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Aleixo CD, Erxleben C, Baysal E, Leibling F, de Bucourt M, Gebauer B, Lenk J. Unilateral embolization of an arterio-cavernous fistula in the treatment of post-traumatic non-ischemic-priapism: permanent coiling after immediate temporary agent failure. CVIR Endovasc 2025; 8:34. [PMID: 40268811 PMCID: PMC12018654 DOI: 10.1186/s42155-025-00547-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2025] [Accepted: 04/07/2025] [Indexed: 04/25/2025] Open
Abstract
A healthy 24-year-old male patient presented with a history of straddle-trauma from a bicycle accident and concomitant non-ischemic-priapism lasting for ten days. On a contrast-enhanced computed tomography scan an arterio-cavernous fistula establishing a connection between the right cavernosal artery and the ipsilateral corpus cavernosum was diagnosed. Super-selective unilateral arterial embolization was performed using gelatin sponge and microcoils. Technical success became evident with the consecutive detumescence of the penis and long-term preservation of baseline urogenital functions.
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Affiliation(s)
- Carolina Dominguez Aleixo
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Christoph Erxleben
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Emre Baysal
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | | | - Maximilian de Bucourt
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Bernhard Gebauer
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Julian Lenk
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
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2
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Bretzman JP, Ziegelmann MJ, Reisenauer CJ. Selective penile artery angioembolization for high flow priapism - a step-by-step overview for the non-radiologist. J Sex Med 2025; 22:380-384. [PMID: 39916390 DOI: 10.1093/jsxmed/qdaf010] [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: 09/18/2024] [Revised: 01/09/2025] [Accepted: 01/21/2025] [Indexed: 04/12/2025]
Abstract
INTRODUCTION Selective angioembolization for high flow priapism (Step-by-step guide). AIM Describe the indications and techniques of angioembolization for high flow priapism. METHODS We outline patient selection, preparation, technique, outcomes, and potential complications of angioembolization for high flow priapism as supported by the literature. MAIN OUTCOME MEASURE The effectiveness of embolization for treating high flow priapism. RESULTS Transarterial embolization is minimally invasive, low risk, and effective method from managing high flow priapism. Success rates range from 70% to 87% depending on the type of agent used for embolization. Side effects include erectile dysfunction with a reported rate of 7%-19%. Complications may be mitigated by embolizing as selectively as possible and using temporary embolic agents. CONCLUSION Embolization is a safe and effective treatment for nonischemic, high flow priapism in patients who have not responded to conservative management.
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Affiliation(s)
- John P Bretzman
- Department of Radiology, Mayo Clinic, Rochester, MN, United States
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3
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Nurfajri DH, Dahril D. Outcome angioembolization in patient with high-flow priapism: A systematic review. Urol Ann 2025; 17:69-73. [PMID: 40352086 PMCID: PMC12063919 DOI: 10.4103/ua.ua_94_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 05/14/2025] Open
Abstract
High-flow priapism (HFP) is a rare disorder that causes prolonged, painless erections. Because it has the potential to permanently damage erectile function, HFP should be promptly treated to regain potency. The suggested therapies for nonischemic priapism include surgical ligation of the arteriocavernous fistulae or selective arterial embolization. However, extensive studies regarding angioembolization in priapismus patients are still lacking, while most of them were case reports, this article aimed to compile and reviewed the available studies regarding therapeutic angioembolization as the management modality of priapism. This systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists. We included 16 studies involving 52 patients in this review. Our review found that angioembolization had favorable rates of clinical symptom alleviation and favorable rates of erectile function improvement.
