Sanguedolce F, Carrieri G, Cormio L. Daily tadalafil for the chronic phase of stuttering priapism: a case report. BMC Urol 2018; 18:54. [PMID: 29855284 DOI: 10.1186/s12894-018-0368-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recurrent (stuttering) ischemic priapism is a challenging clinical condition. Frequent recurrences result in frequent hospital admissions whereas treatment with a shunting procedure often results in erectile dysfunction. Case presentation A 22-year-old man with stuttering idiopathic priapism developed erectile dysfunction (IIEF-5 score 12) following a Winter’s shunt; he was given tadalafil, 5 mg/daily, for 6 months. This treatment resulted in progressive restoration of erectile function in the 6 months following the shunt as well as in preventing recurrence of priapic episodes over a 24-month follow-up. Conclusions This is the first report in literature of chronic treatment of stuttering priapism with a phosphodiesterase-5 inhibitor being able not only to prevent recurrent priapic episodes but also to restore erectile function following a Winter’s shunt.
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Ahmed M, Augustine B, Matthew M, Awaisu M, Sudi A, Hamza KB, Bello A, Maitama HY. Prognostic Factors and Outcome of Management of Ischemic Priapism in Zaria, Nigeria. Niger J Surg 2017; 23:15-19. [PMID: 28584506 PMCID: PMC5441210 DOI: 10.4103/1117-6806.199965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine the nuances of management, prognostic factors, and outcome of ischemic priapism in patients seen at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. PATIENTS AND METHODS We retrospectively studied the case notes of all patients managed for ischemic priapism in the Ahmadu Bello University Teaching Hospital, Zaria, over a period of 10 years (2006-2015). The data extracted included patients' age, occupation, duration of painful penile erection, and previous episodes. Addition information including precipitating factors, hemoglobin genotype, treatment, and complications was also retrieved. Data obtained were analyzed using SPSS version 20. RESULTS The records of a total of forty patients managed for priapism over the period under review were retrieved. Thirty-three (82.5%) of these patients had an operative intervention. The mean age was 23.7 years with a range of 8-53 years. Sixty percent of patients were young adults in their third decade of life. The minimum duration of erection at presentation was 18 h and a maximum period of 10 days with a mean of 105.5 h (4 days). Thirty-three patients (82.5%) had sickle cell anemia (HbSS). Erectile dysfunction (ED) accounted for 60% of all forms of postpriapism complications. Five patients (12.5%) had residual tumescence from fibrosis, and three patients had recurrence outside the immediate postoperative period. Duration of symptoms before surgical intervention, SSA and previous episodes were the most important prognostic factors. CONCLUSION Priapism is a disease of the young, mostly sickle cell anemic patients. Late presentation remains the norm in our environment, hence a higher incidence of ED. The distal penile shunt is an effective means of achieving detumescence even with failed conservative management. Favorable outcome is highly dependent on the duration of erection and early intervention.
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Affiliation(s)
- Muhammed Ahmed
- Department of Surgery, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Benjamin Augustine
- Department of Haematology and Blood Transfusion, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Messi Matthew
- Department of Surgery, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Mudi Awaisu
- Department of Surgery, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Abdullahi Sudi
- Department of Surgery, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Kolapo B Hamza
- Department of Surgery, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Ahmad Bello
- Department of Surgery, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Hussaini Yusuf Maitama
- Department of Surgery, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
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Venkatesan S, Purohit A, Aggarwal M, Singh PK, Seth T, Pati HP. Priapism Associated with Homozygous Hb E State: A Causal Association or an Incidental Finding? Indian J Hematol Blood Transfus 2016; 32:301-303. [DOI: 10.1007/s12288-014-0459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022] Open
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Abstract
Introduction: Priapism has a devastating consequence on the sexual function of men if not promptly managed. We are presenting our experience of the treatment of priapism and the status of sexual function even following successful detumescence achieved after treatment. Materials and Methods: Nineteen patients, who presented with priapism from January 2012 to December 2014, were included in the study. After obtaining a detailed history; color Doppler ultrasonography of penis and blood gas analysis of the initial corporal aspirate were done to ascertain the type of priapism. Standard protocol in our institute for management of priaprism was to start with conservative treatment by corporal aspiration and intracorporeal injection (ICI) of phenylephrine. On the failure of conservative management, distal shunts were performed. Proximal shunts were performed on the failure of distal shunt procedures. Erectile function was evaluated with International Index of Erectile Function-5 questionnaire on admission and during follow-up. Results: All the patients had ischemic type priapism. Age of the patients ranged from 22 to 55 years. Duration of priapism varied from 20 to 480 h (mean 96.7). Etiologies attributed were; over-the-counter sildenafil use, chlorpromazine, opium intake and intracorporeal papaverine injection, chronic myeloid leukemia, and idiopathic. Five patients had preserved erectile function during follow-up. Preservation of normal erectile function following aspiration and ICI, proximal and distal shunt procedures were 66.7%, 18.1% and 20%, respectively. Conclusion: Patients with late presentation and those patients requiring higher treatment modalities (e.g., proximal shunts) for achieving detumescence will subsequently have a poor erectile function. These patients should be counseled about the early penile prosthesis placement during initial surgical management.
