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Barbaro K, Midgley J. Priapism, a symptom of claudication of the cauda equina in spinal stenosis. Musculoskelet Sci Pract 2021; 52:102337. [PMID: 33549525 DOI: 10.1016/j.msksp.2021.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022]
Abstract
Priapism is defined as a persistent penile erection in the absence of sexual arousal. This symptom has been documented in patients with spinal stenosis although it is considered a rare finding. The European Association of Urology guidelines on priapism [Salonia et al., 2014] list cauda equina syndrome and spinal stenosis as causative factors for ischemic priapism although the literature describing this phenomenon appears sparse. Priapism can be a rare symptom of lumbar spine stenosis/transient cauda equina compression. This presentation is complex and believed to be a parasympathetic mediated autonomic disorder. This article discusses the relationship between spinal stenosis, cauda equina syndrome and priapism using available literature. Greater awareness of this clinical finding may help clinicians in their clinical decision making. In patients with suspected cauda equina syndrome, subjective enquiry regarding the symptom priapism may add to the patients overall clinical picture.
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Affiliation(s)
- Karl Barbaro
- Musculoskeletal Department, York Teaching Hospital NHS Foundation Trust, York, United Kingdom.
| | - James Midgley
- Musculoskeletal Department, York Teaching Hospital NHS Foundation Trust, York, United Kingdom.
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Okunlola AI. Priapism secondary to cauda equina compression: A debilitating and socially embarassing pathology. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hirota K, Hanakita J, Takahashi T, Kanematsu R, Ueno M, Kasuya H, Minami M. Walking-Evoked Erection in Patients with Lumbar Degenerative Diseases: Eight Cases and Review of the Literature. Asian Spine J 2020; 15:172-179. [PMID: 32429018 PMCID: PMC8055459 DOI: 10.31616/asj.2019.0340] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/02/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design Narrative review with a case illustration. Purpose The purpose of this study was to evaluate the pathogenesis and outcome of therapy for walking-evoked erection in patients with lumbar degenerative diseases. Overview of Literature Cauda equina compression due to lumbar degenerative diseases rarely cause a walking-evoked erection; however, no review has been undertaken of walking-evoked erection in patients with lumbar degenerative diseases. Methods A total of 1,570 male patients with lumbar degenerative diseases, who underwent surgery between April 2003 and June 2017, were evaluated; from these patients, participants with walking-evoked erection were selected. Preoperative clinical data of walking-evoked erection, paresthesia, and bladder and bowel function were assessed. In our study, the neurological status and the erectile function of each participant were retrospectively evaluated before and after surgery using the Japanese Orthopedic Association score and the Overactive Bladder Symptom Score. Results Among the 1,570 male patients screened in our department, eight patients (0.51%, 8/1,570) presented with walking-evoked erection accompanied by cauda equina symptoms. In six of the patients, the erectile symptoms were associated with paresthesia in the genitalia or perianal region. Of the six patients evaluated for bladder dysfunction, all were diagnosed with prostatic hyperplasia, while four were diagnosed with an overactive bladder. In all patients, walking-evoked erection disappeared entirely after surgery. Conclusions This study comprises the first review of walking-evoked erection in patients with lumbar degenerative diseases. We speculate that sensory input, such as paresthesia in the genitalia or perianal region stimulates the pelvic or perineal nerves through the pudendal nerve and induces reflexogenic erections.
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Affiliation(s)
- Kengo Hirota
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan.,Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Junya Hanakita
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | | | - Ryo Kanematsu
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Manabu Ueno
- Department of Urology, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Hidetoshi Kasuya
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Manabu Minami
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
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Nichols NML, Yerneni K, Chiu AB, Lu AY, Tan LA. Priapism associated with lumbar stenosis: case report and literature review. JOURNAL OF SPINE SURGERY 2020; 5:596-600. [PMID: 32043010 DOI: 10.21037/jss.2019.09.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lumbar spinal stenosis (LSS) is characterized by narrowing of the central canal, lateral recesses, or foramina leading to compression of neural tissue. The clinical syndrome associated with LSS is usually neurogenic claudication, which often presents as lower back and extremity pain, numbness, and tingling upon ambulation. Autonomic dysfunction is rarely observed in patients with LSS; however, a subset of male patients has been reported to experience intermittent priapism associated with the onset of neurogenic claudication symptoms. We present the case of a 33-year-old male who was diagnosed with LSS associated with neurogenic claudication and priapism who underwent minimally invasive decompressive surgery. Complete resolution of claudication and priapism was observed at the 6-week follow-up visit. This case report highlights minimally invasive lumbar decompression as an effective treatment for the rarely observed presentation of priapism associated with LSS.
