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Ali EA, Sardar S, Yassin MA. Priapism in Lymphoproliferative Disorders: A Systematic Review. Hematol Oncol Stem Cell Ther 2022; 15:176-182. [PMID: 34157311 DOI: 10.1016/j.hemonc.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 01/14/2023] Open
Abstract
Priapism is defined as a persistent penile erection lasting more than 4 h. We searched the literature for reviews, case reports, and series for patients with lymphoproliferative disorders who developed priapism. The search involved all the lymphoproliferative disorders included in the revised 2016 World Health Organization classification of lymphoid neoplasms including chronic lymphocytic leukemia, multiple myeloma, Waldenström macroglobulinemia, and lymphomas. A total of 16 articles were found. The search included cases up to 4th January 2021. Priapism was seen most commonly as the first manifestation of lymphoproliferative disorders, rarely seen after treatment or after diagnosis.
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Affiliation(s)
- Elrazi A Ali
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Sundus Sardar
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Hematology and Oncology, Hamad Medical Corporation, Doha, Qatar
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2
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Ali E, Soliman A, De Sanctis V, Nussbaumer D, Yassin M. Priapism in Patients with Chronic Myeloid Leukemia (CML): A Systematic Review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021193. [PMID: 34212918 PMCID: PMC8343736 DOI: 10.23750/abm.v92i3.10796] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Abstract
Background: Priapism is defined as a penile erection that persists four or more hours and is unrelated to sexual stimulation. Priapism resulting from hematologic malignancy is most likely caused by venous obstruction from microemboli/thrombi and hyperviscosity caused by the increased number of circulating leukocytes in mature and immature forms. In patients with leukemia, 50% of cases of priapism are due to Chronic Myeloid Leukemia (CML). We present a systematic review of priapism in CML. Acquisition of evidence: An extensive literature research was carried out in PubMed, Google Scholar, SCOPUS, and Science Citation Index databases. The search included cases up to 4th August 2020. Synthesis of evidence: A total of 68 articles were found and included in our review, including 3 reviews from three different centers. We found 68 articles (102 patients; figure 1) and several case reports on priapism in CML. Priapism was noticed in some patients at the first presentation of CML. However, it was infrequently reported during the start of treatment, following the stop of medication and post-splenectomy. The mean age at presentation was 27.4 years, and the mean time from onset of priapism to the time to get medical attention (presentation) was 78.2 hours. The mean white blood cell count associated with priapism was 321.29x109/L, and the mean platelet count was 569 x10 9/L. The chronic phase of CML was the most common phase where priapism occurred. Most patients were Asian (>50%). Nearly a quarter of patients (27.4%) developed permanent erectile dysfunction. Conclusions: Priapism is a urological emergency requiring urgent multidisciplinary management to prevent erectile dysfunction. Because of the relatively rare occurrence of priapism in CML patients, there is no standard treatment protocol. (www.actabiomedica.it)
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Affiliation(s)
| | | | - Vincenzo De Sanctis
- Coordinator of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A), Ferrara, Italy.
