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Aithal S, Sinha A, Saxena R, Rathod KJ, Pathak M, Jadhav AS, Nayak S. Acquired Urethrocutaneous Fistula in Children: Case Series of Unusual Presentations of a Usual Condition. J Indian Assoc Pediatr Surg 2024; 29:281-284. [PMID: 38912016 PMCID: PMC11192262 DOI: 10.4103/jiaps.jiaps_193_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 06/25/2024] Open
Abstract
Urinary-cutaneous fistulas are typically treated by pediatric urologists and typically arise after surgical interventions. The three atypical cases of acquired urethrocutaneous fistula that we present here have variously resulted from an untreated periurethral abscess to complications of an initial urethral calculi. To prevent an intraoperative surprise, learning from our cases put emphasis on the importance of early intervention and a high index of suspicion for underlying calculi. We also cover the pathology, diagnosis, and therapy of these uncommon instances of acquired urethrocutaneous fistula.
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Affiliation(s)
- Shrilakshmi Aithal
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kirtikumar J Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manish Pathak
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Avinash S. Jadhav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shubhalaxmi Nayak
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Cotter F, Shi M, Sathianathen N, Thevarajah G, Cheng J, Gyomber D, Sundaralingam S, Satasivam P. Corpus cavernosum abscess complicating distal shunt procedures for priapism. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158211027424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abscess of the corpus cavernosum is a rare condition. We describe the case of a 36-year-old male presenting with bilateral corpus cavernousm abscesses, on a background of distal shunt procedures for recurrent priapism, that was managed with a bilateral corporotomy and systemic antibiotic therapy. Level of Evidence: Level 4
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Affiliation(s)
| | | | | | | | | | | | | | - Prassannah Satasivam
- The Northern Hospital, Australia
- Department of Medicine, The University of Melbourne, Parkville VIC, Australia
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3
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Bakhsh A, Daqqaq T, Alhasan A, Alnazari M, Rajih E. The Role of Phosphodiesterase Inhibitors in the Management of Cavernositis With Multifocal Abscesses: A Report of Case Series. Sex Med 2020; 8:318-322. [PMID: 32245661 PMCID: PMC7261669 DOI: 10.1016/j.esxm.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 11/03/2022] Open
Abstract
Introduction Cavernositis is a rare acute infection of the corporal bodies of the penis. It might result in corporal cavernosal abscesses, fibrosis, and subsequently erectile dysfunction if the treatment is inadequate. Previous reports advocate penile aspiration when cavernosal abscesses were significantly present. Aim We report 2 cases of cavernositis treated by the standard antimicrobial therapy in addition to the daily use of phosphodiesterase type 5 inhibitors (iPDE-5). Methods We include 2 patients who fulfill the criteria for the diagnosis of cavernositis. They were diagnosed clinically based on history and physical examination. Patient 1 had multifocal abscesses on initial penile contrast-enhanced magnetic resonance imaging (MRI). This patient showed rapid clinical improvement with the addition of phosphodiesterase inhibitor (PDEi) to the antimicrobial therapy without the need for surgical drainage of the abscesses. Patient 2 had persistent infection despite 3 weeks of oral second-generation cephalosporin (Cefuroxime). But he showed significant clinical improvement after being started on PDEi in conjunction with the current antimicrobial therapy. Follow-up after 3 months by clinical examination and penile magnetic resonance imaging in both patients showed normal erectile function with no scarring. Conclusion PDEi have promising results on disease progression and outcomes. It synergizes the effect of antimicrobial therapy and can potentially reduce the residual corporal fibrosis and erectile dysfunction. However, large studies are required to validate and generalize this treatment approach. Bakhsh A, Daqqaq T, Alhasan A, et al. The Role of Phosphodiesterase Inhibitors in the Management of Cavernositis With Multifocal Abscesses: A Report of Case Series. Sex Med 2020;8:318–322.
