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Priapism

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761. Temporary Cavernosal-Cephalic Vein Shunt in Low-Flow Priapism Treatment. (Abstract)

Temporary Cavernosal-Cephalic Vein Shunt in Low-Flow Priapism Treatment. Surgical shunting might be considered as the only option in the treatment of extended ischemic priapism that does not respond to aspiration and medication.A modified, simple, minimally invasive, and easily applicable artificial cavernosal-venous shunt technique for treating priapism is described in this report.A total of 15 patients with extended and nonresponsive low-flow priapism were treated with this technique between (...) January 1998 and February 2007.When the conservative treatment of low-flow priapism does not yield the expected results, then the temporary cavernosal-cephalic vein shunt should be applied. The standard equipment required for this modified technique includes three angiocaths, two shorn blood serum sets, and saline solution with heparin. The blood in the cavernosa and the saline solution infusion are incorporated into the systemic circulation with the aid of serum sets and angiocaths.Priapism duration

2008 European Urology

762. The Immediate Insertion of a Penile Prosthesis for Acute Ischaemic Priapism. (Abstract)

The Immediate Insertion of a Penile Prosthesis for Acute Ischaemic Priapism. Ischaemic priapism (IP), which is refractory to conventional medical and surgical intervention, results in necrosis of the corpus cavernosum smooth muscle. These patients eventually develop a variable degree of corporal smooth muscle fibrosis that presents as erectile dysfunction and penile shortening.To evaluate the long-term outcome of patients who have undergone the immediate insertion of a penile prosthesis (...) as a treatment for an acute episode of IP refractory to medical therapy or shunt surgery.A total of 50 patients presented with prolonged IP that was unresponsive to conventional treatment. Unsuccessful shunt surgery had been performed in 13 patients. All patients had evidence of cavernosal smooth muscle necrosis and, therefore, underwent an immediate insertion of a penile prosthesis in the acute setting.Mean age, duration of priapism in hours, intraoperative and postoperative complications, the surgical

2008 European Urology

763. Posttraumatic high-flow priapism in children: noninvasive treatment by color Doppler ultrasound-guided perineal compression. (Abstract)

Posttraumatic high-flow priapism in children: noninvasive treatment by color Doppler ultrasound-guided perineal compression. To our knowledge, only 1 case has been reported of high-flow priapism in boys younger than 6 years of age and only a small number of prepubertal boys have had high-flow priapism. Because of this, the diagnostic and therapeutic procedures are still under discussion. We report a case of a 3-year-old boy with posttraumatic high-flow priapism treated by ultrasound-guided

2007 Urology

764. Tadalafil-associated priapism. (Abstract)

Tadalafil-associated priapism. A healthy 46-year-old man presented to the Emergency Department with a 36-hour history of persistent, painful erection after taking the cyclic guanylyl monophosphate-specific phosphodiesterase 5 inhibitor tadalafil. He had no other identified contributing factors for priapism. After confirmation of ischemic priapism and failure of bedside management in the Emergency Department, the patient underwent operative caverno-spongiosal shunting. Postoperatively (...) , the erection initially rebounded but gradually receded with manual compression over 48 hours. At outpatient follow-up, the patient remained flaccid without erections. To our knowledge, this is the first report of tadalafil-associated priapism.

2005 Urology

765. Intracavernosal etilefrine self-injection therapy for recurrent priapism: one decade of follow-up. (Abstract)

Intracavernosal etilefrine self-injection therapy for recurrent priapism: one decade of follow-up. Recurrent idiopathic priapism is a rare condition that, if not properly treated, may lead to impaired quality of life and erectile dysfunction. Treatment can be achieved by prevention of priapism episodes with systemic therapy or by early intervention with intracavernosal self-injection of sympathomimetic agents. We describe a case of a young patient with recurrent idiopathic priapism who has used

2005 Urology

766. Conservative management of priapism in acute spinal cord injury. (Abstract)

Conservative management of priapism in acute spinal cord injury. To perform a retrospective chart review of priapism as a complication of spinal cord injury and review the management and follow-up. Priapism is a known complication of acute spinal cord injury, but little has been written concerning the management of this condition.A retrospective chart review (1992 through 2002) was performed for all patients with a diagnosis of priapism. Of these patients, 6 had priapism in the setting of acute (...) spinal cord injury without pelvic trauma. We reviewed the management of the priapism in these cases, and follow-up was attempted in each case.Of the 6 patients with spinal cord injury-related priapism, 4 had spinal cord injury located at C5-C7, 1 at C5-C6, and 1 at T12. The prolonged erections were managed conservatively in 4 patients and irrigated with intracorporeal phenylephrine in 2. All patients with corporal blood gas measurement (n = 4) had nonischemic priapism. All 4 patients who underwent

