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Dursun M, Kalkanlı A, Tantekin SA, Sevinç AH, Kaçan T, Ercan CC, Kadıoğlu A. The role of the urologist in managing high flow priapism. Int J Impot Res 2025:10.1038/s41443-025-01017-6. [PMID: 39910241 DOI: 10.1038/s41443-025-01017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/02/2025] [Accepted: 01/17/2025] [Indexed: 02/07/2025]
Abstract
High-flow priapism (arterial) is a prolonged erection caused by irregular cavernous arterial flow, often resulting from blunt perineal or penile trauma, or iatrogenic needle injury. This condition leads to the formation of an arteriolacunar fistula, causing unregulated arterial blood flow into the sinusoidal spaces of the penis. Unlike low-flow priapism, high-flow priapism typically presents with a partially erect, non-painful penis. The diagnosis is confirmed through characteristic findings on color Doppler ultrasound, which reveals turbulent high-velocity flow pinpointing the fistula's location. Blood gas analysis typically reflects arterial values, helping to differentiate high-flow priapism from its low-flow counterpart. Although high-flow priapism was historically considered non-urgent, recent evidence suggests that delayed treatment may increase the risk of erectile dysfunction. Therefore, prompt intervention by urologists is crucial. The primary goal is to close the fistula, and the treatment plan should be individualized based on the severity and duration of the condition. Urologists play a critical role in managing this condition, offering a range of therapeutic options. These include conservative approaches, such as observation and compression, medical therapy, arterial embolization, and, in some cases, surgical intervention. The choice of treatment depends on the patient's condition, the fistula's location, and the resources available. By ensuring timely and appropriate management, urologists can minimize complications and preserve erectile function.
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Affiliation(s)
- Murat Dursun
- Istanbul University, Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey
| | - Arif Kalkanlı
- Taksim Training and Research Hospital, Department of Urology, Istanbul, Turkey
| | | | - Ahmet Halil Sevinç
- Istanbul University, Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey
| | - Turgay Kaçan
- Istanbul University, Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey
| | - Celal Caner Ercan
- Istanbul University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Ateş Kadıoğlu
- Istanbul University, Faculty of Medicine, Department of Urology, Section of Andrology, Istanbul, Turkey.
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Uzair M, Waheed T, Imran M, Ali S, Ali A, Habib M. Priapism in children: an experience of the modified Winter procedure. Int Urol Nephrol 2023; 55:3015-3020. [PMID: 37542596 DOI: 10.1007/s11255-023-03728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Priapism in children is a rare disease, which seldom presents during the pediatric surgery practice. It is, however, a surgical and urological emergency. Early diagnosis and prompt management can prevent the devastating sequelae of this potentially fatal condition. MATERIALS AND METHODS A prospective study was conducted between March 1st, 2007 and February 28th, 2019 at the Department of Pediatric Surgery, Khyber Teaching hospital, Peshawar. All the patients between 3 and 15 years of age, with the diagnosis of priapism, were enrolled in the study with ethical approval. RESULTS A total of ten patients were enrolled in the study period from March 1st, 2007 to February 28th, 2019. The age ranged between 3 and 15 years and the mean age of presentation was 8 years. The mean duration of symptoms was 4 h. The mean hospital stay was 4 days. The modified Winter procedure by creating a corporoglanular shunt was performed in all cases. Successful detumescence was achieved in eight patients, while two patients needed further detumescence and manual evacuation. Symptomatic relief was achieved in all the children. CONCLUSION Priparism in children is a rare urological emergency that can lead to permanent erectile dysfunction if prompt medical intervention is not done. The modified Winter procedure technically is a less invasive procedure to achieve satisfactory clinical outcome in terms of achieving good erectile functions.
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Affiliation(s)
- Muhammad Uzair
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Tariq Waheed
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Muhammad Imran
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Sajjad Ali
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Amjad Ali
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Murad Habib
- Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
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Carnicelli D, Bondil P, Habold D. Priapisme veineux aigu aux urgences : procédure fondée sur une revue systématique de la littérature. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le priapisme veineux aigu (PVA) est urgent en raison de séquelles érectiles éventuelles. Sa rareté et l’absence de procédure expliquent des traitements encore inégaux, peu normés.
Objectif : Optimiser la prise en charge initiale d’un PVA grâce à une procédure décisionnelle, adaptée aux urgentistes.
