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Priapism is the abnormal persistence of erection, painful and not sexually induced. Many cases resolve spontaneously, but if it persists for a long time there is anoxic injury and fibrosis of the corporal tissues and the sequelae is impotence. The main problem with priapism is pain and the probability of a resultant impotence. We have managed 2 patients with recurrent priapism with insertion of penile prosthesis with satisfactory results.
Metastases to the penis due to a primary carcinoma of the prostate are rare. In approximately half of the patients, malignant priapism is the main symptom. This study reports on a case of malignant priapism, caused by a direct and metastatic infiltration of the corpora cavernosa by a prostatic adenocarcinoma. Sonography gave hints, the magnetic resonance imaging verified the infiltration and aspiration cytology verified the carcinoma. Hemodynamics, evaluated by Doppler sonography, and intracavernosal blood gas analysis demonstrated a mixed high-low priapism without need of therapy.
Priapism, the persistent painful erection unrelated to sexual stimuli, is called malignant whenever the priapism is due to metastases. A new case of malignant priapism, secondary to metastases of prostatic carcinoma is presented. As usual, survival was poor--our patient died 3 months after diagnosis was established.
12 patients have been treated for priapism between March 1973 and September 1977. Etiologic conditions have been found 9 times, leaving only 3 idiopathic priapisms. Treatment of choice consisted of 8 saphenocavernous shunts, achieving detumescence in 7 cases and preserving sexual potency in 5. The precocity of operation seems of no interest to priapism itself but is mandatory to prevent secondary impotence.
Priapism of the clitoris is a rare entity. A case of painful priapism is reported in a patient who had previously suffered a radical cystectomy for bladder carcinoma pT3-GIII, followed by local recurrence in the pelvis. From a symptomatic point of view she showed a good response to conservative treatment (analgesics and anxiolytics), as she refused surgical treatment. She survived 6 months from the recurrence, and died with lung metastases. The priapism did not recur. The physiopathological mechanisms involved in the process are discussed and the literature reviewed.
Priapism in childhood is most commonly a low-flow state due to sickle cell anemia. A high-flow priapism was seen in a 7-year-old boy following a straddle-injury-induced arteriocavernosal fistula. Penile aspiration, intracorporeal alpha-agonist injection and unilateral arterial embolization failed to resolve the priapism which eventually settled following a cavernosaphenous shunt.
A 29-year-old man experienced four episodes of prolonged painful erection while being treated with perphenazine for paranoid schizophrenia. Each episode of priapism lasted five hours or longer. On two occasions, aspiration of blood from the corpora cavernosa resulted in detumescence; the other episodes were successfully managed with operative shunting of blood from the congested cavernosa. Perphenazine was discontinued after the fourth episode of priapism and antipsychotic treatment with thiothixene was subsequently initiated. During 16 months of follow-up, the patient has reported normal erections without repeat episodes of priapism.
PURPOSE: To describe the effectiveness of transarterial embolization of traumatic priapism. METHODS: Six patients ranging in age from 6 to 37 years with traumatic high-flow priapism underwent superselective embolization with gelatin sponges (n=3) or minicoils (n=3). Embolization was repeated up to 3 times. RESULTS: Embolization was successful in all cases. In 2 patients, repeated embolization led to a flow reduction in the fistula, which spontaneously occluded a few days later. All patients experienced normal erections after intervention, and no side effects were observed. CONCLUSIONS: Transarterial superselective embolization is an effective and well-tolerated therapy in patients with traumatic priapism.
Priapism is characterised by the presence of prolonged, often painful penile erection in the absence of a sexual stimulus. This rare condition has a range of aetiologies, but is most common following self-administration of injection therapy for impotence. Priapism may be classified into high- and low-flow states. Low-flow priapism is an emergency ischaemic condition requiring prompt recognition and treatment to avoid devastating long-term complications of erectile dysfunction. Wide-ranging medical therapies are covered in this review. Diagnostic and treatment algorithms are suggested in light of the current available literature.
A 53 year-old Japanese man was referred to our hospital for persistent priapism, which had been induced by 200 mg (usual dose 25-50 mg) of sildenafil citrate (Viagra) three days earlier. He had a history of erectile dysfunction and had undergone penile injection therapy elsewhere; however, he had not used injection therapy this time. He obtained sildenafil personally without a doctor's prescription. He had not taken any other drugs that affect the metabolism of sildenafil, nor did he have any medical complications that might induce priapism. Since needle aspiration and irrigation were ineffective as first line therapy, surgical treatment was indicated to relieve the condition; a incision of tunica albuginea of both corpora cavernosa was made, and vigorous irrigation of saline washed out the blood clots. This is the first case report of priapism induced by sildenafil. Although this drug can be obtained through private commerce, it should be used under professional guidance as its abuse may lead to severe morbidity.