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Affiliation(s)
- Derri Hafa Nurfajri
- Department of Urology, Hasan Sadikin Academic Medical Center/Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Dahril Dahril
- Department of Surgery, Division of Urology, Faculty of Medicine, Syiah Kuala University, Zainoel Abidin General Hospital, Banda Aceh, Indonesia
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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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5
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Kubo T, Shibuya M, Miyazaki K, Tsuji Y, Nakata M, Kawabe A, Nakasone T, Sakai N, Okuno Y. Transcatheter Arterial Embolization for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Retrospective Study of 44 Patients. Cardiovasc Intervent Radiol 2024; 47:1348-1355. [PMID: 39191997 DOI: 10.1007/s00270-024-03842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE To investigate the preliminary treatment outcomes of transcatheter arterial embolization (TAE) for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS This retrospective study included patients with refractory CP/CPPS who underwent TAE between April 2022 and February 2023. All patients had persistent pelvic pain for at least 3 months, a total score of at least 15 on the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), and lacked evidence of infection. All procedures were performed by injecting imipenem/cilastatin sodium (IPM/CS) from bilateral prostatic arteries ± internal pudendal arteries. NIH-CPSI, pain numeric rating scale (NRS), and complications were evaluated at 1, 3, and 6 months after the initial TAE and at the final follow-up. RESULTS Out of 48 patients, 44 were included in this study, with four excluded because of loss of follow-up. No severe procedure-related complications were observed. Pretreatment and post-treatment evaluations at 1, 3, and 6 months after the initial TAE and at the final follow-up (mean 16.6 months) revealed a decrease in the mean NIH-CPSI scores from 27 ± 6 to 21 ± 8, 20 ± 9, 17 ± 9, and 18 ± 9, respectively (all P < 0.001). Pain NRS scores were also decreased from 7.0 ± 1.6 to 4.8 ± 2.5, 4.1 ± 2.6, 3.7 ± 2.4, and 3.4 ± 2.3, respectively (all P < 0.001). The proportions of clinical success, defined as a reduction of at least 6 points from baseline in the NIH-CPSI, at 6 months after TAE and at the final follow-up were 70 and 64%, respectively. CONCLUSIONS This study provides evidence of the feasibility of TAE using IPM/CS for CP/CPPS, suggesting both symptomatic improvement and safety.
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Affiliation(s)
- Takatoshi Kubo
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Masahiko Shibuya
- Department of Interventional Radiology, Okuno Clinic Kobe, B1 Fl, 1-2-1, Sannomiyacho, Chuo-Ku, Kobe City, Hyogo, 650-0021, Japan
| | - Koichi Miyazaki
- Department of Interventional Radiology, Okuno Clinic Osaka, 3Rd Fl Shinsaibashi Front Bldg., 3-5-11, Minamifunaba, Chuo-Ku, Osaka, 542-0081, Japan
| | - Yusuke Tsuji
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Masaya Nakata
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Atsuhiko Kawabe
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Takashi Nakasone
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Nobuaki Sakai
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Yuji Okuno
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan.
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Pozzi E, Velasquez DA, Varnum AA, Kava BR, Ramasamy R. Artificial Intelligence Modeling and Priapism. Curr Urol Rep 2024; 25:261-265. [PMID: 38886246 DOI: 10.1007/s11934-024-01221-9] [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] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE OF REVIEW This narrative review aims to outline the current available evidence, challenges, and future perspectives of Artificial Intelligence (AI) in the diagnosis and management of priapism, a condition marked by prolonged and often painful erections that presents unique diagnostic and therapeutic challenges. RECENT FINDINGS Recent advancements in AI offer promising solutions to face the challenges in diagnosing and treating priapism. AI models have demonstrated the potential to predict the need for surgical intervention and improve diagnostic accuracy. The integration of AI models into medical decision-making for priapism can also predict long-term consequences. AI is currently being implemented in urology to enhance diagnostics and treatment work-up for various conditions, including priapism. Traditional diagnostic approaches rely heavily on assessments based on history, leading to potential delays in treatment with possible long-term sequelae. To date, the role of AI in the management of priapism is understudied, yet to achieve dependable and effective models that can reliably assist physicians in making decisions regarding both diagnostic and treatment strategies.
