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We describe the case of a 23 year-old man with high-flow priapism following blunt perineal trauma. He was treated successfully with super-selective embolization with a resorbable material (gel foam). We will review the pathophysiology, etiology, and diagnosis and treatment approaches of high-flow priapism based on a review of the medical literature.
Benztropine mesylate was used successfully to treat priapism that developed during anesthesia in 2 horses. After IV injection, there was a rapid resolution of signs in both horses, and no side effects were observed. The choice of an effective method to treat priapism is challenging because precise causes in most patients have not been well-defined. Benztropine mesylate is a synthetic compound resulting from the combination of the active portions of atropine and diphenhydramine, and is believed effective because of its central acetyl-choline-antagonizing properties.
The authors report a case of post-traumatic priapism due to laceration of the left cavernous artery. Blood gases on blood aspirated from the corpora cavernosa revealed the presence of "high-flow" priapism. Transfemoral arteriography confirmed the arteriocavernous fistula which was successfully treated by selective embolisation of the internal pudendal artery. The authors present a review of the literature on this subject with special reference to the diagnostic and therapeutic aspects.
The authors report a case of idiopathic priapism in a 4 year old boy. This is an exceptional disease at this age, which was treated urgently by creating a cavernosospongiosum fistula with a rapidly favourable clinical course. The prognosis appears to be related to the rapidity of treatment. Although aetiological treatment can be proposed in the case of priapism due to haematological malignancies, only surgical treatment appears to be truly effective in the other forms.
We report two cases of priapism in patients previously treated with neuroleptic agents. None of these patients had a previous history of urological or hematological disorders. These two patients warranted emergency treatment by punction-aspiration of the corpora cavernosa and posterior cavernospongiosa shunt. The foregoing approach achieved penile detumescence in both cases. Excellent results were achieved relative to erectile function in one patient. Although the mechanism responsible for phenothiazine-induce priapism has as yet not been elucidated, it has been suggested that this might be due to adrenergic block which directly inhibits the sympathetic impulse of detumescence.
Vasculitis may affect virtually any organ system in the body. We describe a patient who presented with priapism due to isolated genital vasculitis. This responded promptly to oral corticosteroids. In patients presenting with priapism, a possible underlying vasculitis should be considered in the differential diagnosis; the treatment for this may be nonsurgical.
A case of priapism following epidural anesthesia was reported. A 67 year old man received epidural anesthesia for the transurethral resection of a malignant bladder tumor. Epidural anesthesia which he had wanted to receive was given through the L3 to L4 intervertebral space with 18 ml of 2% lidocaine. The penile erection occurred while he was prepared and draped. Additional 8 ml of 1% lidocaine failed to overcome it and the operation cancelled. After this episode, he had anesthesia on 5 occasions in 2 years. General anesthesia was given 3 times without penile erection, but epidural block was tried on 2 occasions, which was followed by penile erection. For the penile erection, intracavernous injection of etilefrine hydrochloride was effective and surgical procedure could be done smoothly. The mechanism of priapism remained unclear but imbalance of the autonomic nervous system may be a involved. This case suggests that intracavernous injection of etilefrine hydrochloride is effective for treatment of penile erection during transurethral surgery.
The authors demonstrate the management of erectile impotence by using Papaverin or the combination of Papaverin-Regitin and its overdosing. The overdosing should be put in mind when using these drugs. The authors also demonstrate three types of priapisms. In according to the management of 72 cases priapism, the authors are advising the irrigation of the corpus cavernosum with Dopamin after punction.
Intracavernous papaverine injection therapy has gained widespread acceptance in the treatment of erectile impotence. Treatment for the opposite, priapism, is also possible with the same technique using a vasoconstrictive drug. We report 5 patients with priapism successfully managed by intracavernous injection with adrenalin.
We experienced two cases of priapism; one, idiopathic and low flow type, the other post-traumatic and high flow type. We tried caverno-spongio-anastomosis (CSA) as an operative treatment in both cases. Postoperative courses were uneventful. We suggest that CSA is a simple and reliable treatment of priapism.
The authors discuss the aetiology and therapy of priapism. They deal in detail with different therapeutic approaches and analyze the results with regard to new pathophysiological findings in a group of 23 patients. They mention possible complications and emphasize the necessity of an urgent approach to the solution of this disease. They decide on treatment after assessment of the type of priapism; as to surgical methods they use puncture fenestration according to Winter, if this does not prove satisfactory then they operate according to Al-Ghorab's method.
We report a case of priapism in a patient with philadelphia positive chronic granulocytic leukemia. Combined medical and surgical therapy, including chemotherapy with hydroxyurea and multiple punctures of the corpora cavernosa respectively, effected a rapid detumescence and resolution of the priapism and control of the primary disease, although subsequent ability of erection was not fully restored.
The authors present their personal experience in connection with two cases to priapism, one of which was solved by unilateral saphenocavernous anastomosis in a leukemic patient, and the second one by bilateral caverno-spongious anastomosis in a patient with idiopathic priapism. Both interventions had a good outcome. The emergency character is stressed, of this type of intervention, that should b performed bilaterally and followed by anticoagulant treatment.
Intracavernous injection of etilefrine hydrochloride (1 or 2 mg) was performed on four patients with fully erected penis after intracavernous injection of 40 mg of papaverine hydrochloride. One case needed three injections of etilefrine hydrochloride (1 mg), but the erection disappeared in the other three cases within 10 minutes after a single injection of 2 mg of etilefrine hydrochloride. The injection resulted in complete detumescence and relief of the erection in all cases. These observations strongly suggest that the intracavernous injection of etilefrine hydrochloride is effective in treating not only iatrogenic priapism but also priapism due to other etiologies. Also, it might be useful to control erection time after intracavernous injection therapy for impotence.
The authors describe a case of a relapse priapism in a 13 year old boy, affected by a sickle cell crisis, successfully treated by a distal caverno-spongiosum anastomosis. They think, that surgical approach of priapism can prevent of fibrosis of the corpus cavernosum. But the recurrence of this affection depends only on the evolution of the primary disease.
The association of priapism with trazodone is reviewed based on data reported to the Food and Drug Administration. The data suggest that priapism may be most likely to occur within the first 28 days of treatment and that the majority of cases occur with doses of 150 mg/day or less. All age groups appear to be vulnerable to this adverse effect. Patients should be informed of this potential side effect and instructed to discontinue the medication if any unusual erectile problems develop.
The authors report a case of recurrent priapism treated by saphenocavernous bypass and accompanied by a congenital internal pudendal arteriovenous fistula. In the light of this case and the literature, they discuss the physiopathology of priapism and the sound basis of the various therapeutic methods proposed.
A case of priapism associated with trazodone is described. Erection subsided spontaneously after 4 hours, with subsequent potency unimpaired. No published reports of priapism with antidepressants were located, but 11 cases have been reported to the manufacturers.