Priapism is regarded as an uncommon disease in white populations, although no previous research has been done into its incidence in a certain geographical area. All cases of priapism in Finland during the years 1975-90 are reviewed here. Its incidence varied from 0.34 to 0.52/100,000 males per year, being very stable during the whole period of 16 years, when cases due to intracorporeal injections for treatment of impotence are excluded. Typical patients were 40-50 years old, and the incidence was higher in the eastern part of the country. Most cases of priapism were seen during the lighter half of the year, between March and August (65%). The use of intracorporeally injected vasoactive drugs for impotence increased the incidence more than two-fold.
A case of priapism following oral intake of papaverine hydrochloride (300 mg) is reported. The priapism persisted after coitus. It resisted conservative treatment, but responded to aspiration of the corpora cavernosa and irrigation with phenylephrine solution. We found no earlier report of priapism induced by oral papaverine. The possible therapeutic role of oral papaverine in impotence merits study.
We reported a case of 45-year-old patient with high flow priapism secondary to arteriovenous fistula produced by perineal trauma. Diagnosis was based on the results of gasometry in cavernous blood, cavernography and pudental arteriography. Although conservative treatment had been tried, complete resolution of priapism was not obtained. We could successfully treat the priapsim by percutaneous temporary embolization of the right internal pudendal artery with Gelatin. Erection and sexual function, after 2 months of treatment, was normal. The rationale for the use of this embolization in the treatment of high flow priapism and its etiology was discussed.
We report a case of 50-year-old man with high flow priapism after blunt perineal trauma. Patient evaluation included intracavernal blood-gasometry, cavernography, color flow Doppler sonography, and internal pudendal arteriography. Although conservative treatment had been tried by an alpha-adrenergic agent, temporary effect was only obtained. We could successfully treat the priapism by percutaneous embolization of the left internal pudendal artery with autologous blood clot and Gelatin. 3 months after the embolization, erectile function of the patient recovered. High flow priapism as reported to date in the literature is also briefly reviewed.
Priapism is a pathologically prolonged and painful penile erection, usually unassociated with sexual desire or intercourse. Causes include certain oral medications, although the mechanism for drug-induced priapism is unknown. We describe two cases of priapism attributed to chlorpromazine who have presented within the past two years.
OBJECTIVE: To report our experience with the management of arterial priapism by embolization. METHODS: Two patients with arterial priapism secondary to perineal trauma are described. Diagnostic evaluation included intracorporal blood gas, echo Doppler and selective pudendal arteriographic assessment. Treatment was by selective autologous embolization. RESULTS: Detumescence was achieved and control follow-up evaluation at 12 and 24 months demonstrated normal erectile function. CONCLUSIONS: In our view, selective embolization is an effective treatment for arterial priapism arising from perineal trauma.
OBJECTIVES: To define, based on the author's experience and the data of the literature, a simple and rigorous practical approach to the management of priapism in developing countries, for which the therapeutic approach is controversial and difficult due to the rarity of this condition. MATERIAL AND METHODS: The reported series is based on 56 cases of priapism in black patients (49 adults and 7 children), observed and treated by the same operator over an 18-year period in Burkina (n = 8) and then in Chad (n = 12), Gabon (n = 19) and Niger (n = 17). The pathophysiology and aetiologies are reviewed. RESULTS: All patients treated surgically underwent various surgical techniques for diversion of the corpora cavernosa. In this group of 51 reported cases, there were 17 successes (33.3%), 5 partial results (9.8%) and 29 failures (56.8%). The overall immediate success rate, resulting in detumescence, was 36/51 (70%). These initial successes almost exclusively concerned patients treated by unilateral cavernoglandular shunt within an interval not exceeding 2 days. Although the long-term results, all treatments combined, were disappointing (56.8% of patients with sufficient follow-up are impotent), creation of a unilateral cavernoglandular fistula to the glans, based on Al Ghorab's technique, appeared to provide the best results with a success rate of 52%, i.e. 13/25 cases of priapism correctly followed. CONCLUSION: Except in the context of sickle-cell anaemia, in which concomitant aetiological treatment can be proposed, only emergency surgery is effective to avoid secondary impotence. The unilateral cavernoglandular shunt is extremely simple and, according to the author, remains the best procedure.
OBJECTIVE: Four additional cases of malignant priapism or priapism secondary to penile metastasis from urogenital tumors are presented and the literature is reviewed. METHODS: Chest and abdominal radiological evaluation, cavernosal and abdominal US, abdominal and pelvic CT and MRI, and cavernosal biopsy were performed for the localization and staging of the primary tumor. RESULTS: Conservative palliative management achieved a survival of only a few months in three of the patients with tumor dissemination to adjacent vital organs. Radical surgery was performed in one patient with tumor localized to the genital area. Currently, this patient has no clinical symptoms, although the follow-up is only 4 months. CONCLUSIONS: Malignant priapism is rare and usually secondary to GU tumors. The prognosis is poor since it generally indicates the presence of multiorgan metastasis. However, the prognosis is better for single metastasis, which is an indication for radical surgery.