| | | | - Mohamed Yassin
- Medical Oncology, Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
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Dutta R, Matz EL, Overholt TL, Anderson WB, Deebel NA, Cowper M, Terlecki RP, Scarberry KA. Patient Education Is Associated With Reduced Delay to Presentation for Management of Ischemic Priapism: A Retrospective Review of 123 Men. J Sex Med 2021; 18:385-390. [PMID: 33422447 DOI: 10.1016/j.jsxm.2020.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adverse outcomes secondary to ischemic priapism (IP) are associated with time to presentation and management. AIM To characterize patterns in presentation delay as a function of etiology and patient education regarding IP risk. METHODS Following institutional review board approval, charts of IP patients presenting to our institution from 2010 to 2020 were reviewed. One episode of IP per patient was included for analysis. OUTCOMES Priapism duration in patients presenting with IP. RESULTS We identified 123 unique patients with IP. Common etiologies included erectogenic intracavernosal injection (24%), trazodone (16%), and other psychiatric medications (16%). Patients with sickle cell anemia or trait and intracavernosal injection-related IP presented sooner than idiopathic cases and those from psychiatric medication (P < .001). Etiology and provider education on IP risk were associated with presentation ≥ 24 hours. Upon multivariate analysis, only a lack of provider education was independently associated with presentation ≥ 24 hours. CLINICAL IMPLICATIONS Men who received provider-based education on the risk of IP associated with their condition or medication regimen were more likely to seek prompt medical attention for IP and, therefore, less likely to require surgery. STRENGTHS & LIMITATIONS This manuscript represents one of the largest series on priapism, an area of urologic practice in need of more evidence-based guidance. The numbers are not inflated by including multiple episodes per patient, and the data collected include etiology, time to presentation, and treatment. Limitations include a retrospective chart review study design at a single institution. CONCLUSION Educational initiatives on the risk of IP associated with particular disease states and medications should target at-risk individuals, as well as prescribers of medications associated with IP. Dutta1 R, Matz1 EL, Overholt TL, et al. Patient Education Is Associated With Reduced Delay to Presentation for Management of Ischemic Priapism: A Retrospective Review of 123 Men. J Sex Med 2021;18:385-390.
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Affiliation(s)
- Rahul Dutta
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ethan L Matz
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Tyler L Overholt
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - William B Anderson
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Nicholas A Deebel
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Matthew Cowper
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ryan P Terlecki
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kyle A Scarberry
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Ralph O, Shroff N, Johnson MJ, AlNajjar HM, Ralph D. Malignancy: A Rare, Important and Poorly Understood Cause of Priapism. Sex Med Rev 2020; 9:312-319. [PMID: 31902677 DOI: 10.1016/j.sxmr.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/13/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Priapism is rare yet has the potential to inflict significant suffering on patients, often with lasting consequences such as erectile dysfunction, corporal muscle necrosis, and a loss of sexual function. Although rare, it is a pathology that has received little focus in the literature, particularly that caused by malignancy, and it is in this form that the long-term prognosis becomes particularly poor. AIM This review looks at malignant priapism in detail moving from the etiology and pathogenesis through investigations and management to provide an up-to-date picture. METHODS In so doing, more than 30 articles are reviewed and examined from databases such as PubMed. Significant cases are provided as examples to provide a comprehensive review of a topic that receives little attention but can cause significant patient morbidity. MAIN OUTCOME MEASURE The main outcome measure was the use of aspiration, sympathomimetics, and surgery as the main treatment modalities and how each one is used with regard to both the underlying etiology of the priapism and also the prognosis. We look at the need for treatment and how that relates to quality of life and erectile function thereafter. RESULTS Solid tumor invasion-both primary and secondary-and hematologic malignancies represent the key etiologies of malignant priapism and aggressive treatment is needed. Recovery of erectile function can occur if intracavernosal phenylephrine is quickly administered or distal shunts are placed; however, the prognosis is often poor, and subsequent chemotherapy treatment is often required. CONCLUSION The importance of a clear history and examination cannot be understated, and although the prognosis is often poor, this review hopes to give clinicians better understanding to be able to recognize malignancy as a potential cause of priapism. Ralph O, Shroff N, Johnson MJ, et al. Malignancy: A Rare, Important and Poorly Understood Cause of Priapism. J Sex Med 2021; 9:312-319.
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Affiliation(s)
- Oliver Ralph
- Department of Engineering, University College London Hospital, 47 Wimpole St, London W1G 8SE, UK
| | - Nikita Shroff
- Department of Engineering, University College London Hospital, 47 Wimpole St, London W1G 8SE, UK
| | - Mark James Johnson
- Department of Engineering, University College London Hospital, 47 Wimpole St, London W1G 8SE, UK
| | - Hussain M AlNajjar
- Department of Urology, University College London Hospital, 47 Wimpole St, London W1G 8SE, UK
| | - David Ralph
- Department of Urology, University College London Hospital, 47 Wimpole St, London W1G 8SE, UK.