2005 Urology

767. High-flow priapism: superselective cavernous artery embolization with microcoils. (Abstract)

High-flow priapism: superselective cavernous artery embolization with microcoils. To determine the effectiveness of superselective cavernous artery embolization.Eight patients with high-flow priapism were included in this study. All were treated by superselective cavernous artery embolization with microcoils and gelatin sponges. The follow-up examinations consisted of color duplex ultrasonography. The International Index of Erectile Function 5-item questionnaire was used to investigate (...) the patients' erectile function before the onset of priapism, at embolization, and 6 months after embolization.A unilateral cavernous fistula was found in 7 patients and bilateral fistulas in 1. Of the 8 patients, 2 (1 with unilateral and 1 with bilateral fistulas) initially underwent embolization with a gelatin sponge but presented with recurrence of tumescence 1 week after treatment and required a repeat embolization procedure with microcoils. The other 6 patients (75%) were successfully detumescent

2008 Urology

768. Three-chamber priapism in a patient with primary epithelioid hemangioendothelioma of penis. (Abstract)

Three-chamber priapism in a patient with primary epithelioid hemangioendothelioma of penis. A 58-year-old man presented with a 6-month history of painful progressive penile firmness, initially diagnosed as Peyronie's disease. Penile fibrosis involved the entire corpora cavernosa and spongiosum, making it consistent with three-chamber priapism. Cavernosal biopsies revealed epithelioid hemangioendothelioma, and the metastatic workup found hepatic and pulmonary lesions. The patient was treated

2004 Urology

769. Idiopathic stuttering priapism: recovery of detumescence mechanism with temporal use of antiandrogen. (Abstract)

Idiopathic stuttering priapism: recovery of detumescence mechanism with temporal use of antiandrogen. We report a case of idiopathic stuttering priapism in a 56-year-old Japanese man. We treated his recurrent priapism in stepwise fashion by withdrawal of the alpha/beta-blocker he used for hypertension, administration of low doses of an antiandrogen and baclofen, and finally by increasing the dose of antiandrogen, which lowered his testosterone to the castration level and was effective (...) in preventing priapism. After 6 months of antiandrogen treatment, his erectile function gradually recovered to the baseline level, and he had no recurrence of priapism during the following 6 months without any medication.

2004 Urology

770. Treatment of posttraumatic high-flow priapism in 8-year-old boy with percutaneous ultrasound-guided thrombin injection. (Abstract)

Treatment of posttraumatic high-flow priapism in 8-year-old boy with percutaneous ultrasound-guided thrombin injection. Treatment of high-flow priapism varies and has included transcatheter embolization when conservative approaches fail. We present the case of an 8-year-old boy with high-flow priapism, who was treated with ultrasound-guided thrombin injection because of encouraging experience with the method obtained when treating aneurysms and pseudoaneurysms. This procedure appears

2007 Urology

771. Stuttering priapism after ingestion of alfuzosin. (Abstract)

Stuttering priapism after ingestion of alfuzosin. A patient who presented with priapism after ingestion of alfuzosin is described. He presented with recurrent priapism, which was relieved temporarily after physical exercise. It did not subside with pharmacologic management and was managed surgically using Winter's procedure. It remained quiescent for a short period, only to reappear later. After additional conservative management, he was well enough to be discharged. At 12 months of follow-up

2006 Urology

772. Stuttering priapism associated with withdrawal from sustained-release methylphenidate. (Abstract)

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.

2004 Journal of Pediatrics

773. Sexual function after highly selective embolization of cavernous artery in patients with high flow priapism: long-term followup. (Abstract)

Sexual function after highly selective embolization of cavernous artery in patients with high flow priapism: long-term followup. We present 15 cases of high flow priapism treated by selective embolization and evaluate erectile function at long-term followup.Between 1995 and 2001, 15 patients underwent highly selective embolization of the cavernous artery for high flow priapism. Trauma was reported by 12 of the 15 patients, and no etiologic causes were evident in the other 3. The fistula (...) not conclusive and a surgical operation was required. The IIEF results showed that sexual function was in the normal range in 80% of patients. Three patients (20%) reported a slight change in the quality of erection. Mean postoperative IIEF score was 26.3 (range 18 to 30).Highly selective embolization of the fistula is an effective and safe treatment option for high flow priapism because it ensures a high level of preservation of pretreatment erectile function.

