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Intracavernous papaverine injection has gained widespread acceptance in the treatment of erectile impotence. The opposite problem--priapism--can be treated with the same technique using a vasoconstrictive drug such as adrenaline. We report on eight patients successfully treated for priapism by intracavernous injection of adrenaline.
Penile fracture commonly results from trauma of sexual intercourse or masturbation. It is common in the Middle East and America, but rare in Nigeria and sub-Sahara Africa. We present a case of penile fracture, an uncommon urologic emergency, complicating priapism, another urologic emergency; precipitated in an unusual circumstance. This report illustrates a 30-year-old undergraduate who has suffered stuttering priapism for about a week and developed penile fracture while forcefully packing the erect organ. He presented early in the hospital and had emergency surgical repair. Prognosis was good. A review of literature is also presented. Immediate surgical repair offers good prognosis in the management of this emergency.
The patient was a 19-year-old man who was examined due to persistent penile erection, which appeared following a blow to the perineal region during work. Color Doppler ultrasonography of the corpora cavernosa revealed a cavity in one part of the cavernous artery that suggested a blood leak, and a diagnosis of high flow type priapism due to trauma was made. Bilateral internal pudendal arteriography demonstrated dilation and extravasation in one part of the right cavernous artery, then transarterial embolization was performed superselectively in the right cavernous artery using an autologous clot. However, 2 weeks after treatment, slight penile erection reoccurred. Color Doppler ultrasonography revealed reformation of the cavity at the treated lesion, and embolization was again performed using a gelatin sponge. Following embolization, the course proceeded satisfactorily without any relapse. Color Doppler ultrasonography, which is non-invasive and can be easily performed, is considered to be an effective means for diagnosis and follow up of arterial high flow priapism.
We report on a 23 year old patient with high flow priapism following blunt perineal trauma in which arterial-cavernosal fistula was missed by penile Doppler ultrasonography but was successfully localized by arteriography and embolized using Gelfoam pledgets. Detumescence was complete in 2 days and sexual function returned to the premorbid state after 4 weeks. The diagnosis, pathophysiology, and treatment of high flow priapism and review of the literature are discussed.
We report a case of high flow priapism secondary to arteriovenous fistula produced by perineal trauma in a 43-year-old patient. Diagnosis was based on the result of gasometry in cavernous blood and color doppler sonography. Superselective embolization of the deep artery of the penis was performed with good results. After 6 months of treatment, erection and sexual function were normal. Our case demonstrates that this procedure is a safe and effective therapy for high flow priapism.
The data of patients treated for priapism in the Department of Urology of Semmelveis University Medical School between 1951 and 1971 are analyzed. Eleven patients were hospitalized and three were outpatients. After a brief survey of the literature, mechanism, aetiology and treatment of the condition are discussed. In the majority of the patients after the cessation of priapism sexual libido returned as a rule without the appearance of erection. Three cases are briefly described. In four patients after some time partial erection and orgasm was experienced under mechanical influence. Two of these patients had married and have children.
OBJECTIVES: To report a case of high flow priapism and to review its diagnostic methodology and treatment options. METHODS: A 25-year-old patient consulted with prolonged erection after penile trauma. Colour Doppler ultrasound and angiogram were performed to confirm diagnosis. Cavernous artery selective embolization with reabsorbable material was performed. RESULTS: The case was resolved, and erectile function recovered. CONCLUSIONS: Colour Doppler ultrasound allows to diagnose high flow priapism. Angiography, in addition to diagnosis confirmation, allows performing selective cavernous artery embolization, which is currently the treatment of choice because it resolves the clinical picture preserving erectile function.
In medicine, priapism is defined as pathological state: a prolonged, generally painful erection not accompanied by sexual desire not ending with an ejaculation. Rare before 1980, priapism became more frequent after introduction of erection-inducing drugs by intracavernosal injections for treatment of impotence. Therefore, the medical practitioner can be faced with this problem, and the authors present with an algorithm the current diagnostic and therapeutic steps based on knowledge of pathology, physiopathology and etiology of this disease.
Some cases of idiopathic priapism are due to uncontrolled, penile arterial inflow. These cases can be successfully treated by percutaneous transcatheter embolization of one or both internal pudendal arteries. Autologous clot is ideal for embolization as it permits revascularization and helps avoid impotence. The authors describe a 10-day old case of refractory priapism which was successfully treated angiographically.
