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The aetiopathogenesis and clinical picture of 3 cases of priapism are described, along with the treatment employed. The first patient suffered from thalassaemia minor, whereas in the second case priapism was a manifestation of aneurysm of the abdominal aorta perforated in the cava. In the last case, erection was a sequela of surgery for hydrocoele performed under peridural anaesthesia.
We report a clinical case of carcinoma of the rectum. A 45-year-old patient had undergone resection of the rectum and proctostomy 22 months ago. Carcinoma caused metastasis to the corpora cavernosa of the penis in this patient, and caused local recurrence of the carcinoma of the rectum, pulmonary metastasis and malignant priapism. A statistical analysis of 62 cases of secondary tumor of the penis in Japan was also made. The present clinical case was the 62nd case of secondary tumor of the penis in Japan, and the 4th case of secondary penile tumor from the rectum. The primary foci of the secondary tumor of the penis are mostly in the urinary bladder and the prostate, followed by the rectum, kidney, pelvis of the kidney and the ureter. Primary sites in the urogenital organs were found in 82.3% and in the neighboring organs in 85.2%. As the route of metastasis of the secondary tumor of the penis, arterial blood, retrovenous, retro-lymph and direct infiltrating metastasis may be possible. Secondary tumor of the penis is mostly found in aged persons, and the major symptoms may be penile nodule and mass, malignant priapism, penile pain and tenderness, and difficulty in urination and retention of urine. Regardless of the length to metastasis and difference in the treatment of the metastatic focus, the secondary tumor of the penis is poor in prognosis, and survival period may be up to 7 months. From the findings of post-mortem examination, secondary tumor of the penis should be regarded as a secondary sign due to recurrence of the primary tumor or presence of metastasis in other organs, and careless surgical operation should be avoided.
UNLABELLED: The authors review the literature with regard to surgery for priapism performed in 138 patients: 92 treated by uni- or bilateral sapheno-cavernous anastomosis and 46 by spongio-cavernous shunt. Sapheno-cavernous anastomosis: in 92 cases operated upon, there were 65 useable records. Conservation of potency in 61.5% of cases (40 out of 65) in particular in young patients aged 40 years or less where the rate of conservation of virility was 73.8%. After the age of 40, this rate fell to 39.1% of cases. It was surprising to note that the results were similar whether the operation was performed during the first 48 hours or later. Results were better after unilateral anastomosis (72.5% of cases with conservation of erection), than after bilateral surgery (54.5% conservation of erection). COMPLICATIONS of this type of surgery consisted of pulmonary embolism and necrosis of the penis. Spongio-cavernous anastomosis: 42 published cases but only 32 useable. Overall, 62.5% of cases with conservation of erection. Results were better before the age of 40 (70% success) than in older patients (50% success). Once again, the functional result obtained was independent of the period for which priapism had been present preoperatively. COMPLICATIONS: urethrocutaneous and urethro-cavernous fistulae. Comparison of the two types of operation failed to reveal any difference before the age of 40 years. By contrast, after 40 spongio-cavernous anastomosis gave slightly superior results (50% as against 39% for sapheno-cavernous anastomosis). On the basis of this general review, the authors drew a more favourable impression of caverno-spongious anastomosis.
Priapism is a pathological and mostly painful permanent penile erection. Typically only both corpora cavernosa and not the corpus spongiosum urethrae and the glans penis are involved. The vascular and nervous preconditions for a normal erection are discussed and a new concept presented. On this basis the conditions for a priapism are enumerated and the principles of therapy are discussed.
A corpora cavernosa-glans penis shunt was carried out to control priapism in eight patients in the past two years. Four of the five patients treated by sertion of a biopsy needle through the glans into the corpora and three patients treated by creation of a window in the tunica albugenia of the corpora through a glans penis incision experienced prompt detumescence and maintained potency. These observations support the efficacy of a venous shunt to achieve rapid detumescence and support the concept that potency is likely to be preserved if venous stasis is relieved promptly and its recurrence prevented. Surgical incision of the glans penis to permit creation of a shunt from each corpora cavernosum under direct vision is simple, safe and effective. This procedure warrants primary consideration as the initial treatment of priapism.
Priapism is a surgical emergency, and a glandular cavernous shunt is good emergency treatment. The technique is simple, easy and quick, can be performed under local anaesthesia if necessary, and has a good chance of success; should it fail or the priapism recur, a more formidable shunt may be performed.
We report here two cases of priapism. One of these cases was suspected to be drug induced and high and low flow mixed type. The patient had taken the drugs, alpha-blocker for hypertension and dysuria by BPH for a long time. He was treated by a caveno-glandular shunt. After surgery, detumescence was obtained for some time, but erection appeared again soon. Transcatheter embolization of the internal pudendal arteries was then performed, and detumescence became permanent. The other case was an idiopathic and high flow type. Detumescence was achieved soon by transcatheter embolization of the internal pudendal arteries only, then he experienced morning erection imperfectly on the 9th day after this treatment. The management of priapism as reported to date is also reviewed.