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Affiliation(s)
| | - Ketan Yerneni
- Department of Neurosurgery, UCSF Medical Center, San Francisco, CA, USA
| | - Antoine B Chiu
- Department of Neurosurgery, UCSF Medical Center, San Francisco, CA, USA
| | - Alex Y Lu
- Department of Neurosurgery, UCSF Medical Center, San Francisco, CA, USA
| | - Lee A Tan
- Department of Neurosurgery, UCSF Medical Center, San Francisco, CA, USA
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Rahimizadeh A, Soufiani H, Williamson WL, Rahimizadeh S, Amirzadeh M, Karimi M. Intermittent penile erection in lumbar spinal stenosis: Report of four new cases and review. Surg Neurol Int 2019; 10:209. [PMID: 31768289 PMCID: PMC6826299 DOI: 10.25259/sni_368_2019] [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: 07/31/2019] [Accepted: 08/03/2019] [Indexed: 11/28/2022] Open
Abstract
Background: Lumbar spinal stenosis (LSS) classically presents with intermittent neurogenic claudication. Rarely, however, it may cause unanticipated, unpleasant, involuntary, and transient penile erections without sexual stimulation along with urinary urgency and claudication. Case Description: The authors present four males with LSS whose principal symptoms were intermittent neurogenic claudication and unanticipated erections while walking, accompanied by urinary urgency. Conclusion: There is scant literature on the topic of LSS presenting with unanticipated penile erections, urinary urgency, and neurogenic claudication.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Housain Soufiani
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Walter L Williamson
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahan Amirzadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mona Karimi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
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Santananukarn M, Pasutharnchat N. Isolated intermittent neurogenic priapism: an unusual presentation in degenerative lumbar spinal stenosis. BMJ Case Rep 2019; 12:12/4/e228107. [PMID: 30988105 DOI: 10.1136/bcr-2018-228107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Priapism is a relatively uncommon clinical presentation. The well-recognised causes are sickle cell anaemia and the use of medications, such as vasoactive erectile agents. Infrequently, it could be the result of lumbar spinal stenosis. The authors reported an elderly man with 1-year history of isolated intermittent priapism aggravated by walking. MRI showed lumbosacral spondylosis with severe stenosis at the level of L4-L5. Total laminectomy of L4 and L5 was done, resulting in a rapid and complete resolution of symptom without recurrence during the follow-up time of 10 years.