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Affiliation(s)
- Abdulaziz Bakhsh
- Department of Urology, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Tareef Daqqaq
- Department of Radiology and Medical Imaging, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Ayman Alhasan
- Department of Radiology and Medical Imaging, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Mansour Alnazari
- Department of Urology, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Emad Rajih
- Department of Urology, Faculty of Medicine, Taibah University, Madinah, Saudi Arabia.
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Abstract
The utility of PET in septicemia for showing its source and possible metastatic infection has been demonstrated. We describe the diagnosis on PET/CT of a spontaneous corpus cavernosum abscess in a 64-year-old man presenting with Streptococcus constellatus septicemia, in whom the clinical diagnosis had been elusive for 10 days.
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Lazarou L, Berdempes M, Markopoulos T, Kostakopoulos N, Spyropoulos K, Mitsogiannis IC. A case of cavernosal abscess after neglected penile fracture and bacteremia. Urol Ann 2019; 11:328-330. [PMID: 31413517 PMCID: PMC6676829 DOI: 10.4103/ua.ua_104_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Penile abscess is a urological entity rarely described in the literature. It has been associated with injection therapy for erectile dysfunction, penile instrumentation, trauma and priapism. Identified risk factors include immunosuppresion and pre-existing local or distant infection. Common causal microorganisms include Staphylococcus aureus, Streptococci and Bacteroides. We herein report on a case of penile abscess in a 37-year-old patient occurring after sexual trauma and presenting with bacteremia.
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Affiliation(s)
- Lazaros Lazarou
- Second Department of Urology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos Berdempes
- Second Department of Urology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Titos Markopoulos
- Second Department of Urology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kostakopoulos
- Second Department of Urology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Spyropoulos
- Second Department of Urology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Iraklis C Mitsogiannis
- Second Department of Urology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Steinkeler JA, Sun MRM. Imaging of Infections of the Urinary and Male Reproductive Tracts. Semin Roentgenol 2017; 52:83-89. [PMID: 28606312 DOI: 10.1053/j.ro.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Maryellen R M Sun
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
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Herrera D, Alonso B, de Arriba L, Santa Cruz I, Serrano C, Sanz M. Acute periodontal lesions. Periodontol 2000 2015; 65:149-77. [PMID: 24738591 DOI: 10.1111/prd.12022] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/30/2022]
Abstract
This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre-existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre-existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re-evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre-existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.
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Paladino JR, Nascimento FJ, Gromatsky C, Pompeo ACL. Corpus cavernosum abscess after Winter procedure performance. BMJ Case Rep 2014; 2014:bcr-2013-202089. [PMID: 24515231 DOI: 10.1136/bcr-2013-202089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 23-year-old male patient with sickle-cell disease reported his third episode of priapism complicated by the presence of a corpus cavernosum abscess after the performance of a Winter procedure 20 days prior to his presentation. While in hospital for 11 days, two penile needle aspirations and three surgical drainages were performed with associated antibiotic therapy. He evolved with erectile dysfunction refractory to drug therapy and his infectious condition improved. An early penile prosthesis implantation followed after the use of a vacuum pump in an attempt to decrease the fibrotic process of the corpora cavernosa. Final results were positive.
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A unique case of penile necrotizing fasciitis secondary to spontaneous corpus cavernosal abscess. Case Rep Urol 2013; 2013:576146. [PMID: 24198996 PMCID: PMC3808107 DOI: 10.1155/2013/576146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/12/2013] [Indexed: 11/18/2022] Open
Abstract
Corpus cavernosal abscess and necrotizing fasciitis occur rarely, and precipitating factors can usually be elicited with careful history and examination. Whilst both conditions share common risk factors such as diabetes mellitus, this is the first reported case of penile necrotizing fasciitis secondary to spontaneous corpus cavernosal abscess in an otherwise healthy patient. A 32-year-old man presented with 4-day history of swollen, painful penis, with ultrasound confirming corpus cavernosal abscess. Biopsies were taken and the cavity aspirated, but, despite intravenous antibiotics, he developed penile necrotizing fasciitis necessitating open cavernostomy and debridement. The overlying skin defect healed by secondary intention, but the patient experienced persistent postoperative erectile dysfunction, so he was referred for penile prosthesis insertion.