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Affiliation(s)
- Dilip Kumar Pal
- Department of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Deepak Kumar Biswal
- Department of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Bastab Ghosh
- Department of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Zacharakis E, De Luca F, Raheem AA, Garaffa G, Christopher N, Muneer A, Ralph DJ. Early insertion of a malleable penile prosthesis in ischaemic priapism allows later upsizing of the cylinders. Scand J Urol 2015; 49:468-471. [PMID: 26116193 DOI: 10.3109/21681805.2015.1059359] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Early insertion of a penile prosthesis in prolonged ischaemic priapism is easier to perform than late prosthesis placement, and preserves the penile length. The aim of this study was to assess whether a delayed exchange to an inflatable implant allows upsizing of the cylinders in patients who have undergone early insertion for refractory ischaemic priapism. MATERIALS AND METHODS Over a 30 month period, 10 patients with ischaemic priapism underwent an early insertion of a malleable penile prosthesis. The mean age was 41.3 years and the mean duration of priapism was 188 h. Following a median period of 130.5 days, all of these patients underwent exchange of the malleable to an inflatable prosthesis. RESULTS At the time of penile implant exchange, a median upsize in the length of the cylinders of 1 cm in either one or both corporal bodies (range 0-3 cm) was recorded. Five patients had deliberate downsizing at the initial operation owing to a previous shunt. The mean score on the five-item International Index of Erectile Function (IIEF-5) before insertion of the malleable prosthesis was 24 (range 20-25). Three months after the initial insertion of a malleable penile implant the satisfaction rate according to the IIEF-5 score was 80%. Three months after the exchange, the patient satisfaction rate increased to 90%. CONCLUSION Insertion of a malleable penile prosthesis is an acceptable option for patients with refractory ischaemic priapism. Although some patients deliberately have a shorter implant inserted initially owing to a previous distal shunt procedure, following a period of resolution the cylinders can be upsized at a later operation.
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Affiliation(s)
- Evangelos Zacharakis
- a 1 Department of Urology, Guy's Hospital, King's College London , London, UK.,b 2 Department of Urology, University College London Hospitals , London, UK
| | - Francesco De Luca
- a 1 Department of Urology, Guy's Hospital, King's College London , London, UK.,b 2 Department of Urology, University College London Hospitals , London, UK
| | - Amr Abdul Raheem
- b 2 Department of Urology, University College London Hospitals , London, UK
| | - Giulio Garaffa
- b 2 Department of Urology, University College London Hospitals , London, UK
| | - Nim Christopher
- b 2 Department of Urology, University College London Hospitals , London, UK
| | - Asif Muneer
- b 2 Department of Urology, University College London Hospitals , London, UK
| | - David J Ralph
- b 2 Department of Urology, University College London Hospitals , London, UK
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Lee C, Su B, Kuo H. The dreadful and the deadly erection—Malignant priapism from renal cell carcinoma. Urological Science 2014; 25:152-154. [DOI: 10.1016/j.urols.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Erdemir F, Firat F, Markoc F, Atilgan D, Parlaktas BS, Kuyucu YE, Gencten Y. The effect of pentoxifylline on penile cavernosal tissues in ischemic priapism-induced rat model. Int Urol Nephrol 2014; 46:1961-7. [PMID: 25027804 DOI: 10.1007/s11255-014-0769-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Priapism is defined as persisting (>4 h), painful and abnormal tumescence that can occur without sexual stimulation. Three subtypes priapisms are seen-the non-ischemic priapism, intermittent and the ischemic priapism. In ischemic priapism, there is an abnormality in the veno-occlusive mechanism, resulting in venous stasis and accumulation of deoxygenated blood within the penile cavernosal tissue. Cavernosal tissue necrosis develops after extended period of ischemia and is eventually replaced by fibrotic tissue. It may results in erectile dysfunction if not treated promptly. Although, standard treatment of the ischemic priapism is penile aspiration and intracavernosal alpha-adrenergic agents, new oral agents have been investigated to reduce the cavernosal damage. In this study, the effect of different doses