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Affiliation(s)
- Manasawan Santananukarn
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nath Pasutharnchat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Persistent Genital Arousal Disorder: Current Conceptualizations and Etiologic Mechanisms. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0122-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ridgley J, Raison N, Sheikh MI, Dasgupta P, Khan MS, Ahmed K. Ischaemic priapism: A clinical review. Turk J Urol 2017; 43:1-8. [PMID: 28270944 PMCID: PMC5330261 DOI: 10.5152/tud.2017.59458] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/06/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Ischaemic priapism is a rare condition characterised by little or no cavernosal blood flow, pain and rigidity of the penis. Immediate intervention is required to restore blood flow, prevent necrosis and erectile dysfunction. This review was conducted to determine the best course of treatment and identify areas in current guidelines to which improvements could be made. MATERIAL AND METHODS PubMed, Ovid, MEDLINE (1946-December 2016) and the Cochrane Library were searched as sources for literature. Key studies in each of the areas of management were identified and analysed. RESULTS A total of 45 articles were reviewed. The first step in treatment should be aspiration of corporeal blood. Further studies are needed to make firm recommendations as to whether irrigation should follow, as currently literature is inconclusive. If this fails to cause detumescence, sympathomimetics should be injected. The sympathomimetic of choice is phenylephrine as it is effective, specific and causes minimal cardiovascular side effects. It should be injected at a concentration of 100-500 μg/mL, with 1 mL being injected every 3-5 minutes for up to an hour (maximum 1mg in an hour). Surgical shunting is the next step, except in the cases of delayed priapism (48-72 hours duration) where immediate penile prosthesis insertion may be considered more appropriate. Distal shunts should be performed first, followed by proximal ones to minimise damage leading to erectile dysfunction. There exists little evidence recommending one shunting procedure over another. The final intervention is insertion of a penile prosthesis. Literature suggests that an inflatable prosthesis inserted immediately will yield the greatest patient satisfaction. CONCLUSION A review of the literature has highlighted areas in which further research needs to be done to make conclusive recommendations, including whether irrigation should accompany aspiration and efficacy of shunting procedures. Further studies are required to ensure that patients receive the treatment most likely to cause detumescence and maintain erectile function.
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Affiliation(s)
- Joanne Ridgley
- GKT School of Medicine, King’s College London, London, UK
| | - Nicholas Raison
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
| | | | - Prokar Dasgupta
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
| | - M. Shamim Khan
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
| | - Kamran Ahmed
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
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Korse NS, Pijpers JA, van Zwet E, Elzevier HW, Vleggeert-Lankamp CLA. Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:894-904. [PMID: 28102451 DOI: 10.1007/s00586-017-4943-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/25/2016] [Accepted: 01/02/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Even though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce. METHODS Medical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, defecation, and sexual function and possible predictors. RESULTS Seventy-five CES patients (52% men) were included with a mean age of 44 years. L5-S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days. Outcomes at second FU moment: micturition dysfunction 48%, defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2. CONCLUSION This study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, defecation, and sexual function and (3) evaluating predictors for outcome.
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Affiliation(s)
- N S Korse
- Department of Neurosurgery, Leiden University Medical Center, LUMC, Postzone J11-R-83, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - J A Pijpers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - E van Zwet
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - H W Elzevier
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - C L A Vleggeert-Lankamp
- Department of Neurosurgery, Leiden University Medical Center, LUMC, Postzone J11-R-83, Postbus 9600, 2300 RC, Leiden, The Netherlands
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Halls JE, Patel DV, Walkden M, Patel U. Priapism: pathophysiology and the role of the radiologist. Br J Radiol 2012; 85 Spec No 1:S79-85. [PMID: 22960245 DOI: 10.1259/bjr/62360925] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Priapism is defined as a penile erection that persists for 4 h or longer and is unrelated to sexual activity. Its identification is important as lack of timely treatment (particularly of the low flow/ischaemic subgroup) can result in persisting erectile dysfunction as a consequence of irreversible corporal fibrosis. This review describes the physiology and anatomy of the normal erection, the aetiology and pathophysiology of the different types of priapism, and the role of the radiologist in the management of the condition. The treatment of iatrogenic priapism following intracavernosal injection of pharmacostimulant is discussed.
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Affiliation(s)
- J E Halls
- Department of Radiology, St George's Healthcare NHS Trust, London, UK
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Abstract
Priapism is defined as a persistent penile erection (typically 4 h or longer) that is unrelated to sexual stimulation. Priapism can be classified as either ischemic or nonischemic. Ischemic priapism, the most common subtype, is typically accompanied by pain and is associated with a substantial risk of subsequent erectile dysfunction. Prompt medical attention is indicated in cases of ischemic priapism. The initial management of choice is corporal aspiration with injection of sympathomimetic agents. If medical management fails, a cavernosal shunt procedure is indicated. Stuttering (recurrent) ischemic priapism is a challenging and poorly understood condition; new management strategies currently under investigation may improve our ability to care for men with this condition. Nonischemic priapism occurs more rarely than ischemic priapism, and is most often the result of trauma. This subtype of priapism, which is generally not painful, is usually initially managed with conservative treatment.