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Song W, Ko KJ, Shin SJ, Ryu DS. Penile abscess secondary to neglected penile fracture after intracavernosal vasoactive drug injection. World J Mens Health 2012; 30:189-91. [PMID: 23596611 PMCID: PMC3623536 DOI: 10.5534/wjmh.2012.30.3.189] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 08/30/2012] [Accepted: 09/21/2012] [Indexed: 11/15/2022] Open
Abstract
Penile abscesses are rare, but can develop after trauma, injection therapy, or surgery of the penis, or as an unusual presentation of sexually transmitted diseases. We report a case of penile abscess in a 51-year-old diabetic man, presented 9 days after neglected penile fracture following intracavernosal injection therapy and sexual intercourse. Penile ultrasonography and surgical exploration confirmed the physical examination findings of involvement of the corpus cavernosum. The pus culture from the abscess revealed Enterococcous faecalis. The patient was successfully treated by surgical drainage of the abscess and primary closure of the ruptured tunica albuginea.
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Affiliation(s)
- Wan Song
- Department of Urology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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11
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Jinga V, Iconaru V. Penile abscess and urethrocutaneous fistula following intracavernous injection: a case report. J Sex Med 2012; 9:3270-3. [PMID: 23088765 DOI: 10.1111/j.1743-6109.2012.02959.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Intracavernous injection with pharmacological agents is described as a safe and efficient method for erectile dysfunction treatment. Among other adverse events, penile abscess is a potentially difficult-to-treat complication. AIM We present a rare case of penile abscess presenting 6 months after intracavernous papaverine injection. The etiology, diagnosis, and management of this condition are discussed briefly. METHODS A 49-year-old afebrile man presented with the development of distal penile shaft swelling. A 6 × 4-cm tender lump was palpable on the left ventrolateral side, with mobile overlying skin but fixed to underlying tissue, without any local or general signs of infection. The swelling gradually increased in volume over a period of 2 weeks following intracavernous papaverine injection. However, the patient did not seek medical advice for 6 months because of the minimal symptoms associated with his condition. RESULTS The abscess was revealed through sub-coronal circumferential skin degloving incision. The thick abscess sheath was incised and pus drained, followed by blunt excision down to the intact cavernosal tunica albuginea. On the 12th postoperative day, the case was further complicated by development of an urethrocutaneous fistula, 6 mm in diameter, on the ventral side of the spongy urethra. The patient was initially managed by suprapubic cystostomy and an Orandi urethroplasty was performed after 3 months. On day 14, post-urethroplasty, the fistula was completely closed and no complaints concerning micturition were reported. At follow-up, the patient showed good functional results in terms of maintained normal sexual function and absent penile curvature. CONCLUSIONS Penile abscess after intracavernous injection is a rare condition. This unusual case speaks to the importance of a thoughtful surgical management with the need of operating team collaboration in order to resolve the abscess and manage potential complications.
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Affiliation(s)
- Viorel Jinga
- Department of Urology, Prof. Dr. Th. Burghele Hospital, Bucharest, Romania.
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12
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Faydaci G, Ozgul A, Kuyumcuoglu U, Aktoz T, Oder M. Dorsal vein rupture after practice of taqaandan, necrotising cavernositis, penile reconstruction, urethroplasty and penile prosthesis implantation. Andrologia 2011; 44 Suppl 1:851-5. [PMID: 22175702 DOI: 10.1111/j.1439-0272.2011.01259.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Penile fracture is an uncommon and emergent urologic condition defined as traumatic rupture of the corpus cavernosum secondary to a blunt trauma of the erect penis. Tunica albuginea is thinned and stretched in the erect state, and a transverse tear in the corpus cavernosums may occur by a buckling force. However, penile dorsal vein tears may mimic penile fracture. Also, corporeal infection and purulent cavernositis are associated with trauma, cavernosography, priapism, intracavernosal injection therapy and penile prosthesis.