Matériel et méthode : Une revue systématique de la littérature recense les algorithmes schématisés ainsi que des articles de revue et mises au point récents. Les critères diagnostiques et thérapeutiques ont été analysés puis comparés pour vérifier s’ils répondaient aux besoins. La validation de cette procédure par des experts a été recherchée. Résultats : L’originalité de notre procédure réside dans sa cible (urgentistes), sa hiérarchisation, « Que faire ? Comment faire ? Quand faire ? Qui fait ? », de façon graduée et séquentielle via une chronologie détaillée, et une priorité donnée à la gazométrie caverneuse, fil conducteur de la prise en charge, facilement disponible. À cela s’ajoutent des tableaux, des check-lists (contexte étiologique et souffrance ischémique), des schémas descriptifs des traitements médicaux indiqués en première ligne (technique, matériel de ponction décompressive et d’injection intracaverneuse d’alpha-stimulant), critères de recours à l’urologue, suivi et hospitalisation. Cette procédure a été validée par le conseil scientifique du réseau nord-alpin des Urgences, le comité d’andrologie et médecine sexuelle de l’Association française d’urologie.
Conclusion : Facile à utiliser, cette procédure inédite répond à un réel besoin. Son appropriation et sa diffusion s’inscrivent dans une démarche qualité adaptée au parcours de soins du PVA en France afin de prévenir les séquelles érectiles de cette urgence affectant majoritairement des sujets jeunes.
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Ingram AR, Stillings SA, Jenkins LC. An Update on Non-Ischemic Priapism. Sex Med Rev 2019; 8:140-149. [PMID: 30987934 DOI: 10.1016/j.sxmr.2019.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/28/2019] [Accepted: 03/09/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Non-ischemic or high-flow priapism is derived from unregulated arterial inflow within the penis, which is significantly less common and, therefore, less well characterized than ischemic or low-flow priapism. AIM We collected the most recent available data and summarized the findings. METHODS All literature related to non-ischemic priapism from 2000-2018 from several databases was reviewed, and 105 articles, including any relevant referenced articles, were ultimately included. MAIN OUTCOME METHODS We evaluated modality success rates, need for repeat procedures, and effects on erectile function. RESULTS 237 cases of non-ischemic priapism were evaluated. Approximately 27% of patients underwent observation or medical management as the first treatment modality, whereas 73% underwent intervention without observation or medical management beforehand. Angiographic embolization with temporary agents was the most common intervention and generally resulted in both moderate resolution of non-ischemic priapism and moderate preservation of baseline erectile function. Patients who underwent embolization with permanent agents experienced higher rates of resolution, as well as lower rates of erectile dysfunction (ED). CONCLUSION Most of the literature is in the form of case reports and small case series, thus limiting the quality and quantity of evidence available to draw decisive conclusions. However, from the available data, it is reasonable to presume that patients can undergo a trial of conservative management, then pursue embolization first with temporary agents. The analysis of the data demonstrated ED rates were higher with temporary agents than permanent agents. The literature quotes ED rates as low as 5% when using temporary agents and 39% with permanent agents. Our results were, in fact, the opposite, with higher ED rates when using temporary agents vs permanent (17-33% vs 8-17%). Further studies are required to better characterize the success and outcomes of angioembolization. Ingram AR, Stillings SA, Jenkins LC. An Update on Non-Ischemic Priapism. Sex Med Rev 2020;8:140-149.
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Affiliation(s)
- Amanda R Ingram
- The Ohio State University Department of Urology, Columbus, Oho, USA
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Neto FTL, Bach PV, Lyra RJL, Borges Junior JC, Maia GTDS, Araujo LCN, Lima SVC. Gods associated with male fertility and virility. Andrology 2019; 7:267-272. [PMID: 30786174 DOI: 10.1111/andr.12599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/12/2019] [Accepted: 01/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human fertility has always been a topic of curiosity and devotion. Many cultures consider fertility to be a necessity for the survival and perpetuation of mankind and since early times, myths were created to explain this fabulous process. Fertility gods were ubiquitous in numerous ancient human cultures and were used both to understand fertility and to cope with infertility by means of rituals and offerings. OBJECTIVES This manuscript aims to catalog and describe the deities associated with male fertility and virility. MATERIAL AND METHODS We conducted a comprehensive search for the terms "male fertility god" and "male virility god" on the internet using web-based search engines. Based on the information retrieved, we selected those deities directed related to male fertility and/or virility and further deepened the search using Pubmed and Medline databases for peer-reviewed articles as well as books and articles about ancient mythology. RESULTS We identified several gods linked to male fertility and virility in various cultures from Egypt, Greece, Rome, India, Southwestern United States, France, Colombia and Buthan.. DISCUSSION Most of these deities were depicted with an erect phallus and with other fertility symbols like snakes. Some deities were also associated with plants and/or animal fertility and their festivals were often held during the harvest period. CONCLUSION Gods of male fertility and virility played important roles in many ancient cultures. Offerings and rituals to these gods were the only available options to deal with problems of reproduction and demonstrate the lengths to which ancient people would go seeking cures for infertility.