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Abstract
INTRODUCTION Priapism is defined as an abnormal prolonged penile erection without sexual interest and failure to subside despite orgasm. The disorder is enigmatic yet devastating because of its elusive etiology, irreversible erectile tissue damage, and resultant erectile dysfunction. A wide variety of provocative factors have been implicated in different types of priapism; however, myelopathy-related ischemic priapism induced by the Valsalva maneuver in the context of spinal extradural arachnoid cyst has never been described. AIM To report a case with spinal extradural arachnoid cyst heralded by Valsalva maneuver-induced priapism and review the mechanistic basis for acute myelopathy-related priapism. METHODS The case report profiled a 42-year-old Chinese man presenting with ischemic priapism following in-flight Valsalva maneuver for unblocking the ears during descent. Magnetic resonance imaging unveiled the hidden culprit behind myelopathy-related priapism, as demonstrated by acute spinal cord compression from a giant extradural arachnoid cyst. RESULTS The symptoms subsided rapidly after treatment with ice packing, analgesics, and corporal irrigation with diluted epinephrine. However, surgical removal of the extradural arachnoid cyst failed to achieve a complete recovery of neurological deficits. After 1 year of follow-ups, he still experienced a mild weakness and hypesthesia of the right leg but no further episodes of priapism or sexual dysfunction. CONCLUSIONS Myelopathy-related priapism potentiated by the Valsalva maneuver can be easily overlooked without heightened vigilance, leading to poor therapeutic response and prognosis. The indolent nature of spinal extradural arachnoid cyst should be reinforced and better outcomes can only be achieved through expeditious diagnosis and management.
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Affiliation(s)
| | - Wei-Chi Tsai
- Department of Neurorehabilitation, Taipei, Taiwan
| | - Yu-Tzu Tsao
- Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Cherian J, Rao AR, Thwaini A, Kapasi F, Shergill IS, Samman R. Medical and surgical management of priapism. Postgrad Med J 2006; 82:89-94. [PMID: 16461470 PMCID: PMC2596691 DOI: 10.1136/pgmj.2005.037291] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Pathologically and clinically, two subtypes are seen-the high flow (non-ischaemic) variety and the low flow (ischaemic) priapism. The low flow type is more dangerous, as these patients are susceptible to greater complications and the long term recovery of erectile function is dependent on prompt and urgent intervention. Many of the causes of priapism are medical, including pharmacological agents, and as such, priapism should be considered as a medical and surgical emergency.
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Affiliation(s)
- J Cherian
- Department of Urology, Bradford Royal Infirmary, Bradford, UK
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Abstract
PURPOSE While a modest amount of medical literature has been written on the topic of priapism, reports heretofore have focused predominantly on diagnostic and management related aspects of the disorder, providing meager information in regard to its pathophysiology. Accordingly the intent of this review was to explore the etiological and pathogenic factors involved in priapism. MATERIALS AND METHODS The review entailed an overview of traditional and modern concepts that have been applied to the pathophysiology of priapism and an evaluation of assorted observational and experimental data relating to this field of study. The basic exercise consisted of a literature search using the National Library of Medicine PubMed Services, index referencing provided through the Historical Collection of the Institute of Medicine of The Johns Hopkins University and a survey of abstract proceedings from national meetings relevant to priapism. RESULTS Insight into the pathophysiology of priapism was derived from a synthesis of evolutionary clinical experiences, mythical beliefs, clinical variants and scientific advances associated with the field of priapism. The results can be summarized. 1) Clinicopathological manifestations of priapism support its basic classification into low flow (ischemic) and high flow (nonischemic) hemodynamic categories, commonly attributed to venous outflow occlusion and unregulated arterial overflow of the penis, respectively. 2) Factual information is insufficient to substantiate etiological roles for urethral infection, bladder distention, failed ejaculation, satyriasis and sleep apnea in priapism. 3) Features of the variant forms of priapism invoke changes in nervous system control of erection and penile vascular homeostasis as having pathogenic roles in the disorder. 4) Clinical therapeutic and basic science investigative studies have revealed various effector mechanisms of the erectile tissue response that may act in dysregulated fashion to subserve priapism. CONCLUSIONS This exercise suggested that, while priapism is commonly defined in terms of adverse mechanical contexts affecting penile circulation, it may also be viewed at least in some situations as an unbalanced erectile response involving derangements in possibly diverse systems of regulatory control. An integrative scientific approach that encompasses tissular, cellular and molecular levels of investigation may allow further understanding of the pathophysiology of the disorder. Ongoing elucidation of this pathophysiology can be expected to promote the development of new priapism therapies.