of pentoxifylline on cavernosal tissues was evaluated. MATERIALS AND METHODS Thirty-six male Wistar albino rats, age 5.5-6 months and weighing 250-300 g, were used in this study. The rats were randomly divided into five groups. In Group 1 (n = 7), the control group, only penectomy was performed. In Group 2 (n = 8), after 1 h of ischemic priapism, penectomy was performed. Group 3 (n = 7) received daily a 10 mg oral pentoxifylline for 4 weeks after 1 h of ischemic priapism, group 4 (n = 7) received a daily 30 mg oral pentoxifylline for 4 weeks after 1 h of ischemic priapism, and group 5 (n = 7) received a daily 100 mg oral pentoxifylline for 4 weeks after 1 h of ischemic priapism. At the completion of a 4-week period, penile tissues were obtained. Before penile tissues were obtained, intracavernosal pressures measured with electrical field stimulation and smooth muscle collagen ratio were evaluated pathologically. RESULTS Electrical field stimulation-induced intracavernosal relaxation decreased in group 2 compared with group 1 (p < 0.05). Electrical field stimulation-induced relaxation enhanced in the group 3, 4 and 5 compared to group 2 (p < 0.05). In group 2, the collagen density was significantly higher than group 1. Administration of pentoxifylline reduced the collagen density caused by ischemic priapism in groups 3, 4 and 5 compared with group 2. CONCLUSION The results of the present study showed that ischemic priapism caused damage in the penile tissues of rats, and treatment with pentoxifylline reduced the harmful effects of ischemic priapism.
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Zacharakis E, Raheem AA, Freeman A, Skolarikos A, Garaffa G, Christopher AN, Muneer A, Ralph DJ. The efficacy of the T-shunt procedure and intracavernous tunneling (snake maneuver) for refractory ischemic priapism. J Urol 2013; 191:164-8. [PMID: 23892191 DOI: 10.1016/j.juro.2013.07.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE The current management of ischemic priapism that is refractory to conventional medical therapy is a form of shunt procedure that diverts blood away from the corpus cavernosum. We assessed the outcome of the T-shunt and intracavernous tunneling for the management of ischemic priapism. MATERIALS AND METHODS During a 36-month period 45 patients presented with prolonged ischemic priapism. Patients were divided into subgroups according to the duration of priapism. All patients had an unsuccessful primary treatment, and underwent a T-shunt and intracavernous tunneling with cavernous muscle biopsies. All patients completed an IIEF-5 (International Index of Erectile Function-5) questionnaire preoperatively and 6 months postoperatively. RESULTS Resolution of the priapism using a T-shunt and snake maneuver occurred in all patients with a priapism duration of less than 24 hours and in only 30% of those with priapism lasting more than 48 hours. After a 6-month median followup the IIEF-5 score was significantly reduced from a mean of 24 (range 23 to 25) preoperatively to 7.7 (range 5 to 24), which was related to the duration of the priapism (p <0.0005). All patients with priapism for more than 48 hours had necrotic cavernous smooth muscle on biopsy and had severe erectile dysfunction requiring the insertion of a penile prosthesis. Those patients with moderate and mild erectile dysfunction were treated with phosphodiesterase type 5 inhibitors. CONCLUSIONS The success of the T-shunt with snake tunneling is dependent on the duration of priapism. When it is less than 24 hours the results are favorable, although erectile dysfunction is still present in 50% of patients. In those with a priapism duration greater than 48 hours the technique usually fails to resolve the priapism and all patients end up with erectile dysfunction due to smooth muscle necrosis.
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Affiliation(s)
- Evangelos Zacharakis
- Institute of Urology, University College Hospital London, London, United Kingdom; 2nd Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Amr Abdel Raheem
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - Alex Freeman
- Histopathology Department, University College Hospital London, London, United Kingdom
| | - Andreas Skolarikos
- 2nd Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Giulio Garaffa
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - Andrew N Christopher
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - Asif Muneer
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - David J Ralph
- Institute of Urology, University College Hospital London, London, United Kingdom.
