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PriapismPriapism - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Priapism Last reviewed: February 2019 Last updated: March 2018 Summary Pathological condition of persistent (>4 hours) penile erection in the absence of sexual excitation. Classified as ischaemic, non-ischaemic, or recurrent/stuttering. Diagnosis is based on history, clinical findings, and assessment of cavernous blood gases and/or colour duplex (...) ultrasound. Treatment of priapism should progress in a step-wise fashion. Ischaemic priapism warrants emergency management. First-line therapy includes therapeutic aspiration of blood with intracavernous injection of diluted alpha-adrenergic sympathomimetic agents. Surgical shunt procedures are performed in refractory cases. Non-ischaemic priapism is managed by observation. If a patient desires active treatment, selective cavernosal artery embolisation may be considered. Acute episodes of recurrent
Treatments for priapism in boys and men with sickle cell disease. Sickle cell disease comprises a group of genetic haemoglobin disorders. The predominant symptom associated with sickle cell disease is pain resulting from the occlusion of small blood vessels by abnormally 'sickle-shaped' red blood cells. There are other complications, including chronic organ damage and prolonged painful erection of the penis, known as priapism. Severity of sickle cell disease is variable, and treatment (...) is usually symptomatic. Priapism affects up to half of all men with sickle cell disease, however, there is no consistency in treatment. We therefore need to know the best way of treating this complication in order to offer an effective interventional approach to all affected individuals.To assess the benefits and risks of different treatments for stuttering (repeated short episodes) and fulminant (lasting for six hours or more) priapism in sickle cell disease.We searched the Cochrane Cystic Fibrosis
Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment İschemic Priapism: A Single-Center Experience. Ischemic priapism (IP) is a urologic emergency that requires early intervention. The main aim of IP treatment is to relieve the cavernosal pressure and provide erectile function.The aim of this study was to determine the correlation between preoperative risk factors (patient's age, duration of priapism, preoperative erectile function) and postoperative erectile (...) the occurrence of IP to surgery was 58 hours (range 24-240). In all cases, rapid resolution of the erection was achieved with the T-shunt ± tunneling procedure. In 1 patient, priapism recurred after 12 hours. Postoperative ED was reported by 16 (84.21%) patients, with degrees of mild, mild to moderate, and severe in 6, 1, and 9 of these cases, respectively. During the follow-up, the mean International Index of Erectile Function-5 (IIEF-5) score was 12.68 (range 5-23). Only 3 (15.78%) patients achieved
Resolution of Acute Priapism in Two Children with Sickle Cell Disease who Received Nitrous Oxide. Nitrous oxide (N2O) is an inhalational medication with few side effects that has anxiolytic, amnestic, potent venodilatory and mild-to-moderate analgesic properties commonly used in the emergency department (ED) setting. Priapism is a serious complication of sickle cell disease (SCD) with few treatment options and an adverse impact on quality of life. Although a 50:50 nitrous oxide/oxygen mix (...) is commonly used in France to enhance analgesia in patients with SCD and vaso-occlusive pain events (VOE) there are no reports of its use to treat priapism. We describe the effects of N2O for the treatment of acute priapism associated with SCD in a pediatric ED.This is a description of two patients with Hb-SS who presented to the ED with acute priapism that failed oral therapy. On each occasion N2O gas was utilized to help facilitate IV catheter placement.In each presentation the patients experienced
Priapism from Recreational Intracavernosal Injections in a High-Risk Metropolitan Community. Recreational use of intracavernosal injections (ICIs) is a high-risk behavior that involves sharing of these agents by men without physician regulation.To characterize the etiologies and outcomes of priapism at a Los Angeles metropolitan medical center to better understand patterns of usage of recreational ICIs and the public health implications of such practices.With institutional review board approval (...) , we retrospectively reviewed all cases of priapism presenting to the emergency room of a Los Angeles tertiary medical center from 2010 to 2018. We compared outcomes between patients who presented with priapism after recreational ICI and patients who presented with other etiologies.We describe patient characteristics, etiologies, and treatments of priapism at our institution.We identified 169 priapism encounters by 143 unique patients. Recreational ICIs accounted for 82 of the 169 priapism
The effect of an antifibrotic agent, pirfenidone, on penile erectile function in an experimental rat model of ischemic priapism. To date, no effective medical approach for the treatment of erectile dysfunction (ED) secondary to ischemic priapism (IP) has been described. The aim of this study was to evaluate the anti-inflammatory, antifibrotic, and antioxidant effects of pirfenidone (PFD) on cavernosal tissue in a rat model of IP. Forty-eight male albino rats aged 8-10 months, with mean weights
Priapism following erector spinae plane block for the treatment of a complex regional pain syndrome. Erector spinae plane block (ESPB) is a novel block where local anesthetic is deposited between the erector spinae muscle and the underlying transverse process. Safety of this technique is emphasized in the majority of reports, but with a continued increase of its use, the number of related complications and side effects is likely to expand. We report the case of a patient treated with ESPB
The first case of neonatal priapism during hypothermia for hypoxic-ischemic encephalopathy and a literature review Neonatal priapism is a rare condition with only 26 described cases in literature since 1879. It is defined as a persistent penile erection occurring in the first 28 days of life, lasting at least 4 h that usually happens in the first days (from 2 to 12 days). It is a very different condition compared to the adult one because in newborns it is a relatively benign phenomenon
Clitoral priapism due to distant clitoral metastasis of high-grade serous ovarian carcinoma: A case report and review of the literature •Cutaneous metastasis at the initial presentation of ovarian carcinoma is rare.•Clitoral metastasis in a gynecological malignancy can occasionally present as clitoral priapism.•Clitoral priapism can be treated with oral or intramuscular alpha blockade.
