Refractory priapism of unknown etiology in a pediatric patient

T-shaped Shunt With Intracavernosal Tunneling for a Pediatric Case of Refractory Ischemic Priapism

We present the first reported case of refractory pediatric priapism treated by intracavernosal tunneling T shunt. A 12-year-old male, with sickle cell disease, presented with 72 hours of painful erection. The patient failed conservative measures including aspiration, injection of phenylephrine, as well as distal shunt procedure. A T-T shunt was performed, as previously described in the adult literature. There was immediate resolution of the erection with no complications. At 1-year follow-up, he reports no subsequent episodes of priapism and normal erections. T shunt with tunneling can be performed in select cases of severe pediatric refractory ischemic priapism.

Painless pediatric priapism and cough

Pediatric priapism can be a medical emergency but is not a common complaint seen in pediatric emergency department. Priapism in a previously healthy child is also rare. We report a case of painless stuttering priapism associated with an acute Mycoplasma pneumoniae infection in a previously healthy boy.

Posttraumatic high-flow priapism in children treated with autologous blood clot embolization: long-term results and review of the literature

BACKGROUND

Usually high-flow priapism is caused by perineal or penile blunt trauma with direct cavernosal artery injury and formation of an arterial-lacunar fistula. Rarely, cavernosal artery injury may result from penetrating trauma. Treatment of high-flow priapism is not considered an emergency because patients are at low risk for permanent complications. For this type of priapism there are several options for treatment including embolization or surgical ligation.

OBJECTIVE

To describe the technique of superselective transcatheter embolization with the use of autologous blood clot and to discuss the long-term results.

MATERIALS AND METHODS

Seven children with a mean age of 10 years suffering from high-flow priapism were treated with superselective transcatheter embolization with autologous blood clot. In all cases, colour Doppler US was performed to demonstrate increased cavernous blood flow with definitive diagnosis established by superselective arteriography. After the angiographic diagnosis, superselective transcatheter embolization of the fistula with autologous blood clot was performed during the same session. The children were followed up on a monthly basis up to 1 year with clinical findings and penile colour Doppler US examinations. After 1 year, they were followed up annually with clinical assessment only. The mean follow-up period was 6.0 years.

RESULTS

Following embolization complete detumescence was achieved in all but one child, who was treated with a second embolization 3 d after the initial session. In addition, for one child a second session of embolization was performed due to the recurrence of partial erection during the 1 week period after the initital embolization. In both cases, complete detumescence was achieved after the second embolization, and no recurrence of priapism was observed in the follow-up period.

CONCLUSION

Selective arterial embolization with autologous clot achieved treatment for high-flow priapism in this study with 100% occlusion rate with a maximum of two sessions and no signs of erectile dysfunction were observed in any of the children during long-term follow-up.

Successful treatment of idiopathic priapism in a 13-year-old boy

Priapism is a medical emergency. An idiopathic case can be a difficult clinical problem in the pediatric emergency room. This case highlights the successful use of penile irrigation and injection of phenylephrine in a 13-year-old boy with idiopathic ischemic priapism 12 h after sexual intercourse.

Priapism in children: treatment with embolotherapy

BACKGROUND

Priapism is defined as involuntary, prolonged penile erection caused by factors other than sexual arousal, and is classified as either low-flow or high-flow. Embolotherapy is an accepted form of therapy in adults with high-flow priapism. Because the differences in etiology, management and outcome are significant, accurate and timely diagnosis is imperative.

OBJECTIVE

The purpose of this report is to present our experience with embolotherapy for treatment of high-flow priapism in three children.

PATIENTS AND METHODS

This was a retrospective study. During an 18-month period, three boys ranging in age from 6 to 15 years presented with priapism. All three children were treated with embolotherapy.

RESULTS

All three children were successfully treated with angiography and embolotherapy. One boy had a presentation that initially raised the possibility of low-flow priapism. No complications occurred, and to date all children are able to maintain normal erections.

CONCLUSION

Subselective transcatheter embolization is the procedure of choice for high-flow priapism. In cases where priapism persists despite adequate therapy, angiography might be useful to exclude high-flow disease. In children with high-flow priapism, selective occlusion of the penile arteriovenous fistula led to detumescence and normal erectile function.

Priapism as a presentation of T-cell acute lymphoblastic leukaemia in a child

We report a case of a child who presented to the ED with priapism. This was the initial presentation of T-cell acute lymphoblastic leukaemia (ALL). To our knowledge, this is the first report of a child with T-cell ALL presenting with priapism. This case demonstrates the importance of identifying the underlying cause of priapism, as it directly impacts on both initial and ongoing management.

Stuttering priapism associated with withdrawal from sustained-release methylphenidate

Stuttering priapism is intermittent, prolonged, painful, pathologic erections with intervening periods of detumescence. An adolescent had stuttering priapism associated with withdrawal from sustained-release methylphenidate. To our knowledge, this is the first such report of stuttering priapism associated with stimulant drugs for treatment of attention deficit hyperactivity disorder.