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Priapism may be classified as the classical veno-occlusive form or the more recently described high flow, arterial type. We report a case of posttraumatic arterial priapism in a 7-year-old boy. The successful management with percutaneous transcatheter embolization of the internal pudendal artery is described.
In a therapeutic attempt on an 18-year-old patient with iatrogenic priapism lasting for more than 2 weeks after internal urethrotomy, intracavernous lysis was commenced with 80,000 IU streptokinase per hour. Following a dosage of 300,000 IU streptokinase the lysis was stopped because of severe bleeding from the urethrotomy scar. At 4 weeks after the patient was discharged from the hospital he reported normal erections and intercourse, while single potential analysis of cavernous electrical activity and ultrasound returned to normal. Provided there are no contraindications, intracavernous lysis seems to be an effective treatment for long-lasting priapism induced by intracavernous thrombosis.
Pharmacological prolonged erections or priapism due to anesthesia were treated in 36 patients with intracorporeal injections of phenylephrine. Detumescence was obtained rapidly in every case and no marked side effect was reported. Considering the possible toxicity of other adrenergic agents, phenylephrine is strongly recommended in the treatment of priapism.
High flow priapism is often treated effectively with intracavernous vasoconstrictive agents or surgical shunting. If these maneuvers fail treatment is unclear. A 21-year-old black man, who had failed previous pharmacological and surgical therapies, temporarily (8 hours) responded to intracavernous methylene blue, which is known to antagonize endothelial derived relaxation factor. Recurrent priapism was managed successfully by embolization of the left internal pudendal artery with absorbable gelatin sponge. Review of the literature reveals that only 7 patients have been managed with arterial embolization and our case represents the first in which intracavernous methylene blue produced detumescence.
To our knowledge we report the first 2 cases of priapism occurring in hypogonadal men receiving gonadotropin releasing hormone therapy. Hypogonadal patients receiving hormonal therapy should be informed about the possibility of priapism and the importance of early urological consultation.
Priapism is a recognized complication of intracavernous self-injection of vasoactive agents for the management of impotence. We report a case of heterotopic bone formation in the corpus cavernosum of a patient with papaverine-induced priapism.
Cocaine abuse has escalated to epidemic proportions in the United States. In addition to the social and economic problems associated with the recreational use of this agent, a variety of medical complications have been reported. The occurrence of priapism with intranasal use has not been documented previously. We report a case of priapism secondary to intranasal cocaine abuse and describe the possible neurochemical etiology for this phenomenon.
We report our experience with 18 consecutive cases of priapism treated with intracorporeal irrigations of dilute epinephrine solution. Of the 18 patients 16 were treated successfully. The 2 failures had priapism 36 hours and 5 days in duration, respectively.
The recent finding of terbutaline as the treatment of choice to manage intraoperative penile tumescence with the patient under anesthesia (general and regional) has prompted us to use this beta-2 agonist (5 mg. orally) for persistent penile erection and priapism resulting from injection of pharmacological agents, such as phentolamine, phenoxybenzamine and papavarine, into the penis for erectile impotence. The drug also has been used successfully (0.25 to 0.5 mg. intravenously or subcutaneously) to treat priapism developing despite a cavernosum-spongiosum shunt procedure. This and other pure beta 2 agonists will have an important role in the treatment of undesirable and painful penile erection, alone or in association with other invasive and noninvasive intervention.
Prompt relief of priapism is essential to prevent importance. We report a case of priapism treated rapidly and effectively with intracorporeal epinephrine.
To investigate the mechanism of drug-induced priapism, we gave the antipsychotic agent chlorpromazine and the antidepressant trazodone to 14 dogs by intravenous and intracorporeal injection. Bilateral intracorporeal pressure, blood flow within the internal pudendal artery, and systemic blood pressure were monitored. Venous outflow restriction was evaluated by continuous saline infusion of the corpus cavernosum with the infrarenal aorta clamped. When delivered by intracorporeal injection, both drugs induced erection in a manner similar to that of intracorporeal injection of papaverine. Internal pudendal arterial flow increased slightly at the beginning of tumescence, and excellent venous restriction occurred. Intravenous injection, however, could neither induce an erection nor facilitate an erection after sub-threshold neurostimulation. We believe that the alpha-adrenergic antagonist properties of chlorpromazine and trazodone probably cause priapism by local action.
We report 2 cases of successful treatment of priapism by transcatheter embolization of the internal pudendal arteries. Recovery of penile blood flow was confirmed by Doppler flowmetry and potency was preserved. Embolization with autologous clot is at least partially reversible and interventional angiography warrants consideration in the treatment of priapism.
Priapism is a rare but recognized complication of certain antihypertensive agents. An association between the antihypertensive, prazosin, and priapism has been reported in the European literature but not in the American urologic literature.
A case is described of idiopathic priapism successfully treated by transcatheter embolization of the left internal pudendal artery with autologous clots. The rationale for the use of this new approach in the treatment of priapism is discussed briefly.
A 26-year-old man with post-traumatic priapism was treated successfully by occlusion of the left internal pudendal artery with an autologous clot. The recovery was marked by the return of entirely normal sexual function. This excellent result suggests that autologous clot injection of the internal pudental artery should be considered as an appropriate form of therapy for the treatment of selected patients with priapism.
Deep and superficial dorsal vein to corpus cavernosum shunts successfully relieved priapism lasting 6 and 3 1/2 days in 2 patients. Since the procedures are anatomically sound, require a small surgical field, do not require saphenous vein mobilization and cannot result in a urethrocutaneous fistula further, clinical trials are warranted. If this brief procedure is unsuccessful in relieving priapism corpus cavernosum to saphenous vein or corpus cavernosum to corpus spongiosum shunts can be accomplished without again preparing or positioning the patient.
A case of congenital non-spherocytic hemolytic anemia of unknown etiology is described. The patient had priapism and further hematologic evaluation revealed a glucose phosphate isomerase deficiency. This is the first report of priapism secondary to a defect of erythrocyte metabolism.
During a 10-year period 11 cases of priapism were treated with a saphenocavernous bypass. Uniformly good functional results were obtained if the procedure was done within 36 hours of the commencement of priapism. Prior aspiration and irrigation appear to lengthen this interval. The formation of temporary cavernovenous communication with the superficial venous system of the penis by aspiration and irrigation with large needles is demonstrated and is postulated as a mechanism by which this method of treatment alone is occasionally successful. Persisting graft patency has been associated with impotence. If erection does not occur within 3 months of the saphenous bypass the shunt should be ligated.