High-flow priapism and urinary retention 29888190 2019 02 26 2214-4420 19 2018 Jul Urology case reports Urol Case Rep High-flow priapism and urinary retention. 48-49 10.1016/j.eucr.2018.05.006 Filho Luiz G Freitas LGF Department of Urology, Hospital Santa Marcelina, Brazil. Nasser Felipe F Department of Vascular Surgery, Hospital Santa Marcelina, Brazil. Ingrund José Carlos JC Department of Vascular Surgery, Hospital Santa Marcelina, Brazil. Burihan Marcelo Calil MC Department of Vascular (...) Surgery, Hospital Santa Marcelina, Brazil. Brandão George Dias GD Department of Vascular Surgery, Hospital Santa Marcelina, Brazil. Budib Luiz J LJ Department of Urology, Hospital Santa Marcelina, Brazil. eng Case Reports 2018 05 12 United States Urol Case Rep 101626357 2214-4420 Angiography Children High-flow priapism Super-selective embolization Urinary retention 2018 04 05 2018 05 08 2018 05 10 2018 6 12 6 0 2018 6 12 6 0 2018 6 12 6 1 epublish 29888190 10.1016/j.eucr.2018.05.006 S2214-4420(18
Priapism as the initial sign in hematologic disease: Case report and literature review Priapism is an uncommon sign and sometimes considered a diagnosis challenge into systemic disease; this is defined as ≥4 h continuous penile erection, without sexual stimulation. We state that this work has been reported in line with the SCARE criteria PRESENTATION OF CASE: A Mexican 52-year-old man was brought to the emergency room with priapism of six days of evolution. His medical history reported fatigue (...) and Philadelphia translocation t(9:22) (q34;q11.2) with P210 BCR-ABL1 fusion transcriber, patient was discharged with dasatinib for maintenance phase. Actually, he has a satisfactory evolution without relapses.The majority of reported cases shows the individual importance of hematological diseases in priapism as it is shown in the analysis of the literature of 10 years (2006-2016) that we made. It is imperative to consider the type of priapism, and the genetic and demographic patient aspects due to the early
Recent advances in the management of priapismPriapism is an uncommon urological emergency that can lead to permanent impotence if prompt presentation and medical intervention is not performed. It is a breakdown of the usual physiological mechanisms controlling penile tumescence and detumescence, leading to a prolonged penile erection (>4 hours) that is unrelated to sexual stimulation. Currently, there are three accepted subtypes: ischaemic, non-ischaemic, and stuttering priapism, which is also (...) known as recurrent ischemic priapism. The aim of treatment is the immediate resolution of the painful erection and the preservation of cavernosal smooth muscle function in order to prevent cavernosal fibrosis, which can lead to penile shortening and permanent erectile dysfunction.