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Zahran AR, Abdel Daiem H, Youssif M. Does pentoxifylline enhance the recovery of erectile function after a T-shunt procedure for prolonged ischaemic priapism? A prospective randomised controlled trial. Arab J Urol 2012; 10:425-8. [PMID: 26558062 PMCID: PMC4442918 DOI: 10.1016/j.aju.2012.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/02/2012] [Accepted: 05/05/2012] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the role of oral pentoxifylline for enhancing the recovery of erectile function (EF) in patients who had a T-shunt, a technically simple procedure for treating prolonged ischaemic priapism, as the recovery of EF has been reported in many patients treated by this procedure. Patients and methods This prospective randomised study was conducted on 40 patients with prolonged ischaemic priapism treated with a T-shunt. Patients were randomly divided into two groups; group A received oral pentoxifylline from the second day after surgery for 3 months, and group B received placebo. Patients were followed for 18 months. Results The pain resolved in all patients, and EF recovered in 15 patients in group A and 10 in group B within 3 months. All patients but three had recovery of EF within the 18-month follow-up. Six patients had recovery of EF by using on-demand 50 mg sildenafil. The three patients who did not recover EF had a penile prosthesis implanted after the end of the study. Conclusion Pentoxifylline had no significant effect on the recovery of EF after a T-shunt procedure, but a larger study (double-blinded) is required for a more accurate assessment of any beneficial effect of pentoxifylline after a T-shunt procedure.
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Affiliation(s)
| | | | - Mohamed Youssif
- Department of Urology, Alexandria University, Alexandria, Egypt
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Sinkeviciute I, Kroken RA, Johnsen E. Priapism in antipsychotic drug use: a rare but important side effect. Case Rep Psychiatry 2012; 2012:496364. [PMID: 22934218 DOI: 10.1155/2012/496364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 04/16/2012] [Indexed: 11/25/2022] Open
Abstract
Priapism is a rare but important side effect of antipsychotic drugs which may evolve into a urological emergency. Most antipsychotic drugs are alpha-1 adrenergic antagonists, which is thought to be the principal mechanism involved in antipsychotic-induced priapism. Other aetiologies exist, however. A case is presented with multiple episodes of priapism during the use of several different antipsychotic drugs. The case is representative of many patients treated with antipsychotic drugs, as there were hyperprolactinemia, and illicit drug use, which are known causes of priapism. Moreover, the patient used combinations of antipsychotic drugs. The case thus illustrates the etiological complexity which could delay a diagnosis of antipsychotic-induced priapism, and the problem of establishing a link between priapism and one particular ingredient of a drug combination. The case presents how a treatment regimen was finally established balancing antipsychotic efficacy to acceptable side effects and offers guidance to physicians regarding how antipsychotic-induced priapism may be resolved.
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Teichgräber UK, De Bucourt M. Chronic post-traumatic high-flow priapism treated with temporary gelatin sponge embolization. Acta Radiol Short Rep 2012; 1:10.1258_arsr.2012.120028. [PMID: 23986838 PMCID: PMC3738347 DOI: 10.1258/arsr.2012.120028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 04/18/2012] [Indexed: 12/03/2022] Open
Abstract
We report the case of a 26-year-old man who presented with a non-painful priapism with a history of 3 months permanent erection after suffering a perineal trauma. An arteriocorporal fistula with a turbulent flow between the right cavernosal artery and the corpus cavernosum, conclusive for a high-flow priapism was initially detected by colour Doppler ultrasound. A superselective embolization with Gelatin sponge was safe and effective to treat the high-flow priapism. The use of gelatin sponge resulted in a temporary embolization with long-term effect of penile detumescence and preservation of erectile function.
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Affiliation(s)
- Ulf Km Teichgräber
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin
- Department of Radiology, University Hospital Jena, Freidrich-Schiller-University Jena, Jena, Germany
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Abstract
PURPOSE Refractory ischemic priapism results in cavernous smooth muscle necrosis, fibrosis and eventual penile shortening. Immediate penile implant insertion for acute ischemic priapism is done to avoid consequent fibrosis and shortening but ineffective shunt surgery trials may lead to potential weakness and erosion at the corporeal tip. We evaluate nonabsorbable sling sutures to fix the implant cylinder in place and prevent protrusion through the weak corporeal tip. MATERIALS AND METHODS We prospectively evaluated 12 men who presented with prolonged refractory ischemic priapism a median of 120 hours (range 60 to 168) in duration. All patients were unresponsive to conventional treatment and 11 had undergone unsuccessful shunt surgery. Early malleable penile prosthesis implantation had been done in all cases. To avoid possible distal protrusion a nonabsorbable sling suture was taken through the cylinder and the edges of the opened tunicae albuginea to fix the cylinder to the corporotomy edges. RESULTS Penile implants were successfully inserted in all patients. No intraoperative or early postoperative complications were noted except in 1 with sickle cell priapism, in whom dilation led to unilateral corporeal perforation, which was managed intraoperatively. All patients were satisfied with the surgical results. No distal erosion was noted through the weak corporeal tip. No postoperative infection was reported at a median followup of 15 months (range 6 to 36). All patients successfully achieved sexual intercourse. CONCLUSIONS Early penile prosthesis insertion for acute ischemic priapism is simple and successful. Distal cylinder protrusion through the defective corpora due to previous shunt surgery remains to confound surgical success. Nonabsorbable sling suture of the cylinder to the tunica albuginea is effective, simple and safe treatment for this formidable complication.