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Affiliation(s)
- Edoardo Pozzi
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
- University Vita-Salute San Raffaele, Milan, Italy.
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - David A Velasquez
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alexandra Aponte Varnum
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Bruce R Kava
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
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7
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Lounici N, Maireche A, Cheifa A, Saadat MR, Sahbane S, Seddiki K. Interventional radiology: Diagnosis and treatment of post-traumatic nonischemic priapism: A case report. Radiol Case Rep 2024; 19:3533-3537. [PMID: 38948900 PMCID: PMC11214341 DOI: 10.1016/j.radcr.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 07/02/2024] Open
Abstract
Priapism is defined as a form of erectile dysfunction characterized by a prolonged and involuntary penile erection, either partial or complete, occurring without sexual stimulation and lasting for more than 4 hours. Its incidence is estimated to be 0.5-0.9 cases per 100,000 people per year. The most frequent form is ischemic priapism, results from paralysis of the cavernous smooth muscles, which are unable to contract, leading to the stagnation of hypoxic blood within the sinusoidal spaces. Characterized by a painful rigid and sustainable erection. Non-ischemic priapism constitutes a rare entity, unlike the former, this type is typically painless. It is caused by an excessive influx of blood into the penis without a concomitant increase in outgoing blood flow. Blunt trauma is the most commonly reported etiology. And finally, recurrent priapism is characterized by recurrent episodes of prolonged erection and can be challenging to treat, often requiring long-term management to prevent recurrences. We report a case of high-flow priapism in a 10-year old child, secondary to a cavernous arterial fistula following a straddle injury during sports activity. It was suspected clinically and confirmed by ultrasound-Doppler, then successfully treated radiologically with highly selective embolization, with very satisfactory postoperative outcomes.
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Affiliation(s)
- Nazim Lounici
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
| | - Ammar Maireche
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
| | | | | | - Souad Sahbane
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
| | - Karima Seddiki
- Central Military Hospital, Ain Naadja, 16205, Algiers, Algeria
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8
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Rosellen J, Hauptmann A, Wagenlehner F, Diemer T. [Priapism]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:566-572. [PMID: 38653788 DOI: 10.1007/s00120-024-02338-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/25/2024]
Abstract
Priapism is defined as penile erection lasting more than four hours that is unrelated to sexual arousal. Priapism is classified based on the oxygenation of the penile tissue into ischemic and non-ischemic subtypes. As the most common form, ischemic priapism is usually associated with pain and carries a significant risk of permanent loss of erectile function; thus, rapid intervention is necessary. Initial therapy consists of corporal aspiration and injection of sympathomimetic agents. If detumescence is not achieved, a cavernosal shunt is necessary. Non-ischemic priapism is less common than the ischemic type and is usually the result of perineal trauma. In this subtype, there is usually no pain and treatment is initially conservative. Recurrent (stuttering) priapism is a variant of the ischemic subtype, but is self-limiting and usually occurs during sleep with a duration of less than three to four hours. In the case of prolonged erection, therapy is analogous to that of the ischemic subtype.
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Affiliation(s)
- Jens Rosellen
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland.
| | - Arne Hauptmann
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland
| | - Florian Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland
| | - Thorsten Diemer
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland
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9
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Sawadogo H, Kambou HWM, Tougma WF, Zoundi AM, Coulibaly G, Kaboré FA. Arterial priapism in dengue: A case report and literature review. Urol Case Rep 2024; 53:102683. [PMID: 38404684 PMCID: PMC10884335 DOI: 10.1016/j.eucr.2024.102683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024] Open
Abstract
Arterial priapism, rare and often traumatic, is generally associated with cavernous arterial lesions. We report an unprecedented case in a 17-year-old adolescent, occurring spontaneously after severe dengue, expanding the understanding of this pathology. No similar association has been previously documented in the literature. The patient was successfully treated with conservative measures, and erections returned to normal. Dengue, by causing vascular leaks, could be a rare trigger for arterial priapism. Further studies are needed to elucidate these mechanisms and potential clinical implications.