A Rare Case of Severe Idiopathic Stuttering Priapism in a Young Healthy Man Priapism, a persistent erection of the penis which has no association with sexual activity and lasts longer than four hours, is a urologic emergency. It can be classified into ischemic, nonischemic, and stuttering categories. The pathophysiology of stuttering priapism is not well understood; however, the dysregulation of nitric oxide and phosophodiesterase-5 (PDE5) has been put forward as a possible mechanism. A 35-year (...) -old male with a history of recurrent priapism presented with continuous penile erection for more than 48 hours. In the emergency room, penile aspiration and an intracavernous phenylephrine injection were attempted which did not help. Subsequently, a distal penile shunt was surgically created; however, the patient's symptoms still persisted. A second round of penile irrigation, aspiration, and an intracavernous phenylephrine injection were attempted, but it was not helpful. Finally, another
Malignant priapism in metastatic prostate cancer: A late event occurring early 29888172 2019 02 26 2214-4420 19 2018 Jul Urology case reports Urol Case Rep Malignant priapism in metastatic prostate cancer: A late event occurring early. 1-3 10.1016/j.eucr.2018.03.001 Barrett-Campbell Odeth O Department of Medicine, SUNY Downstate Medical Center, New York, United States. Petkovska Iva I Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States. Slovin Susan F SF (...) Genitourinary Oncology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, New York, United States. eng Case Reports 2018 03 31 United States Urol Case Rep 101626357 2214-4420 Carboplatin/docetaxel Chromogranin A MRI Malignant priapism Prostate cancer Radiation 2018 02 15 2018 03 02 2018 6 12 6 0 2018 6 12 6 0 2018 6 12 6 1 epublish 29888172 10.1016/j.eucr.2018.03.001 S2214-4420(18)30062-7 PMC5991306 Rev Urol. 2011;13(2):90-4 21935340 Urol J. 2017 Jan
Penoscrotal Decompression-Promising New Treatment Paradigm for Refractory Ischemic Priapism. For prolonged ischemic priapism, outcomes after distal shunt are poor, with only 30% success for priapic episodes lasting longer than 48 hours.To present a novel, glans-sparing approach of corporal decompression through a penoscrotal approach for cases of refractory ischemic priapism (RIP) after failed distal shunt procedures.We describe the technique and present our initial experience with penoscrotal (...) presented after a prolonged duration of priapism (median = 61 hours) after which the priapism was refractory to multiple prior treatments (median = 3, range = 1-75) including at least 1 distal shunt. MPP was inserted in 8 patients (57.1%), whereas the most recent 6 patients (42.9%) underwent PSD. All patients with PSD (6 of 6, 100%) were successfully treated with corporal decompression without additional intervention and noted immediate relief of pain postoperatively. In contrast, 37.5% of patients (3
Selective Penile Arterial Embolization Does Not Affect Long-Term Erectile Function in Patients with Non-Ischemic Priapism: An 18-Year Experience. To report long term outcomes of selective arterial embolization for nonischemic priapism on erectile function utilizing validated outcome questionnaires after selective arterial embolization.Twenty men, mean age of 36 years (range: 8-58 years), underwent selective penile embolization for nonischemic priapism between December 1997 and February 2016 (...) (218 months). Each identified case of nonischemic priapism was embolized using gelatin sponge, autologous blood clot, platinum microcoils, polyvinyl alcohol particles, or a combination of these. A variety of procedural details, immediate complications, recurrence of nonischemic priapism, post-procedure performance on Sexual Health Inventory for Men and International Index of Erectile Function Questionnaires, and follow-up duration were recorded.Mean time from development of symptoms until treatment
Daily tadalafil for the chronic phase of stuttering priapism: a case report. Recurrent (stuttering) ischemic priapism is a challenging clinical condition. Frequent recurrences result in frequent hospital admissions whereas treatment with a shunting procedure often results in erectile dysfunction.A 22-year-old man with stuttering idiopathic priapism developed erectile dysfunction (IIEF-5 score 12) following a Winter's shunt; he was given tadalafil, 5 mg/daily, for 6 months. This treatment (...) resulted in progressive restoration of erectile function in the 6 months following the shunt as well as in preventing recurrence of priapic episodes over a 24-month follow-up.This is the first report in literature of chronic treatment of stuttering priapism with a phosphodiesterase-5 inhibitor being able not only to prevent recurrent priapic episodes but also to restore erectile function following a Winter's shunt.
The Hemodynamic Effects of Intracavernosal Phenylephrine for the Treatment of Ischemic Priapism. We sought to evaluate whether the administration of phenylephrine (PE) at concentrations higher than those described in guidelines resulted in any significant changes in vital signs or impacted outcomes.After receiving institutional review board approval, we retrospectively reviewed the charts of patients presenting to our emergency department between May 1, 2014, and August 15, 2016, using (...) International Classification of Diseases, Ninth Edition and Internation Classification of Disease, Tenth Edition diagnosis codes for priapism. Treatment was reviewed, including corporal aspiration/irrigation, injection of PE, and shunt procedures. Vital signs were compared before and after treatment with PE. Baseline variables were explored with categorical data analysis (chi-squared tests, t-tests, and Mann-Whitney nonparametric tests). Where feasible, linear regression was used to evaluate