2004 Journal of Urology

774. Use of antivenin to treat priapism after a black widow spider bite. (Abstract)

Use of antivenin to treat priapism after a black widow spider bite. Black widow spider envenomation (BWSE) is commonly associated with severe abdominal pain, muscle cramping, and hypertension. Treatment is primarily symptomatic with the use of opiates and benzodiazepines. Priapism is a complication of BWSE that has only rarely been reported. We describe a 17-month-old male who developed priapism after known BWSE. His priapism did not respond to opiates or benzodiazepines, and he was treated (...) with black widow spider antivenin. Complete detumescence followed within several hours. The patient required no additional opiates for pain and was discharged from the hospital the following day. The patient's rapid improvement after antivenin suggests its efficacy in treating BWSE-associated priapism.

2004 Pediatrics

775. Priapism associated with the switch from oral to injectable risperidone. (Abstract)

Priapism associated with the switch from oral to injectable risperidone. Priapism is a rare, but serious, side effect of psychotropic medications. Psychotropic medication-induced priapism is believed to be caused by the alpha-adrenergic antagonism of these medications. Among the atypical antipsychotics, cases of priapism or prolonged erection have been associated with clozapine, olanzapine, risperidone, and quetiapine. Risperidone has primarily serotonergic, dopaminergic, and alpha-adrenergic (...) antagonist properties. It has one of the highest affinities for the alpha1-adrenergic receptor blockade among the atypical antipsychotics. To date, there are 17 case reports of risperidone-associated priapism either in monotherapy or in combination with other psychotropics. To our knowledge, there are no published case reports of priapism on the injectable preparation of risperidone. We report a case of a 50-year-old man who developed priapism while being switched from the oral to the intramuscular

2006 Journal of Clinical Psychopharmacology

776. Juvenile posttraumatic high-flow priapism: current management dilemmas. (Abstract)

Juvenile posttraumatic high-flow priapism: current management dilemmas. High-flow priapism results from disruption of the intercavernosal artery resulting in an arteriocavernosal fistula and is rarely encountered in the pediatric and adolescent population. Clinically it manifests as a painless, prolonged erection after perineal trauma. Treatment has ranged from expectant management to open surgical exploration with vessel ligation. Internal pudendal arteriogram and superselective embolization (...) with autologous blood clot has emerged as a safe and effective treatment modality in the young male population. Here the authors present 3 patients with high-flow priapism and discuss management of this rare clinical entity.

2005 Journal of Pediatric Surgery

777. An alternative noninvasive approach for the treatment of high-flow priapism in a child: duplex ultrasound-guided compression. (Abstract)

An alternative noninvasive approach for the treatment of high-flow priapism in a child: duplex ultrasound-guided compression. We are presenting a 5-year-old boy with a traumatic high-flow priapism developed after a straddle injury and successfully treated by compression and simultaneous monitoring with a duplex ultrasound probe. We believe that this may be an alternative method against conventional treatment modalities including conservative follow-up, sympathomimetic drug administration

2006 Journal of Pediatric Surgery

778. A modification of Winter's shunt in the treatment of pediatric low-flow priapism. (Abstract)

A modification of Winter's shunt in the treatment of pediatric low-flow priapism. Cavernous shunt operations available for treating priapism are frequently unsuitable for children owing to high chances of persistent venous leak that results in postoperative erectile dysfunction. In this article, a modification of Winter's shunt, which is suitable for treating low-flow priapism in children, is described.Using a large bore needle, multiple punctures were made in the tip of corpora cavernosa (...) through the glans. The needle tracks functioned as temporary cavernoglandular fistula thereby, causing detumescence. This modified technique was used in 7 children all of whom had ischemic priapism. The age range was 9 months to 17 years, and the mean duration of symptom was 11 hours (range, 5-20 hours).In all the patients, priapism was successfully relieved by the modified technique. Immediate recurrence of priapism was noted in only one patient. In 5 patients for whom adequate follow-up details

2008 Journal of Pediatric Surgery

779. Appendicitis and low-flow priapism in children. (Abstract)

Appendicitis and low-flow priapism in children. Priapism is a sustained erection that is maintained for over 4 hours in the absence of sexual stimulation [Postgrad Med J. 2006;82(964):89-94; J Urol. 2003;170:1318-1324]. Distinction is made between low- and high-flow variants [J Urol. 2003;170:1318-1324; Cardiovasc Intervent Radiol. 2002;25(4):326-329]. Low-flow priapism (LFP) and acute appendicitis are rarely associated. Including ours, there are 4 cases reported in the literature, all of which

2008 Journal of Pediatric Surgery

780. Pediatric high-flow priapism and super-selective angiography--an Australian perspective. (Abstract)

Pediatric high-flow priapism and super-selective angiography--an Australian perspective. High-flow priapism is an uncommon entity in the pediatric and adolescent population. It is usually caused by perineal trauma. Here we describe the experience of our institution in this condition over the past 10 years, the various treatment options available, and the successful application of super-selective angiographic embolization as our treatment modality of choice. Included here is the case of a 4-year

2008 Journal of Pediatric Surgery

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