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Affiliation(s)
- Emad A Salem
- Urology and Dermatology (OEA) Departments, Zagazig University, Zagazig, Egypt.
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Brant WO, Garcia MM, Bella AJ, Chi T, Lue TF. T-Shaped Shunt and Intracavernous Tunneling for Prolonged Ischemic Priapism. J Urol 2009; 181:1699-705. [DOI: 10.1016/j.juro.2008.12.021] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Tom Chi
- University of California, San Francisco, San Francisco, California
| | - Tom F. Lue
- University of California, San Francisco, San Francisco, California
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Abstract
Priapism is a rare disorder defined as a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation. There are two types of priapism; ischemic low-flow type or non-ischemic high flow, with differing etiologies. Priapism associated with thrombophilia is a well-recognized entity. However, the pathogenesis of this association is not fully understood. We report a rare case of recurrent (stuttering) priapism in a patient with protein C deficiency while maintained on Warfarin therapy. This therapy was also complicated by Warfarin-induced skin necrosis.
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Affiliation(s)
- R A H Abu Sham'a
- Department of Internal Medicine and Cardiology, Makassed Hospital, Jerusalem, Israel.
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Hekal IA, Meuleman EJ. Idiopathic low-flow priapism in prepuberty: a case report and a review of literature. Adv Urol 2008;:549861. [PMID: 18827893 DOI: 10.1155/2008/549861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 08/02/2008] [Accepted: 08/30/2008] [Indexed: 11/30/2022] Open
Abstract
Introduction. The incidence of priapism in adults is higher than in children. Although approximately 50% of all episodes of priapism are thought to be idiopathic, there are a number of known specific causes of this disorder. In adults intracavernous therapy with papaverine, phentolamine, alprostadil or combinations of these agents is the most common cause of ischemic priapism. In children the most common etiology is sickle cell anemia for low-flow priapism or post-traumatic high-flow priapism. We present a 13-year-old boy, not sexually active presented to our outpatient clinic suffering from long standing (3.5 hours) sustained painful erection. To the best of our knowledge the idiopathic low-flow priapism in pre-pubertal boy was not reported before in literature. Our case is the first case to be reported in pre-pubertal age.
Conclusion. In pre-pubertal boys idiopathic recurrent priapism is a rare condition. In the literature, several empirical therapies are described. Recently, it is postulated that a low dose of a PDE5 inhibitor. The early conservative management is the best treatment option to safe the corporeal smooth muscles from irreversible damage.
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Stein RJ, Patel AS, Benoit RM. Treatment of postpriapism erectile dysfunction by closure of persistent distal glans-cavernosum fistulas 5 years after shunt creation. Urology 2005; 65:592. [PMID: 15780394 DOI: 10.1016/j.urology.2004.09.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Accepted: 09/20/2004] [Indexed: 11/18/2022]
Abstract
Erectile dysfunction is common after the formation of a glans-cavernosum shunt for intractable priapism. Often patients require placement of a penile prosthesis to restore sexual function. We report a case of restoration of full erections after reversal of a glans-cavernosum shunt in a 30-year-old man who had been treated for priapism 5 years previously. On the basis of our experience, it seems reasonable to attempt shunt reversal for correction of erectile dysfunction in selected patients who likely have a persistent vascular fistula.
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Affiliation(s)
- Robert J Stein
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Abstract
Priapism is a fairly uncommon presentation to the Emergency Department, but when it does present, it represents a true urologic emergency. Prompt treatment will decrease the risk of permanent sequelae including impotence. Treatment should be based on etiology and follow an organized approach. Various cases will arise when conservative management will not remedy the priapism and more aggressive measures will be needed, particularly if emergent urological consultation is not available. This article reviews the causes of priapism and systematically reviews techniques and procedures used to manage and treat priapism.
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Affiliation(s)
- Gary M Vilke
- Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California 92103, USA
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Abstract
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.
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Affiliation(s)
- Hossein Sadeghi-Nejad
- Division of Ultrasound, Department of Radiology, Case Western Reserve University, University Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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