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Scherzer ND, Reddy AG, Le TV, Chernobylsky D, Hellstrom WJG. Unintended Consequences: A Review of Pharmacologically-Induced Priapism. Sex Med Rev 2018; 7:283-292. [PMID: 30503727 DOI: 10.1016/j.sxmr.2018.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/14/2018] [Accepted: 09/16/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Priapism has been linked to many commonly prescribed medications, as well as recreational drugs and toxins. Although the incidence of priapism as a result of medication is small, the increasing use of antidepressants, antipsychotics, and recreational drugs may lead to more cases of pharmacologically-induced priapism in the future. AIM To provide a comprehensive, up-to-date review of the most common causes of pharmacologically induced priapism and discuss incidence, pathophysiology, and basic management strategies. METHODS A review of the available literature from 1960 to 2018 was performed using PubMed with regards to pharmacologically induced priapism. MAIN OUTCOME MEASURE We reviewed publications that outlined incidence, pathophysiology, and management strategies for various pharmacologic causes of priapism: antidepressants, antipsychotics, antihypertensives, methylphenidate, cocaine, heparin, gonadotropin-releasing hormone, propofol, spider bites, and other miscellaneous causes. RESULTS An understanding of the pathophysiology behind common pharmacologic causes of priapism can assist in the development of better treatment strategies and prevent future episodes of priapism. By understanding the potential risks associated with the use of medications with α-blocking or sympathomimetic properties, physicians can reduce the likelihood of priapism in their patients, especially those with other medical conditions that put them at increased baseline risk. Early corporal aspiration and injection of phenylephrine reduces additional complications related to priapism. In select patients, early placement of a penile prosthesis may prevent further morbidity. CONCLUSION By developing a greater understanding of common pharmacologic causes of priapism, physicians can promptly identify and manage symptoms, leading to decreased patient morbidity. Scherzer ND, Reddy AG, Le TV, Chernobylsky D, Hellstrom WJG. Unintended Consequences: A Review of Pharmacologically-Induced Priapism. Sex Med Rev 2019;7:283-292.
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Affiliation(s)
| | - Amit G Reddy
- Department of Urology, Tulane University, New Orleans, LA, USA
| | - Tan V Le
- Department of Urology, Tulane University, New Orleans, LA, USA; Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
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Abstract
The relationships between sport and sexuality in males are of great social and clinical interest, because of sports and motor activities that highly promote social and sexual relationships. Even if few literature exist, two main questions should be taken into account: whether and how physical exercise and sport positively or negatively influence sexual health and behavior and/or whether and how sexual behavior may affect a sub-sequent sport performance. Physical exercise and sport per se can influence, positively or negatively, the hypothalamic-pituitary-testicular axis function and, consequently, the individual's reproductive and/or sexual health. This depends on individual factors such as genetic and epigenetic ones and on different variables involved in the practice of sport activities (type of sport, intensity and duration of training, doping and drug use and abuse, nutrition, supplements, psychological stress, allostatic load, etc.). If well conducted, motor and sport activities could have beneficial effects on sexual health in males. Among different lifestyle changes, influencing sexual health, regular physical activity is fundamental to antagonize the onset of erectile dysfunction (ED). However, competitive sport can lead both reproductive and/or sexual tract damages and dysfunctions, transient (genital pain, hypoesthesia of the genitalia, hypogonadism, DE, altered sexual drive, etc.) or permanent (hypogonadism, DE, etc.), by acting directly (traumas of the external genitalia, saddle-related disorders in cyclists, etc.) or indirectly (exercise-related hypogonadism, drug abuse, doping, stress, etc.). Sexual activities shortly performed before a sport competition could differently influence sport performance. Due to the few existing data, it is advisable to avoid an absolute pre-competition sexual abstinence.