OBJECTIVES: To report one case of metachronous recurrence of idiopathic high flow priapism. METHODS. We describe the case of a 28-year-old male patient who presents with penile partial tumescence which started 10 hours before and history of a similar episode seven years before. Physical examination confirmed the clinical picture, with mild local discomfort on palpation. Blood tests were normal. Cavernous blood gases were compatible with arterial blood O2 saturation levels. The patient had a satisfactory progressive response to oral administration of diazepam. No pathologic findings were seen at the time of arteriography. RESULTS: Complete resolution of the episode. Erectile function was satisfactorily preserved. There was no relapse after one year of follow-up. CONCLUSIONS: We remark the validity of a deferred therapeutic attitude in front of pictures of high flow priapism, as well as the possibility of resolution with conservative measures. We emphasize the peculiarities of this case, mainly its idiopathic character and the metachronous recurrence.
We report a case of a 73 year-old male diagnosed with T1 N0 M0 prostate cancer, Gleason score 7, undergoing a course of radical radiotherapy using 7600 cGY delivered in 38 fractions. Several hours after receiving his 27th fraction, he reported experiencing a painful penile erection lasting more than 6 hours. A history and several investigations were conducted to determine the etiology of this adverse event. Although several possible etiologies were considered, the two most likely possibilities were direct prostate-irradiation and/or his use of alfuzosin, a novel alpha 1-adrenergic antagonist. A literature search revealed one case of priapism secondary to radiotherapy as well as reports of priapism associated with drugs similar to alfuzosin.
A 48-year-old man, who previously had normal erectile function, visited our hospital complaining of a painless erection that had persisted for 6 days. He had suffered perineal trauma in a traffic accident 9 days earlier. A diagnosis of post-traumatic high-flow priapism was suggested from the findings on penile blood gas analysis. Selective internal pudendal arteriography showed an arterial blush along the bilateral cavernous arteries. Subsequently, embolization of a cavernous fistula was performed with an autologous clot. However, the embolus was removed within a minute, so the procedure was repeated with Gelfoam. This patient had normal erectile function after 11 months, with no recurrence of priapism.
We report the case of a 29 years old patient who presented, in the last three moths, four episodes of priapism without any other symptoms and any previous traumatism. An hemogram reveled that the repeted episodes of priapism were caused by a chronic myeloid leukaemia.
A healthy 5-year-old child was brought to the general practitioner with priapism that had been observed for a few days, without any other symptoms. Angiography revealed an arteriovenous fistula originating from the left A. dorsalis penis, which was successfully embolised. The diagnosis was 'high flow' priapism. A possible cause in the anamnesis was a fall from a swing two weeks before the embolisation. The doctor's delay was caused by unfamiliarity with this rare disorder; due to the risk of impotence (impotentia coeundi), it is an emergency situation.
High flow priapism is a rare pathology resulting mainly from trauma to the perineum leading to arterial-lacunar fistula. Management includes arterial embolization using absorbable material, as well as conservative approach. In this case, the effect of prolonged semi-erection in prepubertal high flow priapism on increased penile size is discussed.
The authors describe a rare case of priapism in a newborn infant. Treatment with intravenous ketamine hydrochloride produced rapid detumescence. The literature is reviewed with respect to priapism in the newborn and its management, and the authors propose injection of ketamine hydrochloride as an alternative method of management for this condition in newborn infants.
INTRODUCTION: Neonatal priapism is known to be associated with a wide range of aetiologies, but an association with spontaneous purulent cavernositis has not been reported in the paediatric literature. We report the first of such case. CLINICAL PICTURE: A 24-day-old neonate was brought with the history of persistent erection of penis since day 4 of life and swollen penis of 4 days' duration, which revealed frank pus on cavernosal aspiration bilaterally. TREATMENT: The child was treated with closed aspiration drainage; cross-irrigation with antibiotic solution under systemic antibiotic cover helped in achieving complete detumescence. OUTCOME: On follow-up, child demonstrated normal full bladder tumescence and colour doppler revealed bilateral normal corporo-cavernosal appearance and blood flow, indicating good functional and anatomical recovery. CONCLUSION: This case report describes the presentation, successful management and excellent functional and anatomical outcome, on follow-up, of this rare association of neonatal priapism with spontaneous bilateral pyocavernositis. An attempt has been made to describe the underlying pathophysiology.
OBJECTIVE: We report the case of a patient consulting with a four-year history of priapism, its diagnosis and subsequent therapeutic management. METHODS: We reviewed the literature for etiology, types of presentation, discussion of the clinical and radiological findings, and differential diagnosis. RESULTS: The patient underwent the embolization of the internal pudendal artery with excellent results. CONCLUSIONS: The embolization of the internal pudendal artery is an effective treatment for the resolution of high flow priapism secondary to arterial venous fistula.