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Affiliation(s)
- Arthur L Burnett
- Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, 600 North Wolfe Street, Marburg 407, Baltimore, MD 21287-2411, USA
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Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine (Phila Pa 1976) 2000; 25:1515-22. [PMID: 10851100 DOI: 10.1097/00007632-200006150-00010] [Citation(s) in RCA: 238] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A meta-analysis of surgical outcomes of cauda equina syndrome secondary to lumbar disc herniation. OBJECTIVES To determine the relationship between time to decompression after onset of cauda equina syndrome and clinical outcome, and to identify preoperative variables that were associated with outcomes. SUMMARY OF BACKGROUND DATA The timing of surgical decompression for cauda equina syndrome is controversial. Although most surgeons recommend emergent decompression, results in certain studies show that delayed surgery may provide a satisfactory outcome. METHODS A meta-analysis was performed to determine the correlation between timing of decompression and clinical outcome. One hundred four citations were reviewed, and 42 met the inclusion criteria. Preoperative and postoperative data were recorded. Length of time to surgery was broken down into five groups: less than 24 hours, 24-48 hours, 2-10 days, 11 days to 1 month, and more than 1 month. Logistic regression was used to determine the association between preoperative variables and postoperative outcomes. RESULTS Outcomes were analyzed in 322 patients. Preoperative chronic back pain was associated with poorer outcomes in urinary and rectal function, and preoperative rectal dysfunction was associated with worsened outcome in urinary continence. In addition, increasing age was associated with poorer postoperative sexual function. No significant improvement in surgical outcome was identified with intervention less than 24 hours from the onset of cauda equina syndrome compared with patients treated within 24-48 hours. Similarly, no difference in outcome occurred in patients treated more than 48 hours after the onset of symptoms. Significant differences, however, were found in resolution of sensory and motor deficits as well as urinary and rectal function in patients treated within 48 hours compared with those treated more than 48 hours after onset of symptoms. CONCLUSIONS There was a significant advantage to treating patients within 48 hours versus more than 48 hours after the onset of cauda equina syndrome. A significant improvement in sensory and motor deficits as well as urinary and rectal function occurred in patients who underwent decompression within 48 hours versus after 48 hours.
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Affiliation(s)
- U M Ahn
- Departments of Orthopaedic Surgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Baba H, Maezawa Y, Furusawa N, Kawahara N, Tomita K. Lumbar spinal stenosis causing intermittent priapism. PARAPLEGIA 1995; 33:338-45. [PMID: 7644261 DOI: 10.1038/sc.1995.76] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The current report concerns the unusual symptom of intermittent priapism, or what may be termed 'involuntary penile erection', associated with proven degenerative lumbar spinal stenosis. Seven patients who were treated for intermittent claudication and spontaneous priapism during walking were studied in terms of clinical presentation, imaging findings, and some electrophysiological testing. Varying degrees of walking and standing tolerance with these unusual symptoms appeared to be correlated with cauda equina constriction as was seen by radiological imaging. Although not statistically valid, external urethral sphincter evoked electromyography suggested the possibility of monitoring the unusual symptom during walking. Surgical spinal decompression is recommended to alleviate this symptom and the claudication.
