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PubMed1986

Aetiological factors and management of priapism in Bristol 1978-1983.

Twenty-two patients with priapism presented in the Bristol clinical area during the period 1978-1983. Idiopathic priapism was present in eight patients only (36.4%) and identifiable causes were present in the remaining fourteen (63.6%). Fourteen various surgical shunts were carried out. Success of surgical treatment, as demonstrated by detumescence and maintenance of potency, was best achieved in those patients who were treated less than 12 hours following onset of priapism irrespective of whichever venous shunting technique was used (6 out of 7 patients--85.7%).

Adolescent↗
PubMed1979

RBC exchange pheresis for priapism in sickle cell disease.

An intermittent-flow blood cell separator was used to perform a sub-total RBC exchange pheresis with prompt relief or priapism secondary to sickle cell disease. The blood cell separator offers an efficient, practical, safe method of performing exchange transfusion in the adult. Surgical procedures in the treatment of priapism have met with limited success and carry a 50% rate of subsequent impotence. We believe that RBC exchange pheresis offers a superior approach in the treatment of complications of sickle cell crisis, including priapism, and should be instituted in the symptomatic patient before more drastic procedures are undertaken.

Adult↗
PubMed1981

Priapism after aortic valve replacement.

An unusual case of priapism is described. The cause was unknown but the onset of the condition coincided with the start of Coumadin therapy which was given orally to a 65-year-old man who had undergone aortic valve replacement. Management of this patient was difficult. Conservative measures failed, but a corpus spongiosum--cavernosum shunt successfully resolved the problem. The authors emphasize that priapism must be treated urgently if potency is to be maintained. They also consider the various possible causes and treatment of priapism.

Aged↗
PubMedDate not supplied

[Priapism; a surgical emergency].

Only emergency surgery performed within the first 36 hours can reduce priapism, which leads inevitably to impotence if unoperated. In a case of priapism, the venous return of the corpora cavernosa is prevented and so it is necessary to deflect the blood contained in the corpus cavernosum either towards the long saphenous vein, or towards the corpora spongiosa: in a case of priapism, only the corpora cavernosa are involved in irreducible erection. The two best procedures are the formation of a bilateral passage between the long saphenous vein, brought into a subcutaneous canal, with the corpora cavernosa at the base of the penis, and the inosculation of the corpora cavernosa and spongiosa, level with the perineum, just before the bulb. The shunt between the corpora cavernosa and spongiosa may ultimately be achieved quite simply by using bistoury to open a passage between the corpus cavernosum and the gland which is itself an extension of the corpora spongiosa. Cavernous radiography will register the quality of the venous return, and any resultant cavernous residual sclerosis, which is one cause of failure.

Humans↗
PubMed1996

Intracorporeal phenylephrine in the treatment of priapism.

PURPOSE: The effectiveness and complications of intracorporeal phenylephrine without aspiration or irrigation as a treatment for priapism were assessed. MATERIALS AND METHODS: Nine consecutive patients who presented with priapism were treated with 0.5 mg. phenylephrine diluted in 2 cc normal saline injected directly into the corpus cavernosum. Blood pressure and pulse were measured before and after injection, and monitored every 15 minutes. If no detumescence was noted after 15 minutes the injection was repeated. Neither penile blood aspiration nor irrigation was performed. RESULTS: Of 9 patients 8 responded with detumescence. The number of injections required ranged from 1 to 6. No changes in blood pressure, heart rate or side effects were observed. CONCLUSIONS: We believe that this is a safe and effective method for treatment of priapism. Routine initial aspiration or irrigation of the corpora before intracorporeal injection of alpha-adrenergic agents does not appear to be necessary.

Adrenergic alpha-Agonists↗
PubMed1995

[High flow priapism following a straddle-injury-induced arteriocavernosal fistula: a case report].

A 26-year-old man with high flow priapism after blunt perineal trauma, is described herein. Patient evaluation included intracavernal blood-gasometry, cavernography, color flow Doppler sonography. The blood-gasometry showed pH 7.413, pO2 77.9 mmHg, pCO2 41.0 mmHg, HCO2- 26.1 mmol/L, BE 2.0 mmol/L. By direct cavernosography, pooling of contrast agent was seen at the root of the penis. Color flow Doppler sonography revealed pulsatile, turbulent flow within left corpus cavernosum. Our case was diagnosed as high flow priapism from these findings. Detumescence was not achieved by an alpha-adrenergic agent. Superselective embolization of the deep artery of the penis with autologous blood clot was performed with good results. Our case demonstrates that this procedure is a safe and effective therapy for high flow priapism and that erectile function can return to normal.