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Affiliation(s)
- G Faydaci
- Department of Urology, Dr Lütfi Kirdar Training and Research Hospital, Istanbul, Turkey
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Bertolotto M, Pavlica P, Serafini G, Quaia E, Zappetti R. Painful Penile Induration: Imaging Findings and Management. Radiographics 2009; 29:477-93. [DOI: 10.1148/rg.292085117] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ehara H, Kojima K, Hagiwara N, Phuoc NB, Deguchi T. Abscess of the corpus cavernosum. Int J Infect Dis 2007; 11:553-4. [PMID: 17398131 DOI: 10.1016/j.ijid.2007.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 01/27/2007] [Accepted: 01/30/2007] [Indexed: 11/30/2022] Open
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Sood R, Wadhwa SN, Jain V. Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2006. [DOI: 10.47102/annals-acadmedsg.v35n6p425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Introduction: Neonatal priapism is known to be associated with a wide range of aetiologies, but an association with spontaneous purulent cavernositis has not been reported in the paediatric literature. We report the first of such case.
Clinical Picture: A 24-day-old neonate was brought with the history of persistent erection of penis since day 4 of life and swollen penis of 4 days’ duration, which revealed frank pus on cavernosal aspiration bilaterally.
Treatment: The child was treated with closed aspiration drainage; cross-irrigation with antibiotic solution under systemic antibiotic cover helped in achieving complete detumescence.
Outcome: On follow-up, child demonstrated normal full bladder tumescence and colour doppler revealed bilateral normal corporo-cavernosal appearance and blood flow, indicating good functional and anatomical recovery.
Conclusion: This case report describes the presentation, successful management and excellent functional and anatomical outcome, on follow-up, of this rare association of neonatal priapism with spontaneous bilateral pyocavernositis. An attempt has been made to describe the underlying pathophysiology.
Key words: Corporeal abscess, Erectile dysfunction, Persistent penile erection of newborn
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Affiliation(s)
- Rajeev Sood
- Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Vikas Jain
- Dr Ram Manohar Lohia Hospital, New Delhi, India
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Köksal T, Kadioğlu A, Tefekli A, Usta M, Beşişik A, Erol B. Spontaneous bacterial abscess of bilateral cavernosal bodies. BJU Int 1999; 84:1107-8. [PMID: 10571649 DOI: 10.1046/j.1464-410x.1999.00372.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- T Köksal
- Department of Urology, Faculty of Medicine, Istanbul University, Turkey
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Sandock DS, Seftel AD, Herbener TE, Goldstein I, Greenfield AJ. Perineal abscess after embolization for high-flow priapism. Urology 1996; 48:308-11. [PMID: 8753749 DOI: 10.1016/s0090-4295(96)00176-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
High-flow priapism is unusual and is most often due to blunt perineal trauma with resultant laceration of the cavernosal artery, creating an arteriocavernosal fistula. Although few cases have been reported, the consensus on management appears to be embolization of the fistula with autologous clot, alone or in combination with Gelfoam. We present a case of high-flow priapism treated in this manner. The embolized pseudoaneurysm evolved into an abscess that eventually spread to the perineum. The rarity of this entity and the postprocedural morbidity are reported.
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Affiliation(s)
- D S Sandock
- Department of Urology, Case Western Reserve University, Cleveland, OH 44106-5046, USA
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Focal Inflammation of the Corpus Cavernosum in a Diabetic Man Due to Acute Occlusion of the Cavernous Artery. J Urol 1995. [DOI: 10.1097/00005392-199505000-00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Focal Inflammation of the Corpus Cavernosum in a Diabetic Man Due to Acute Occlusion of the Cavernous Artery. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67480-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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