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Affiliation(s)
- H Baba
- Department of Orthopaedic Surgery, Fukui Medical School, Japan
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Saadeh IK, Illis LS, Jamshidi Fard AR, Hughes PJ, Sedgwick EM. Reversible motor and sensory neurophysiological abnormalities in cauda equina claudication. J Neurol Neurosurg Psychiatry 1994; 57:1252-4. [PMID: 7931390 PMCID: PMC485497 DOI: 10.1136/jnnp.57.10.1252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A case of cauda equina claudication with canal stenosis is presented. Neurophysiological studies show reversible changes during symptomatic and asymptomatic phases. The somatosensory evoked potential from the tibial nerve was reduced in amplitude. Central motor conduction time (CMCT) after transcranial magnetic stimulation of the brain was reversibly prolonged in the symptomatic phase. Reversible CMCT changes have not been previously shown. The findings are discussed in the light of the pathophysiology of ischaemic nerve.
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Affiliation(s)
- I K Saadeh
- Wessex Neurological Centre, Southampton University Hospital, UK
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Baba H, Furusawa N, Tanaka Y, Imura S, Tomita K. Intermittent priapism associated with lumbar spinal stenosis. INTERNATIONAL ORTHOPAEDICS 1994; 18:150-3. [PMID: 7927963 DOI: 10.1007/bf00192470] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Nine patients with intermittent priapism associated with lumbar spinal stenosis are described. They had severe intermittent claudication and priapism when walking, and 7 had sensory disturbances affecting the lumbosacral nerve roots at rest. Radiographs showed degenerative central stenosis in 6, and degenerative spondylolisthesis in 3. Seven were treated by surgical decompression and 2 refused operation. Six of the 7 had improvement in their priapism, but symptoms recurred in one as a result of spondylolisthesis developing after operation.
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Affiliation(s)
- H Baba
- Department of Orthopaedic Surgery, Fukui Medical School, Japan
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Levine JF, Saenz de Tejada I, Payton TR, Goldstein I. Recurrent prolonged erections and priapism as a sequela of priapism: pathophysiology and management. J Urol 1991; 145:764-7. [PMID: 2005696 DOI: 10.1016/s0022-5347(17)38445-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Veno-occlusive priapism may be associated with prolonged corporeal ischemia, subsequent fibrosis of the corpora and impotence. We report on 6 patients who presented with an unusual sequela of veno-occlusive priapism, recurrent episodes of prolonged erections or priapism. In all cases the subsequent episodes were idiopathic and veno-occlusive, occurred with a frequency ranging from several times per day to once per month and were symptomatically disabling. Pharmacocavernosometry ruled out mechanical occlusion of corporeal venous drainage by demonstrating elevated flows to maintain intracavernosal pressures following smooth muscle contraction and markedly decreased flow rates following smooth muscle relaxation. Treatment of the recurrent episodes with intracavernous self-injection of phenylephrine resulted in successful detumescence. The use of oral phenylpropanolamine reduced the frequency and duration of the recurrences, and markedly reduced the need for adrenergic self-injection. It is proposed that this syndrome may develop secondary to the initial ischemic episode, resulting in a functional alteration of the adrenergic and/or endothelial-mediated mechanisms that control penile tumescence and maintain penile flaccidity.
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Affiliation(s)
- J F Levine
- Department of Urology, Boston University School of Medicine, Massachusetts
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Moreland LW, López-Méndez A, Alarcón GS. Spinal stenosis: a comprehensive review of the literature. Semin Arthritis Rheum 1989; 19:127-49. [PMID: 2683093 DOI: 10.1016/0049-0172(89)90057-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- L W Moreland
- Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham
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Maurice-Williams RS, Marsh HT. Priapism as a feature of claudication of the cauda equina. SURGICAL NEUROLOGY 1985; 23:626-8. [PMID: 3992466 DOI: 10.1016/0090-3019(85)90016-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A case is reported of a man 60 years of age with degenerative stenosis of the lumbar canal at the L3-4 level and lumbar arachnoiditis, whose symptoms of claudication of the cauda equina were accompanied by uncomfortable involuntary erections. All symptoms were relieved by surgical decompression.
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