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Affiliation(s)
- Hassami Sawadogo
- University Joseph KI-ZERBO, Training and Research Unit in Health Sciences, Yalgado OUEDRAOGO University Hospital Center, Department of Urology, Burkina Faso
| | - Harmony Wenpanga Morgane Kambou
- University Joseph KI-ZERBO, Training and Research Unit in Health Sciences, Yalgado OUEDRAOGO University Hospital Center, Department of Urology, Burkina Faso
| | - Wendkuni Félicien Tougma
- University Joseph KI-ZERBO, Training and Research Unit in Health Sciences, Yalgado OUEDRAOGO University Hospital Center, Department of Urology, Burkina Faso
| | - Abdoul Moumouni Zoundi
- University Joseph KI-ZERBO, Training and Research Unit in Health Sciences, Yalgado OUEDRAOGO University Hospital Center, Department of Urology, Burkina Faso
| | - Gérard Coulibaly
- University Joseph KI-ZERBO, Training and Research Unit in Health Sciences, Yalgado OUEDRAOGO University Hospital Center, Department of Urology, Burkina Faso
| | - Fasnéwindé Aristide Kaboré
- University Joseph KI-ZERBO, Training and Research Unit in Health Sciences, Yalgado OUEDRAOGO University Hospital Center, Department of Urology, Burkina Faso
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10
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Schreen W, Huch B, Vogele D, Zengerling F. [A bicycle fall with consequences]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:1309-1314. [PMID: 37816873 PMCID: PMC10700420 DOI: 10.1007/s00120-023-02202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/12/2023]
Affiliation(s)
- Wilhelm Schreen
- Klinik für Urologie- und Kinderurologie, Universitätsklinikum Ulm, Oberer Eselsberg 23, 89081, Ulm, Deutschland.
| | - B Huch
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Oberer Eselsberg 23, 89081, Ulm, Deutschland
| | - D Vogele
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Oberer Eselsberg 23, 89081, Ulm, Deutschland
| | - F Zengerling
- Klinik für Urologie- und Kinderurologie, Universitätsklinikum Ulm, Oberer Eselsberg 23, 89081, Ulm, Deutschland
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Suttorp M, Sembill S, Kalwak K, Metzler M, Millot F. Priapism at Diagnosis of Pediatric Chronic Myeloid Leukemia: Data Derived from a Large Cohort of Children and Teenagers and a Narrative Review on Priapism Management. J Clin Med 2023; 12:4776. [PMID: 37510891 PMCID: PMC10380995 DOI: 10.3390/jcm12144776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Pediatric chronic myeloid leukemia (CML) is a very rare malignancy (age-related incidence 0.1/100,000) typically presenting with leucocyte counts >100,000/µL. However, clinical signs of leukostasis are observed at diagnosis in only approximately 10% of all cases and among these, priapism is infrequent. Here, we analyze data from pediatric CML registries on the occurrence of priapism heralding diagnosis of CML in 16/491 (3.2%) boys (median age 13.5 years, range 4-18) with pediatric CML. In the cohort investigated, duration of priapism resulting in a diagnosis of CML was not reported in 5 patients, and in the remaining 11 patients, occurred as stuttering priapism over 3 months (n = 1), over 6 weeks (n = 1), over 1-2 weeks (n = 2), over several days (n = 2), or 24 h (n = 1), while the remaining 4 boys reported continuous erection lasting over 11-12 h. All patients exhibited splenomegaly and massive leukocytosis (median WBC 470,000/µL, range 236,700-899,000). Interventions to treat priapism were unknown in 5 patients, and in the remaining cohort, comprised intravenous fluids ± heparin (n = 2), penile puncture (n = 5) ± injection of sympathomimetics (n = 4) ± intracavernous shunt operation (n = 1) paralleled by leukocyte-reductive measures. Management without penile puncture by leukapheresis or exchange transfusion was performed in 3 boys. In total, 7 out 15 (47%) long-term survivors (median age 20 years, range 19-25) responded to a questionnaire. All had maintained full erectile function; however, 5/7 had presented with stuttering priapism while in the remaining 2 patients priapism had lasted <12 h until intervention. At its extreme, low-flow priapism lasting for longer than 24 h may result in partial or total impotence by erectile dysfunction. This physical disability can exert a large psychological impact on patients' lives. In a narrative review fashion, we analyzed the literature on priapism in boys with CML which is by categorization stuttering or persisting as mostly painful, ischemic (low-flow) priapism. Details on the pathophysiology are discussed on the background of the different blood rheology of hyperleukocytosis in acute and chronic leukemias. In addition to the data collected, instructive case vignettes demonstrate the diagnostic and treatment approaches and the outcome of boys presenting with priapism. An algorithm for management of priapism in a stepwise fashion is presented. All approaches must be performed in parallel with cytoreductive treatment of leukostasis in CML which comprises leukapheresis and exchange transfusions ± cytotoxic chemotherapy.
