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Arterial or 'high-flow' priapism is a rare complication of penile or perineal trauma. The case is reported of a patient with a more than 2-week history of priapism who was successfully treated by selective arterial embolization, with maintenance of potency.
High flow rate priapism was diagnosed in a 14-year-old adolescent 5 days after a fall onto the perineum. Highly selective embolization of the 2 internal pudendal arteries was performed with gelatin (SPONGEL). Rapid resolution of the priapism as well as return of normal erection were observed within 48 hours. Doppler ultrasound revealed a high flow rate and identified the side of the traumatized artery. Endovascular embolization allows effective treatment of traumatic arteriocavernous fistula.
A 44-year-old man visited a local urologist complaining of continuous pain and tumescence at penis persisting for 3 days. He was diagnosed with priapism. A caverno-glandular and caverno-saphenous shunt was performed. He presented to our hospital 3 days later, because the symptoms especially tumescence continued. We confirmed the diagnosis of low-flow priapism from cavernosography and intracavenal blood-gasometry and performed caverno-spongiosum shunt. Detumescence was finally achieved after the operation.
High flow priapism is an infrequent entity, generally following traumatic injuries in the genito-perineal area. Anamnesis, cavernous bodies blood gasometry and Doppler are the basic diagnostic tools for these condition. Therapeutical management is considerably different from that used for low flow venous priapism. Selective arteriography of the internal pudendal artery allows to locate the arterial lesion and, at the same time, to perform supraselective embolization of the lacerated cavernous artery which is currently considered the choice treatment. This paper presents the case report of a ten-year old patient successfully resolved through application of angioradiologic procedures.
Recurring periods of prolonged erections in patients with sickle cell disease (stutter priapism) are uncommon, yet troubling sequelae of hemoglobinopathies. Medical or surgical therapy is variably successful in these men. We report a case of stutter priapism successfully treated with an oral antiandrogen.
Priapism is a rare complication of hematological diseases. Among leukemia, it is most frequently seen in patients with chronic myeloid leukemia, due to the high leukocyte counts that these patients achieve. We report a 22 years old male who presented with a priapism lasting more than 24 hours. Thirty six hours after admission and subsequent to a leukopheresis, penile relaxation was obtained. Despite good hematological response to therapy, an extensive penile and uretral necrosis, associated to an Acinetobacter infection, ensued between the fourth and fifth day of admission, that required surgical treatment.
Relatively rare high-flow priapism is most frequently caused by contusion or direct injury of the cavernous artery with a subsequent uncontrolled inflow of arterial blood into the cavernous bodies. Knowledge of this pathophysiology and the development of intervention radiology made a more selective therapeutic approach possible. The authors present a report on a case of arterial or high-flow priapism which was successfully resolved by a minimally invasive approach--percutaneous superselective transcatheter embolization of the internal pudendal artery.
We report a case of painful priapism of the clitoris lasting 24 hours, which was believed to be pathophysiologically associated with the administration of trazodone hydrochloride. Drug-induced unusual erectile activity in the clitoris has been described previously. However, to our knowledge this is the first reported case of drug-induced priapism of the clitoris. Management involved discontinuation of the offending agents and administration of adrenergic agonists to induce clitoral smooth muscle contraction. Clitoral function, proposed to be the ability to engorge and enable extrusion of the glans clitoris, was not obviously adversely affected by the priapistic episode.
Priapism is uncommon in children. When it does occur the etiology is usually leukemia, sickle cell disease, or trauma.(1) We present a case of priapism in a child in whom the underlying etiology was acute appendicitis. To our knowledge, this has never been reported in the literature.
Priapism is rare on clinical condition with complicated pathogenesis which is very difficult to cure. The paper reported a case of a long-time priapism, complicated local skin necrosis, which was caused by circumcision. After the failure of routine therapy, we treated the patient with traditional Chinese therapy, such as TCM herbs combined with bone scraping and depletion therapy, and achieved the satisfactory effect.
OBJECTIVE: To improve the clinician's ability for emergency treatment of priapism. METHODS: Both cases received 2 mg to 8 mg of metaraminol injection at the root of cavernous body, and perfusion of heparinized saline at glans and root of cavernous body of the penis by contrecoup, but they had not good response to the above therapy. At last surgery was performed. RESULTS: Total penectomy was performed for both cases. One case was diagnosed of penile sarcoma, and another was metastatic transitional cell carcinoma. CONCLUSION: Priapism due to neoplasma is infrequent, it should not be misdiagnosed in case of emergency.
Malignancy metastasis to the penis is an uncommon clinicopathological entity. We present two cases of malignant priapism following penile metastasis, in which the diagnosis was established by core needle biopsy of the corpus cavernosum. Primary tumors were urothelial carcinoma of the urinary bladder in one case (the patient having concomitant high-grade prostatic adenocarcinoma) and prostatic adenocarcinoma in the other. The clinicopathological features of 51 previously reported cases of penile metastasis in the recent literature are reviewed.
We report a case of severe priapism occurring in a patient with unstable hemoglobin, hemoglobin Köln, and underline several factors that may have contributed to this complication: abnormal plasticity of red cells, splenectomy, and cytomegalovirus infection. Since emergency treatment may prevent impotence, patients and parents should be educated about this complication.
Sickle cell anemia, the most prevalent type of hemoglobinopathy, appears almost exclusively in backs. Since the first report of sickle cell anemia in a Caucasian by Cooley and Lee in 1929 [1], additional cases have been reported, mainly from Mediterranean countries, the Persian Gulf, and India [2]. Several cases were also found among Arabs in Israel with a relatively benign clinical course [3, 4]. The present report describes a unique case of sickle cell anemia associated with alpha-thalassemia in a non-black young adult. The diagnosis was made at the age of 23 years. Severe priapism was almost the first manifestation of the disease and subsided following transfusion of five units of packed red blood cells.
We describe a case of renal cell carcinoma with metastasis to the penis clinically presenting with priapism. Six such cases found in the literature are reviewed. Neoplastic disease is far advanced in these cases and therapy is only palliative.
Idiopathic segmental thrombosis of the corpus cavernosum as a cause for partial priapism is an uncommon event. Diagnosis and treatment in the past have principally involved invasive methods. We present a case in which both conventional invasive methods and noninvasive imaging were used.
A 10-year-old boy presented with priapism of 10 h duration which after unsuccessful conservative measures, was relieved by a saphenocorporeal shunt. A 4-year history of intermittent vague aching of fingers and toes accompanied by low-grade fever was reported. Fabry disease was confirmed by the lack alpha-galactosidase activity in serum and leucocytes. Other characteristic features of Fabry disease were not present. The condition was also diagnosed in his 14-year-old brother and suspected in his maternal grandfather who died at the age of 49 from renal failure of unknown aetiology.
A 22-year-old man suffered a hiking accident with perineal trauma and developed a nonpainful priapism secondary to bilateral arterial-cavernosal fistulas. To minimize the risk of impotence in this young patient, successive selective embolizations with autologous blood clot were performed to close the fistulas. This led to an uncomplicated full recovery. No fistula was detectable on Doppler ultrasonography at 1-year follow-up. Review of the literature confirms the safety of embolization with autologous clot.