Treatment of priapism with intracavernous alpha-adrenergic agonist vasoconstrictor agents is well accepted, particularly for patients with priapism secondary to intracavernous injections of papaverine, phentolamine and/or prostaglandin E1. Although many alpha-adrenergic agonists are commercially available, phenylephrine is preferred because it has potent and selective alpha 1-adrenergic stimulatory properties, which can decrease arteriolar flow to the cavernous sinusoids, and no beta 1-stimulatory effect, which could cause arrhythmias and angina in susceptible patients. Before intracavernous injection or irrigation an alpha-adrenergic agonist must be diluted. However, no readily available reference source lists this information. Therefore, we prepared a chart for extemporaneous preparation of dilutions of alpha-adrenergic agonists for intermittent injection or irrigation.
The authors describe their experience obtained in the treatment of 25 patients with priapism. The results are analysed on the basis of recent physiological concepts and immediate surgery is recommended. Priapism is a urological emergency and requires urgent treatment. The method commonly used at their clinic is described.
Nonischemic arterial high flow priapism caused by traumatic laceration of a branch of the penile cavernous artery is rare. We report a case of laceration of the left and right branches of the intracavernous artery, which was confirmed by selective internal pudendal arteriography. Bilateral cavernous artery embolization was performed using gelatin sponge and detumescence occurred immediately. Normal potency was evident 4 months later. Our case demonstrates that selective cavernous arterial embolization is a safe and effective therapy for arterial priapism and that erectile function can return to normal.
The authors report two cases of priapism of more than six hours, following intracavernous injection of 15 and 10 mcg PgE1 respectively, in six patients with impotence after radical cystoprostatectomy. Bearing in mind the proven safety of intracavernous injection of PgE1 in the treatment and diagnosis of erectile dysfunction, such a proportion of priapism in this group of patients has called our attention. It is probably due to an increased in the PgE1 intracavernous metabolism, due to the ligation of the penile venous drainage during surgery.
OBJECTIVE: An unusual case of Klinefelter's syndrome with ischemic priapism is described. METHODS: The clinical course of the present case is described and discussed. CONCLUSIONS: This unusual case cannot be completely ascribed to the hormonal changes in Klinefelter's syndrome, although hormone imbalance may have favoured the development of ischemic priapism.
The case of a young man with depressive illness who developed priapism while being treated with paroxetine is reported for the first time. Other sexual side effects are reported with paroxetine : delayed ejaculation, anorgasmy, erectile dysfunction and decreased libido. Other antidepressants are known to cause priapism : fluoxetine and especially trazodone.
A permanent open shunt as a cause of impotence or impaired potency after a shunt operation for priapism is an unusual situation. In this series we studied the persistence of an open shunt in 26 patients who had developed impotence or impaired potency after operative treatment for priapism. All patients had been examined by cavernosography on the suspicion of an open shunt, giving a positive finding in five of 26 cases, in all of which impotence was cured by closure of the shunt. In five patients without a permanent open shunt potency returned to normal only after 6-12 months.
A patient with high-flow priapism was treated by transcatheter embolization of a posttraumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate (NBCA), resulting in complete detumescence. Erectile function has been preserved during a 3-month follow-up. Only two patients with NBCA embolization for high-flow priapism have been reported previously.
Presentation of a new case of high flow priapism in a patient with recent background of perineal traumatism. Diagnosis, already inferred through anamnesis, was later suspected from the results of blood gasometry in cavernous bodies, and eventually confirmed by Eco-Doppler. A revision of the related literature revealed a total of 20 patients in whom supraselective embolization has been used as the therapeutical approach, Bucrylate being used in only two of them. Finally, a few considerations are contributed on the therapeutical management of these patients and the relevance of a correct diagnosis of the two distinct groups of priapism, since they differ considerably in terms of treatment.
Priapism is a condition of prolonged penile erection which often causes pain and is unrelated to sexual desire. There is a high risk of impotence despite immediate intervention. The incidence has doubled since the introduction of intracorporeal injection therapy for impotence. Two subtypes of priapism have been described, depending on the underlying cause. The more common type, termed low flow, is characterised by inadequate venous outflow, leading to a hypoxic painful prolonged erection. The etiology is either idiopathic or related to intracorporeal injection therapy. Treatment consists of aspiration and instillation of a diluted alpha-adrenergic agent, or surgery, depending on the degree of hypoxia. The less common subtype, high flow, is arteriogenic, and causes less pain and no ischemia. Injury to a cavernous artery leads to a fistula between the artery and the corpora cavernosa. Treatment is either conservative with immediate ice pack and compression, or delayed selective embolization of the fistula.
We present the case of a patient with classical protein C deficiency presenting with acute priapism during warfarinization for thrombophlebitis. Priapism is a well-recognized complication of a number of conditions including sickle cell disease and haematological malignancies, but to our knowledge it has not previously been reported in association with protein C deficiency. This case highlights the potential dangers of initiating oral anticoagulant therapy using conventional loading dose regimens in patients with protein C deficiency.