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At least 253 records · Page 14Linked to original sources
PubMed1996

Preventive treatment of priapism in sickle cell disease with oral and self-administered intracavernous injection of etilefrine.

OBJECTIVES: Priapism is a common and currently unsatisfactorily managed complication of sickle cell disease (SCD). In June 1994, 6 SCD patients received a new therapeutic regimen to prevent the occurrence and recurrence of priapism. METHODS: The patients (5 with SS and 1 with SC) were adults and had frequent episodes of stuttering priapism (SP), and two of them had had acute episodes (AP) lasting more than 3 hours. The treatment consists of preventive oral administration of the alpha-adrenergic agent etilefrine, and self-administered intracavernous injection (SICI) of the same agent to reverse episodes lasting more than 1 hour. RESULTS: Since the beginning of treatment, all patients were protected against AP, 4 patients had no recurrence with the oral treatment alone, 2 had to use SICI, 1 occasionally and 1 constantly. There was no modification of sexual activity and no complications. Blood pressure was unaffected. CONCLUSIONS: This treatment is simple, cheap, and self-administered. It should be proposed to all patients with SCD in all geographic areas as part of an educational program for active prevention of this severe complication.

Administration, Oral↗
PubMed1997

Post-traumatic priapism treated with selective cavernosal artery ligation.

Two cases of post-traumatic high-flow priapism after blunt trauma to the penis are presented. Diagnosis of high-flow priapism was accomplished with the use of both color-flow Doppler ultrasound and arteriography, which demonstrated arteriocorporal fistulas. In each patient, angiographic embolization was attempted but abandoned because the distal artery feeding the fistula could not be safely catheterized. Both patients were definitively treated with surgical ligation of the arteriovenous fistula, guided by intraoperative ultrasound. Operative management with arterial ligation provides a safe, selective, and effective alternative treatment to embolization. Two surgical approaches are discussed, one extracorporal and the other transcorporal. We believe that although transcorporal dissection poses increased risks, it is appropriate for arterial priapism of prolonged duration, especially if a well-formed vascular pseudocapsule is identified.

Adolescent↗
PubMed1998

Erythropoietin-induced recurrent veno-occlusive priapism associated with end-stage renal disease.

This is the first report of a male hemodialysis patient experiencing recurrent dialysis-associated priapism that resolved when his concurrent erythropoietin dose was reduced from 2000 to 1500 U one time per week and held if his hemoglobin was greater than 10 g/dL. We discuss dialysis-associated priapism and the effects of erythropoietin on the coagulation cascade and male hormone levels in an effort to elucidate the etiology of priapism in this patient.

Adult↗
PubMed2000

Sildenafil citrate-associated priapism.

We report the first case of priapism associated with the use of sildenafil citrate. The patient was a 28-year-old man with mild erectile dysfunction after penile trauma who self-treated with a 100-mg dose of sildenafil citrate, resulting in low-flow priapism. After aspiration and intracorporal injection of alpha-agonists, the priapism resolved. The patient's erectile function returned to his prepriapism baseline.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2000

Priapism after androstenedione intake for athletic performance enhancement.

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.

Adrenergic alpha-Agonists↗
PubMed2004

[Transitional carcinoma and malignant priapism].

Malignant priapism is rare and usually secondary to genitourinary tumors. The prognosis is poor since it generally indicates the presence of multiorgan metastasis. A case of malignant priapism or priapism secondary to penile metastasis from transitional carcinoma is presented and the literature is reviewed.

Aged↗
PubMed2002

High-flow priapism: a combined interventional approach with angiography and colour Doppler.

Traumatic high-flow priapism caused by a pathologic influx from lacerated arteries to the cavernous bodies is usually treated by transcatheter arterial embolisation. The purpose of this study was to evaluate a combined interventional approach with intraoperative perineal colour Doppler ultrasound (US) while performing the embolisation procedure. Our aim was to reduce radiation exposure and application of iodinised contrast media. To achieve an optimal position of the angiography catheter directly before or in the fistula, instead of several x-ray examinations with contrast media, a perineal colour Doppler US examination was performed while saline or US contrast media were injected through the catheter. The flow pattern allows the assessment of the occlusion of the fistula and the intact flow in the arteries that were not damaged. In four patients (unilateral fistula: 1, bilateral fistulas: 3) with traumatic high-flow priapism, this technique was performed combined with a conventional angiographic control of the embolisation. Seven embolisation sessions were performed. Only in one case, a dislocation of a microcoil required a second session. In all cases, the priapism disappeared immediately after the final session, leading to a restored erectile function. This combined approach may reduce the exposure to radiation and contrast media, especially in children, who often suffer from multiple fistulas and need more than one session. The procedure also prevents an occlusion of intact arteries that affects the penile perfusion and increases the risk of erectile dysfunction.

Adult↗
PubMed2001

An experience of percutaneous embolization to post-traumatic arterial priapism in a child.

We report an experience of percutaneous transcatheter embolization to posttraumatic arterial priapism in a child. Priapism was successfully treated with this method. Angiography with subsequent selective embolization should be considered to be the treatment of choice for arterial priapism in children as well as in adults when less invasive treatments fail.

Angiography↗
PubMed2000

Priapism of ambiguous classification in a sickle cell patient.

We report a case of recurrent priapism in a sickle cell patient who had undergone physiological transformation from a low-flow state to a mixed high-flow/low-flow picture. An oral alpha-adrenergic agonist/histamine-1 antagonist combination maintained a balance of potency without stutter in the latter state, whereas an oral alpha-adrenergic agonist in the early part of his course did not prevent priapic progression. Concomitant use of a non-steroidal anti-androgenic agent rendered him impotent despite good libido. Other etiologies should be considered in the setting of recurrent priapism and failed standard therapies; duplex ultrasound is useful in order to delineate the hemodynamics. This case supports contentions that priapism is a spectrum phenomenon, and raises questions regarding the mechanism by which alpha-adrenergic agents prevent priapic progression.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

Changing diagnostic and therapeutic concepts in high-flow priapism.