Adult↗
PubMed1993

An unusual case of priapism.

A case of sickle cell disease with 63 documented episodes of priapism that were managed medically is presented. The case is very unusual because of the fact that despite so many episodes of priapism, he did not lose sexual potency. On the contrary, over a period of time, his penis hypertrophied. To the best of our knowledge, this is the first such case with so many episodes of priapism reported in the English literature. We present a hypothesis for such unusual occurrence.

Adult↗
PubMed1993

[Priapism. Apropos of 10 cases].

The authors report a retrospective study collecting ten cases of priapism over fifteen years. Clinical diagnosis is evident. Idiopathic priapism is most frequent of all the medical treatments available, no one seems to be efficient. Among surgical procedures draining the venous blood from the cavernous bodies, spongiocavernous shunt (Al-Ghorab) has been a simple, fast and effective method in the last five patients. Functional result depends on the age and especially on the precocity of the surgical treatment. Therefore priapism is an andrologic emergency.

Adolescent↗
PubMed1996

Evolving concepts in the diagnosis and treatment of arterial high flow priapism.

PURPOSE: We investigated 2 evolving concepts in the management of arterial priapism: 1) the efficacy of perineal duplex Doppler ultrasound as a diagnostic alternative to arteriography and 2) the therapeutic alternative of expectant management. MATERIALS AND METHODS: We evaluated 10 patients with high flow arterial priapism. RESULTS: Compared to selective internal pudendal arteriography, perineal duplex Doppler ultrasonography was associated with 100% sensitivity and 73% specificity rates. Compared to physical examination, followup duplex ultrasonography had a sensitivity of 75% and specificity of 100%. Followup penile duplex ultrasound demonstrated restoration of antegrade flow in the cavernous artery after embolization. Patients on expectant management remained potent as long as 31 years. CONCLUSIONS: Diagnostic perineal duplex Doppler ultrasonography and expectant management are valuable tools for the treatment of arterial priapism. A new algorithm for patient care is presented.

Adolescent↗
PubMed1996

Priapism associated with sickle cell hemoglobinopathy in children: long-term effects on potency.

PURPOSE: Children with sickle cell priapism have traditionally been treated conservatively with surgery done as a last resort. Only sparse subjective data are available on the long-term assessment of potency in these patients. MATERIALS AND METHODS: We retrospectively reviewed the charts of all pediatric patients with sickle cell priapism who presented to Children's Hospital of Michigan between 1972 and 1992, and subsequently assessed erectile capabilities subjectively by questionnaire and objectively by RigiScan. RESULTS: Of the 15 patients interviewed 5 had undergone shunt procedures. The return of potency tended to vary inversely with patient age at onset and duration of priapism. CONCLUSIONS: Shunts performed within 48 hours, especially in postpubertal children, seemed more likely to preserve potency.

Adolescent↗
PubMed1997

[Ambulatory treatment and prevention of priapism using alpha-agonists. Apropos of 172 cases].

From 1985 to 1995, 172 patients (149 on self intracavernous injection of vasoactive drugs, 16 with Sickle cell disease, 6 surgical patients under heparin therapy, and 1 after oral administration of trazodone), having experienced one or several episodes of priapism, lasting from 3 h to 8 days have been treated or submitted to self medication with alpha-agonist agents (eprephrine, phenylephrine or etilefrine) with an eventual drainage of the corporae. All episodes have disappeared and sexual function was preserved. A conservative treatment of priapism has been designed using corporal drainage and intracavernous etilefrine for acute priapism; as well as preventive treatment for those of the patients exposed to Sickle cell disease to avoid surgery and its frequent fribrotic sequelae, leading to impotence in 50% of the cases.

Adolescent↗
PubMed1998

[Priapism in adults. 16 cases].

Priapism is a rare disease, characterized by prolonged, painful and irreducible erection, not resulting in ejaculation. It is an andrological emergency with a poor prognosis, as the risk of impotence is 50% despite appropriate management. Treatment is essentially surgical. The authors report their experience of 16 cases of priapism observed over a 15-year period. The mean age of the patients was 36 years (range: 21 to 56 years). The diagnosis was clinical. The mean time to consultation was 8 days (range: 1-28 days). Priapism was secondary to neuroleptics in 6 cases (37%), chronic myeloid leukaemia in 2 cases, sickle-cell anaemia in one case, radiotherapy in 1 case and the cause remained unknown in 6 cases (37%). Treatment was surgical in every case and consisted of spongiocavernous anastomosis in 11 patients (Winter's procedure in 1 case, Al-Ghorab's procedure in 6 cases and transperineal in 4 cases, with saphenocavernous anastomosis in 5 cases). The overall failure rate of surgical treatment was 37%. The success rate of spongiocavernous fistula was 70% and the authors preferred the Al-Ghorab type of spongiocavernous fistula.