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Affiliation(s)
- F T L Neto
- Andros Recife, Recife, Brazil.,Departamento de Cirurgia, Universidade Federal de Pernambuco, Recife, Brazil
| | - P V Bach
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | | | | | - G T D S Maia
- Departamento de Cirurgia, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - S V C Lima
- Departamento de Cirurgia, Universidade Federal de Pernambuco, Recife, Brazil
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Fanni C, Marcialis MA, Pintus MC, Loddo C, Fanos V. The first case of neonatal priapism during hypothermia for hypoxic-ischemic encephalopathy and a literature review. Ital J Pediatr 2018; 44:85. [PMID: 30053817 PMCID: PMC6063002 DOI: 10.1186/s13052-018-0514-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/21/2018] [Indexed: 11/29/2022] Open
Abstract
Neonatal priapism is a rare condition with only 26 described cases in literature since 1879. It is defined as a persistent penile erection occurring in the first 28 days of life, lasting at least 4 h that usually happens in the first days (from 2 to 12 days). It is a very different condition compared to the adult one because in newborns it is a relatively benign phenomenon. As a result of this paucity of described cases, classification and management are not well known by most of neonatologists and currently there are no established guidelines for its management. Most cases are idiopathic but other aetiologies are possible (polycythemia, blood transfusion and drugs). We describe our only case, which occurred during hypothermia therapy and review the literature to clarify the best choice in management of this rare entity.
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Affiliation(s)
- Claudia Fanni
- Department of Surgical Science, University of Cagliari and Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, I-09042, Italy
| | - Maria Antonietta Marcialis
- Department of Surgical Science, University of Cagliari and Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, I-09042, Italy
| | - Maria Cristina Pintus
- Department of Surgical Science, University of Cagliari and Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, I-09042, Italy
| | - Cristina Loddo
- Department of Surgical Science, University of Cagliari and Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, I-09042, Italy
| | - Vassilios Fanos
- Department of Surgical Science, University of Cagliari and Neonatal Intensive Care Unit, Puericulture Institute and Neonatal Section, Azienda Ospedaliera Universitaria, Cagliari, I-09042, Italy.
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Yücel ÖB, Pazır Y, Kadıoğlu A. Penile Prosthesis Implantation in Priapism. Sex Med Rev 2018; 6:310-318. [PMID: 28916463 DOI: 10.1016/j.sxmr.2017.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/28/2017] [Accepted: 08/06/2017] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Priapism is defined as a full or partial erection lasting longer than 4 hours after sexual stimulation and orgasm or unrelated to sexual stimulation. The main goal of priapism management is to resolve the episode immediately to preserve erectile function and penile length. Corporal smooth muscle necrosis is likely to have already occurred, and medically refractory erectile dysfunction is expected in patients with a protracted episode. Penile prosthesis implantation (PPI) in the early or late phase of priapism can restore erectile function. AIM To review the literature on PPI in priapism. METHODS A PubMed search of all English-language articles published before 2017 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using the following search terms: penile prosthesis implantation, priapism, and corporal fibrosis. All publications reporting on PPI during or after priapism episodes were included for review. MAIN OUTCOME MEASURES Three types of priapism were reviewed for management using PPI. Surgical techniques, outcomes, and patient satisfaction were reported. RESULTS Early implantation (during the episode) is technically easier and has lower complication rates compared with delayed (electively, after the erectile dysfunction is observed) surgery. Immediate PPI also allows preservation of penile length, which is related to higher satisfaction rates. CONCLUSIONS The paradigm is shifting toward immediate PPI in the management of ischemic priapism. Patients with non-ischemic priapism or recurrent priapism, even without a major ischemic episode, are at high risk for erectile dysfunction and are candidates for PPI. Yücel ÖB, Pazır Y, Kadıoğlu A. Penile Prosthesis Implantation in Priapism. Sex Med Rev 2018;6:310-318.
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Affiliation(s)
- Ömer Barış Yücel
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yaşar Pazır
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ateş Kadıoğlu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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