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Affiliation(s)
- Meinolf Suttorp
- Pediatric Hematology and Oncology, Medical Faculty, TU Dresden, 01307 Dresden, Germany
| | - Stephanie Sembill
- Pediatric Oncology and Hematology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany; (S.S.); (M.M.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Krzysztof Kalwak
- Supraregional Center of Pediatric Oncology “Cape of Hope”, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Markus Metzler
- Pediatric Oncology and Hematology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany; (S.S.); (M.M.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Frederic Millot
- Inserm CIC 1402, University Hospital of Poitiers, 86000 Poitiers, France;
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12
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Holay Q, Baboudjian M, Lechevallier E, André M, Savoie PH. Percutaneous embolization by direct puncture for the treatment of high-flow priapism. Asian J Urol 2023; 10:208-209. [PMID: 36942118 PMCID: PMC10023522 DOI: 10.1016/j.ajur.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 10/15/2022] Open
Affiliation(s)
- Quentin Holay
- Department of Radiology, Conception Academic Hospital, Marseille, France
| | | | - Eric Lechevallier
- Department of Urology, Conception Academic Hospital, Marseille, France
| | - Marc André
- Department of Radiology, Conception Academic Hospital, Marseille, France
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13
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Li G, Liu Y, Wang HY, Du FZ, Zuo ZW. High-flow priapism due to bilateral cavernous artery fistulas treated by unilateral embolization: A case report. World J Clin Cases 2023; 11:225-232. [PMID: 36687183 PMCID: PMC9846992 DOI: 10.12998/wjcc.v11.i1.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 12/09/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND High flow priapism (HFP) is a rare type of priapism. Perineal trauma is the most common cause of HFP. Trauma-induced penile artery injury may lead to an arterial-cavernosal fistula, whereas persistent irregular arterial blood flow entering the corpora cavernosum can cause a persistent penile erection. The routine treatment of HFP focuses on addressing the abnormal penile erectile status and avoiding post-treatment erectile dysfunction. Interventional embolization is an important therapeutic modality for HFP, and bilateral embolization therapy is currently the most commonly used technique for patients with bilateral cavernous artery fistulas; however, unilateral embolization therapy has yet to be reported.
CASE SUMMARY Herein, we report of the case of a 26-year-old Chinese male who presented with a persistent abnormal erection for 12 h after perineal impact injury. Medical history, cavernous arterial blood gas analysis and radiological examinations led to a diagnosis of HFP caused by bilateral cavernous artery fistulas. We performed routine conservative treatment (compression therapy and ice application) for the patient after admission; however, 10 d later, his symptoms had not been relieved. After completion of the preoperative workup, right (severe side) selective perineal artery embolization was performed; the left cavernous artery fistula was left untreated. After postoperative continuation of conservative treatment for 72 h, the patient experienced complete penile thinning. The patient had no symptoms of erectile dysfunction over a follow-up period of 12 mo.