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Affiliation(s)
- P Sgrò
- Unit of Endocrinology, Section of Health Sciences, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - L Di Luigi
- Unit of Endocrinology, Section of Health Sciences, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
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Azık FM, Atay A, Kürekçi AE, Ay H, Kibar Y, Ozcan O. Treatment of Priapism with Automated Red Cell Exchange and Hyperbaric Oxygen in an 11-year-old Patient with Sickle Cell Disease. Turk J Haematol 2012; 29:270-3. [PMID: 24744672 PMCID: PMC3986753 DOI: 10.5505/tjh.2012.78553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 03/05/2011] [Indexed: 12/03/2022] Open
Abstract
Priapism affects up to 50% of all males with sickle cell disease, and there is no standard treatment. Delayed and unsuccessful treatment leads to corporal fibrosis and impotence. It is therefore necessary to determine the best treatment methods for this complication in order to offer effective interventions to all affected patients. Herein we report an 11-year-old patient with sickle cell disease that presented with priapism 72 h after onset, and was successfully treated with automated red cell exchange and hyperbaric oxygen following unsuccessful surgical and conventional interventions.
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Affiliation(s)
- Fatih Mehmet Azık
- Gülhane Military Medical Academy, Department of Pediatric Hematology, Ankara, Turkey
| | - Avni Atay
- Gülhane Military Medical Academy, Department of Pediatric Hematology, Ankara, Turkey
| | - Ahmet Emin Kürekçi
- Gülhane Military Medical Academy, Department of Pediatric Hematology, Ankara, Turkey
| | - Hakan Ay
- Gülhane Military Medical Academy, Department of Underwater and Hyperbaric Medicine, Ankara, Turkey
| | - Yusuf Kibar
- Gülhane Military Medical Academy, Department of Urology, Ankara, Turkey
| | - Okan Ozcan
- Gülhane Military Medical Academy, Department of Pediatric Hematology, Ankara, Turkey
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8
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Rodgers R, Latif Z, Copland M. How I manage priapism in chronic myeloid leukaemia patients. Br J Haematol 2012; 158:155-164. [PMID: 22571386 DOI: 10.1111/j.1365-2141.2012.09151.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Ryan Rodgers
- Bone Marrow Transplant Unit; Beatson West of Scotland Cancer Centre; Gartnavel General Hospital; Glasgow
| | - Zak Latif
- Department of Urology; Royal Alexandra Hospital; Paisley
| | - Mhairi Copland
- Bone Marrow Transplant Unit; Beatson West of Scotland Cancer Centre; Gartnavel General Hospital; Glasgow
- Paul O'Gorman Leukaemia Research Centre; Institute of Cancer Sciences; College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow UK
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Gogia A, Sharma A, Raina V, Gupta R. Priapism as an initial presentation of chronic lymphocytic leukemia. Leuk Lymphoma 2012; 53:1638-9. [DOI: 10.3109/10428194.2012.656636] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Affiliation(s)
- Ilias Tazi
- From the Department of Medicine, Hematology Unit, Centre Hospitalier Regional, Beni-Mellal, Morocco
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Hsiao HL, Wang CJ, Li WM, Chang TH, Li YC, Huang CH. The Winter procedure as management for prolonged low-flow priapism: a case report. Kaohsiung J Med Sci 2007; 23:531-5. [PMID: 18055300 DOI: 10.1016/s1607-551x(08)70012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Priapism is a prolonged penile erection that is not associated with sexual stimulation. Although the time course has not been formally defined, it is usually considered to be one that lasts for more than 4-6 hours. Low-flow (ischemic) priapism is usually associated with sickle cell disease, hemoglobinopathies, neoplastic syndrome, anticoagulant therapy, psychotropic medication or idiopathic causes. Here, we report a case of prolonged low-flow priapism lasting for 2 weeks, which was successfully treated with the Winter procedure after several attempts of conservative treatment. Although the potency remains unclear and the patient needs a longer period of follow-up, the case reported here still shows that prolonged low-flow priapism can be successfully treated with the Winter procedure when conservative treatments fail.