High-flow priapism (HFP) is defined as pathological increased arterial influx into the cavernosal bodies. Since 1960, 202 cases have been published in the literature. This study evaluates the effect of the changing diagnostic and therapeutic concepts. The data of 202 cases of HFP was evaluated regarding diagnostic and therapeutic procedures and long-term results. Success was defined as restored erectile function without recurrent priapism. The major etiology of HFP is trauma, especially in children or young adults; in older men, HFP is a rare event mainly caused by malignoma. Cavernosal blood-gas analysis, color-Doppler ultrasound and angiography were the most effective diagnostic tools to distinguish high- from low-flow priapism. The success rate was 20% for shunt operations and 89% for arterial embolization. In conclusion, embolization was effective in the majority of cases of traumatic HFP, while shunt surgery remained disappointing. For HFP caused by inherited diseases and malignoma conservative therapy is mandatory.

Adolescent↗
PubMedDate not supplied

Unresolved priapism secondary to tamsulosin.

Tamsulosin is the most potent adrenergic alpha-1 antagonist used for the treatment of benign prostatic hyperplasia. Priapism has been reported rarely in patients taking Prazosin, Doxazosin and Terazosin. We describe an otherwise healthy man with recurrent and then persistent unresolved priapism after the use of tamsulosin. Initial treatment consisted of aspiration and intracavernosal irrigation of iced saline and vasoconstrictive agent, but in vain. We then performed Winters procedure but that too failed and the priapism persisted. Health-care professionals should inform all patients taking such medications about rare but possible serious adverse effects.

Adrenergic alpha-Antagonists↗
PubMed2002

Etilefrine for the prevention of priapism in adult sickle cell disease.

Priapism is a common complication of sickle cell disease (SCD) that could lead to erectile dysfunction and psychosocial problems. Treatment of established fulminant priapism is usually not satisfactory. It is therefore important to prevent this complication of SCD. The alpha-adrenergic agonist etilefrine (50-100 mg/d) produced a good clinical response in 13 of 18 (72%) adults who have recurrent priapism; 17 had SCD and one sickle cell trait. After a follow-up of 1-48 months, none of the 18 people on etilefrine developed hypertension or sexual dysfunction. Similar efficacy and safety profiles of the drug have been reported previously.

Adrenergic alpha-Agonists↗
PubMed2000

Priapism in adult Nigerians.

OBJECTIVES: To review the presentation and treatment of adult Nigerians with priapism. PATIENTS AND METHODS: Thirty-five men (mean age 35 years, range 20-54) were seen over a 12-year period. All patients underwent an immediate modified or conventional cavernospongiosus shunt and were assessed at 2, 6 and 12 weeks after discharge for erection, orgasm and fibrosis of corpora cavernosa. RESULTS: Ten patients initially presented to traditional healers and 13 presented early to qualified medical practitioners, and were managed conservatively. As a result, 21 of the 35 patients presented to the author's hospital 6-10 days after the onset of erection. Many did not realise that priapism was abnormal, or had no money to attend hospital. After surgical treatment detumescence was obtained in all patients and maintained. At 12 weeks, 14 patients had normal erections, 13 reduced erections and eight no erections. A local aphrodisiac was identified as the commonest predisposing factor, followed by sickle-cell disease. CONCLUSION: This study shows clearly that even if a patient with priapism presents late, vigorous treatment in the form of an adequate shunt should be undertaken as soon as possible, as this is the only chance the patient has to regain potency.

Adult↗
PubMed2006

Tardive priapism associated with clozapine. A case report.

A man affected by schizoaffective disorder and alcohol abuse presented priapism after eleven years of clozapine treatment. After surgical intervention and resolution of priapism, he continued clozapine treatment at the same dose without problems. Clozapine withdrawal is not mandatory in patients who develop priapism in the course of treatment.

Adult↗
PubMed1987

[Angiographic, cavernosonographic and clinical differentiation of two forms of priapism with different prognoses].

Based on the findings upon arteriography, cavernosography and clinical features two different kinds of priapism are differentiated: Type I ("low flow priapism") is characterized by severe blood stasis within the corpora cavernosa and reduction of arterial perfusion through compression of the deep arteries of the penis. The penis is very hard and painful upon palpation. A delay of treatment over 48 hours will result in a damage of the corpora cavernosa and impotence. Type II ("high flow priapism") is characterized by arterial hyperperfusion. Outflow obstruction is absent. The penis is erected but of an elastic consistence, pain is absent. Even with a delay of treatment of up to 6 months the corpora cavernosa remain intact, normal erectile function is preserved.

Diagnosis, Differential↗
PubMed2002

Risperidone-induced priapism.

Priapism is well documented as a potential side effect of psychotropic medications. To date, there have been no reports of risperidone-induced priapism in the urologic literature. We report a case of risperidone-induced priapism requiring surgical treatment.

Antipsychotic Agents↗
PubMed2003

Priapism of the glans and corpus spongiosum. Report of two cases with angiography.

Priapism, whether of the arterial or veno-occlusive type, mainly affects the cavernous bodies, leaving the low-pressure system in glans and corpus spongiosum soft without urethral compression. In the present 2 case reports, the pathologically increased pressure primarily affected the corpus spongiosum. One had arterial priapism following penile revascularization and the other veno-occlusive priapism due to thrombosis of the internal pelvic veins. Both had ulcerations of the glans and urinary retention requiring suprapubic catheterization. Arteriography revealed the disease mechanism in both, and led to embolization in 1.

Adult↗