CONCLUSION Compared with bilateral cavernous artery fistula embolization, we believe that unilateral cavernous artery fistula embolization can achieve positive clinical efficacy and reduce the risk of postoperative erectile dysfunction secondary to penile ischemia.
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Affiliation(s)
- Guo Li
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Yi Liu
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Hao-Yang Wang
- Department of Nuclear Medicine, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Fei-Zhou Du
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Zhi-Wei Zuo
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
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Yap JD, Power MA. Super-selective Gelfoam embolisation in high-flow priapism. J Med Imaging Radiat Oncol 2022. [PMID: 36203271 DOI: 10.1111/1754-9485.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION High-flow priapism is a rare condition with limited data in the literature, particularly in Australia. There is therefore no clear consensus regarding treatment. We aim to present our institutional network experience in managing this condition over the last decade with super-selective gelatin sponge (Gelfoam) embolisation of the internal pudendal artery. METHODS We retrospectively searched for and reviewed the patient records of all cases of priapism encountered within our multicentre institutional network over the last 10 years. Of these, the cases of high-flow priapism treated with embolisation were analysed in depth and compared with the current literature. RESULTS Overall, 93 patients in our network were diagnosed with priapism from 1 January 2012 to 1 January 2022. And 89 of these patients (96%) had low-flow priapism and four patients (4%) had high-flow priapism. Of these four patients, two were treated within our network with super-selective Gelfoam embolisation of the internal pudendal artery. Following embolisation, both patients achieved rapid detumescence and returned to baseline premorbid erectile function. There was no report of recurrence or erectile dysfunction on follow-up. CONCLUSION Super-selective embolisation of the internal pudendal artery should be considered as a treatment option for high-flow priapism, with Gelfoam as an appropriate temporary embolic agent of choice. We show that it was a safe and effective option for the patients treated in this series, enabling quick and long-term return to baseline erectile function. Our results support data provided by the limited number of cases in the literature.
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Affiliation(s)
- Joshua D Yap
- Department of Interventional Radiology, St George Hospital, Sydney, New South Wales, Australia.,Department of Interventional Radiology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Mark A Power
- Department of Interventional Radiology, St George Hospital, Sydney, New South Wales, Australia.,Department of Interventional Radiology, Wollongong Hospital, Wollongong, New South Wales, Australia
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Moussa M, Abou Chakra M, Papatsoris A, Dellis A, Peyromaure M, Barry Delongchamps N, Bailly H, Roux S, Yassine AA, Duquesne I. An update on the management algorithms of priapism during the last decade. Arch Ital Urol Androl 2022; 94:237-247. [PMID: 35775354 DOI: 10.4081/aiua.2022.2.237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 01/29/2023] Open
Abstract
Priapism is a persistent penile erection lasting longer than 4 hours, that needs emergency management. This disorder can induce irreversible erectile dysfunction. There are three subtypes of priapism: ischemic, non-ischemic, and stuttering priapism. If the patient has ischemic priapism (IP) of less than 24-hours (h) duration, the initial management should be a corporal blood aspiration followed by instillation of phenylephrine into the corpus cavernosum. If sympathomimetic fails or the patient has IP from 24 to 48h, surgical shunts should be performed. It is recommended that distal shunts should be attempted first. If distal shunt failed, proximal, venous shunt, or T-shunt with tunneling could be performed. If the patient had IP for 48 to 72h, proximal and venous shunt or T-shunt with tunneling is indicated, if those therapies failed, a penile prosthesis should be inserted. Non-ischemic priapism (NIP) is not a medical emergency and many patients will recover spontaneously. If the NIP does not resolve spontaneously within six months or the patient requests therapy, selective arterial embolization is indicated. The goal of the management of a patient with stuttering priapism (SP) is the prevention of future episodes. Phosphodiesterase type 5 (PDE5) inhibitor therapy is considered an effective tool to prevent stuttering episodes but it is not validated yet. The management of priapism should follow the guidelines as the future erectile function is dependent on its quick resolution. This review briefly discusses the types, pathophysiology, and diagnosis of priapism. It will discuss an updated approach to treat each type of priapism.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut.
| | - Mohamad Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut.