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Affiliation(s)
- Hsi-Lin Hsiao
- Department of Urology, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, Taiwan
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12
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Negro JJ, Sarasola JH, Fariñas F, Zorrilla I. Function and occurrence of facial flushing in birds. Comp Biochem Physiol A Mol Integr Physiol 2005; 143:78-84. [PMID: 16337158 DOI: 10.1016/j.cbpa.2005.10.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Revised: 10/21/2005] [Accepted: 10/22/2005] [Indexed: 11/20/2022]
Abstract
So far overlooked as a pigment involved in visual communication, the haemoglobin contained in the blood of all birds is responsible for the red flushing colours in bare skin areas of some species. Our aim has been twofold: (1) to study sub-epidermical adaptations for blood circulation in two flushing species: the crested caracara (Polyborus plancus) and the hooded vulture (Necrosyrtes monachus), and (2) to provide the first compilation of avian species with flushing skin. The bare facial skin of both the caracara and the hooded vulture contains a highly vascularised tissue under the epidermis that may be filled with blood and would thus produce red skin colours. In contrast, feathered areas of the head show very few vessels immersed in connective tissue and have no potential for colour changes. Species with flushing colours are few but phylogenetically diverse, as they belong to 12 different avian orders and at least 20 families. The majority are dark-coloured, large-sized species living in hot environments that may have originally evolved highly vascularised skin patches for thermoregulation. Bird behaviour as well as sex and age differences within species suggest that a signalling system for condition or status based on haemoglobin may have been super-imposed to the physiological process of heat dissipation.
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Affiliation(s)
- Juan José Negro
- Department of Applied Biology, Estación Biológica de Doñana, CSIC, Avda. de María Luisa s/n, Pabellón del Perú, 41013 Sevilla, Spain.
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Arrigo T, Crisafulli G, Salzano G, Zirilli G, De Luca F. High-flow priapism in testosterone-treated boys with constitutional delay of growth and puberty may occur even when very low doses are used. J Endocrinol Invest 2005; 28:390-1. [PMID: 15966517 DOI: 10.1007/bf03347210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vilke GM, Harrigan RA, Ufberg JW, Chan TC. Emergency evaluation and treatment of priapism. J Emerg Med 2004; 26:325-9. [PMID: 15028333 DOI: 10.1016/j.jemermed.2003.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Accepted: 12/08/2003] [Indexed: 11/18/2022]
Abstract
Priapism is a fairly uncommon presentation to the Emergency Department, but when it does present, it represents a true urologic emergency. Prompt treatment will decrease the risk of permanent sequelae including impotence. Treatment should be based on etiology and follow an organized approach. Various cases will arise when conservative management will not remedy the priapism and more aggressive measures will be needed, particularly if emergent urological consultation is not available. This article reviews the causes of priapism and systematically reviews techniques and procedures used to manage and treat priapism.
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Affiliation(s)
- Gary M Vilke
- Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California 92103, USA
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Chen CC, Wang CJ, Chen CW, Lee YC, Chou YH, Huang CH. Management of low-flow priapism using the Winter procedure: a case report. Kaohsiung J Med Sci 2003; 19:88-92. [PMID: 12751604 DOI: 10.1016/s1607-551x(09)70455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Priapism is a prolonged penile erection that is unrelated to sexual stimulation. Low-flow priapism has been associated with sickle cell disease and other hemoglobinopathies, neoplastic syndrome, anticoagulant therapy, psychotropic medication, and idiopathic causes. We report the successful treatment of idiopathic low-flow priapism using the Winter procedure. Initial treatment consisted of aspiration and intracavernous irrigation with iced saline and a vasoconstrictive agent, but in vain. We then performed the Winter procedure, in which fistulas between the corpora cavernosa and the glans penis were created. This resulted in the simultaneous detumescence of the penis, without complication. The erectile function of the penis was normal 1 year after the procedure. This case shows that idiopathic low-flow priapism can be successfully treated using the Winter procedure when conservative treatment fails.