Adult↗
PubMed1998

[Posttraumatic priapism in a 6-year-old boy: a case report].

A 6-year-old boy showed priapism after blunt perineal trauma. We diagnosed him with venous priapism mainly based on clinical symptoms, although we could not deny an arterial type. In fear of possible erectile dysfunction as a late complication of the venous type, we performed a shunt operation. The shunt was created between glans penis and corporacavernosa, resulting in disappearance of priapism and preservation of erectile function. We also reviewed 14 cases reported previously.

Child↗
PubMed2004

Transitional cell carcinoma presenting as clitoral priapism.

BACKGROUND: Clitoral priapism is an uncommon cause of clitoromegaly. It should be suspected in the absence of hirsuitism and the presence of clitoral engorgement, pain, and local irritation. CASE: A 48-year-old female had a straight catheterization of her bladder for a history of frequent urinary tract infections. She was noted to have a clitoral size of 5 x 2.5 cm along with the classic findings of priapism. She had an 8 x 10 cm pelvic mass that was biopsied and revealed transitional cell carcinoma with papillary squamous component. CONCLUSION: Clitoral priapism presents with clitoral engorgement in the absence of sexual stimulation. The most common etiologies include medications, pelvic tumors, blood dyscrasias, or retroperitoneal fibrosis. A thorough investigation is warranted to identify potential pelvic venous or lymphatic obstruction.

Carcinoma, Transitional Cell↗
PubMed1996

Priapism following splenectomy in an unstable hemoglobin: hemoglobin Olmsted beta 141 (H19) Leu-->Arg.

We report a case of severe priapism occurring in a patient with an unstable hemoglobin, Hb Olmsted (beta 141 Leu-->Arg) This is a rare hemoglobin variant, which until now has been reported only once. The clinical course of the 12-year-old boy was characterized by severe hemolytic anemia leading to splenectomy and cholecystectomy at the of 3.5 years. The priapism occurred 8 years after splenectomy, during a hemolytic febrile episode and required aspiration of the corpora cavernosa. This report raises the question of the benefit of splenectomy in patients suffering from a chronic hemolytic anemia such as that due to an unstable hemoglobin. This treatment lowers the frequency and the severity of acute hemolytic attacks, but several cases of vascular complications have been reported after splenectomy.

Anemia, Hemolytic↗
PubMed1980

Priapism complicating chronic granulocytic leukemia.

Since 1952 we have seen nine patients with priapism leading to a diagnosis of chronic granulocytic leukemia (CGL) and a tenth patient who gave a history of priapism when CGL was diagnosed as a result of other symptoms. Seven patients had had one or more transient episodes of prolonged erection before the diagnosis of CGL was established. All ten had high blood leukocyte counts (mean 380 X 10(9)/liter, range 186-782) in comparison with other newly diagnosed patients. We estimate the incidence of this complication at 1%-2% of all male patients presenting with CGL. Treatment of patients in this series varied greatly. Five patients were treated mainly by local measures with r without cytotoxic drugs at conventional dosage, three were treated by sapheno-cavernous bypass operations and leukapheresis followed by cytotoxic drugs at high dosage, and two were treated initially by leukapheresis alone. In general, the prompt initiation of measures designed to reduce the leukocyte count seemed more valuable than the surgical procedures employed in these patients.

Adolescent↗
PubMedDate not supplied

Post-traumatic high-flow priapism: management by superselective transcatheter autologous clot embolization and duplex sonography-guided compression.

High-flow priapism is caused by uncontrolled arterial inflow into the penis, often from direct arterial trauma. We report a case of arterial or high-flow priapism that was treated with a combination of selective transcatheter autologous clot embolization and duplex sonography-guided compression therapy. Sonography showed a pulsatile, anechoic area at the base of the penis inside the left corpus cavernosum after blunt perineal trauma, and color Doppler examination revealed an arteriosinusoidal fistula. Autologous clot embolization was only partially successful, and 3 sessions of ultrasound-guided compression therapy were necessary to achieve complete thrombus formation in the fistulous tract, which became isoechoic a day after compression therapy.

Adult↗
PubMed1991

Induced priapism and its management.

The authors present the seamy side of the beneficial practice to handle erectile impotence with papaverine or with the papaverine-Regitin combination. Attention is called to danger. The various forms of priapism are defined. In connection with 72 cases of priapism the attained results and the way to stop the priapic condition are described.

Dopamine↗