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens.
| | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens; Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens .
| | - Michael Peyromaure
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Nicolas Barry Delongchamps
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Hugo Bailly
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Sabine Roux
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Ahmad Abou Yassine
- Internal Medicine, Staten Island University Hospital, Staten Island, NY.
| | - Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
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Abstract
PURPOSE OF REVIEW Priapism is a rare condition that has different presentations, etiologies, pathophysiology, and treatment algorithms. It can be associated with significant patient distress and sexual dysfunction. We aim to examine the most up-to-date literature and guidelines in the management of this condition. RECENT FINDINGS Priapism is a challenging condition to manage for urologists, since the etiology is often multi-factorial and the suggested treatment algorithms are based on small studies and expert anecdotal experience, perhaps due to the rarity of the disorder. Ischemic priapism of less than 24 h can be managed non-surgically in most cases with excellent results. Ischemic priapism of more than 36 h is frequently associated with permanent erectile dysfunction. Management of prolonged priapism with penile shunting still may result in poor erectile function, so penile prosthesis can be discussed in these scenarios.
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Lee JM, Sung AW, Lee HJ, Song JH, Song KH. Presumptive Non-Ischemic Priapism in a Cat. Vet Sci 2022; 9:vetsci9010029. [PMID: 35051112 PMCID: PMC8780230 DOI: 10.3390/vetsci9010029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/30/2021] [Accepted: 01/13/2022] [Indexed: 01/16/2023] Open
Abstract
A 14-year-old neutered male British shorthair cat presented with a 21-day history of persistent erection and dysuria, along with overgrooming of the perineal region. Mild palpation induced pain and rigid corpora cavernosa with flaccid glans were observed during physical examination. Ultrasonography of the penis did not detect significant blood flow in the penile cavernosal artery. The drawing of aspirate blood from cavernosal bodies for gas analysis was impossible because of the anatomically small penis size of cats. Conservative management, including topical steroid ointment, lidocaine gel, gabapentin, and diazepam, was prescribed for supportive management. The clinical signs resolved, and ultrasonographic examination of the penis revealed no abnormalities. The cat remains clinically well without recurrence during the 6 months after treatment. To our knowledge, this is the first report of non-ischemic priapism in a cat.
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Marcu D, Iorga L, Mischianu D, Bacalbasa N, Balescu I, Bratu O. Malignant Priapism - What Do We Know About It? In Vivo 2020; 34:2225-2232. [PMID: 32871745 PMCID: PMC7652445 DOI: 10.21873/invivo.12033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022]
Abstract
Malignancy as an etiological factor involved in priapism pathogenesis is rare. Malignant priapism (MP) can arise as a result of penile tumor invasion, either from primary penile tumors or from metastatic penile tumors, or due to hematological malignancies. Non-urological penile metastases are associated with significant worse prognosis compared to urological penile metastases, the appearance of priapism in such cases affecting even more the prognosis and the survival of these patients. Patients diagnosed with hematological malignancies and priapism present significant higher survival rates compared to those who develop MP in the context of a non-hematological malignancy, this being related to the fact that hematological malignancies are more sensitive to chemo- and radiotherapy. Most malignant priapism cases are ischemic; therefore the management should be based on the initial steps of the IP therapeutic protocol. Considering the trigger factor that has led to the priapic event specific oncologic treatment can be added as well.
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Affiliation(s)
- Dragos Marcu
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucian Iorga
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania
| | - Dan Mischianu
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Academy of Romanian Scientists, Bucharest, Romania
| | - Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
- "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | | | - Ovidiu Bratu
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Academy of Romanian Scientists, Bucharest, Romania
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