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Affiliation(s)
- Chung-Chin Chen
- Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection adequate for satisfactory intercourse. It is a common problem among approximately 50% of men between the ages of 40 and 70. Erectile dysfunction is not only stressful to both the affected individual and his partner, but it can also negatively affect self-esteem. Biomechanical models have recently been developed to study both the structural and hemodynamic factors involved in normal and pathological erectile conditions. These computational models, which are reviewed in the present paper, allow for better understanding of the mechanisms acting in ED and provide a suitable basis for development of state-of-the-art interdisciplinary treatment approaches aimed to improve the quality of life for these men.
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Affiliation(s)
- A Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, 69978, Tel Aviv, Israel.
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Majeed S, Schor JA, Jacobson S, Jagoda A, Mahadeo R. Refractory priapism of unknown etiology in a pediatric patient. Pediatr Emerg Care 2000; 16:347-51. [PMID: 11063367 DOI: 10.1097/00006565-200010000-00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Priapism is a urologic emergency that can occur in any age group and every patient should receive prompt urologic consultation. Management of priapism is based on the recognition of underlying pathophysiology; ready differentiation between high-flow and low-flow priapism; reversal of any potential precipitating factors; the use of corporal aspiration irrigation combined with intracavernosal alpha adrenergic therapy; and when necessary, a shunting procedure. Delay in recognition or treatment can be crucial as the incidence of long-term complication rises substantially with the duration of the priapism.
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Affiliation(s)
- S Majeed
- Department of Emergency Medicine, New York Hospital Medical Center of Queens, Flushing 11355, USA
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McCarthy LJ, Vattuone J, Weidner J, Skipworth E, Fernandez C, Jackson L, Rothenberger S, Waxman D, Miraglia C, Porcu P, Danielson CF. Do automated red cell exchanges relieve priapism in patients with sickle cell anemia? THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 2000; 4:256-8. [PMID: 10910030 DOI: 10.1046/j.1526-0968.2000.00222.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Priapism is a dramatic, painful complication for some men afflicted by sickle cell anemia. Although the natural history remains unclear, many believe replacing the patient's abnormal red blood cells (RBCs) with normal RBCs by apheresis is effective. However, no controlled trials have demonstrated its effectiveness. We exchanged 7 men after medical management failed. All procedures reduced sickle hemoglobin levels to < 30%. Two patients underwent emergency automated red cell exchanges without any detumescence or reduction of pain. The remaining 5 patients were exchanged non-emergently; 4 experienced no detumescence or relief of pain. One adult experienced resolution 8 h postexchange. However, he had a history of "stuttering" priapism. All required decompression procedures. Automated RBC exchanges were not effective in achieving detumescence or reducing pain.
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Affiliation(s)
- L J McCarthy
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine and Indiana University Hospital, Indianapolis 46202-5283, USA.
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Abstract
Priapism is a relatively rare condition characterized by persistent painful erection of the corpora cavernosum that occurs unrelated to sexual stimulation or desire. It has been associated with cocaine exposure, sickle cell anemia, anticoagulant therapy, neoplastic syndromes, diabetes, and the use of psychotropic medications. Androstenedione is a testosterone precursor used by athletes to enhance performance; the lay press has recently touted this substance as an over-the-counter sexual stimulant. We describe an otherwise healthy man with 2 episodes of priapism after the use of androstenedione. The patient did not have any factors known to precipitate priapism.
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Affiliation(s)
- P N Kachhi
- Department of Emergency Medicine, University of Southern California School of Medicine, Los Angeles, CA 90033, USA
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