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Intracorporeal papaverine injection therapy for impotence has been reported recently as a therapeutic option with low morbidity. We report 2 cases of papaverine-induced priapism that required surgical intervention.
A new cavernoglandular shunt technique for the treatment of priapism is described. The shunt is created by use of a skin biopsy punch, which establishes a large and effective communication between the glans and corpus cavernosum, and provides efficient means of venous drainage from the corpora cavernosa. Since free communication exists between the corpora cavernosa through the median septum, the shunt is performed only on 1 side. However, if this method fails to resolve the problem the procedure is performed on the other side as well. This technique was performed successfully in 4 patients with satisfactory results.
Late treatment of priapism may be associated with unsuccessful aspiration and irrigation of the corpora cavernosa. In such cases intracorporeal instillation of streptokinase resulted in dramatic improvement in detumescence. A subsequent venous shunt procedure achieved good results.
The occurrence of a urethrocavernous fistula after creation of a cavernospongiosum shunt for priapism is rare. We report a case in which the fistula, likely the sequela of traumatic urethral catheterization, occurred 3 months after establishment of the shunt.
The treatment of priapism has changed significantly because of better understanding of the physiology of erection and of the pathophysiology of the disease. Several operative procedures have been advised to provide better venous drainage to the corpora. Herein we describe our experience with 20 patients. In 7 cases a modification of the cavernospongiosum shunt was used. This shunt is done under direct vision at the level of the proximal glans, thus, providing a better cavernosum-spongiosum shunt.
We report the third documented case of partial priapism. The proximal right corpus was distended and separated from the distral flaccid corpus by a transverse membrane. Histologic examination revealed the obstructing lesion to be owing to thrombosis of vascular erectile tissue probably secondary to trauma. Excision of this membrane promptly cured the condition.
We report a case in which extracorporeal circulation was used as an alternative to other forms of corpus-venous shunting and resulted in complete detumescence and maintenance of potency. The relative simplicity and the ability to repeat the procedure in cases of recurrent priapism suggest this as a reasonable form of treatment in patients who do not respond to conservative measures.
For the surgical treatment of priapism we have created a percutaneous fistula between the glans penis and the corpus cavernosum with good results. This is our preferred method of management for all patients except those undergoing sickle cell crisis.
After assessing the data currently available on the multiple modalities used to manage priapism secondary to sickle cell disease we adopted a specific therapeutic regimen for the treatment of this problem. Early non-surgical measures, including hydration, alkalization and analgesics, rapid red cell infusion to double the hematocrit and late shunting procedures in conjunction with exchange transfusion, offer the soundest approach on pathophysiological grounds. There is currently no evidence to support early surgical intervention as the best approach to conserve potency in this problem.
Review of 7 cases of post-traumatic priapism indicated that, despite the type of initial therapy, all patients expressed dissatisfaction with the total efforts, although erections were resumed. A surgical effort directed at drainage of fluid collections and correction of the ruptured tunic seems warranted and may aid the patients in further sexual activities.
A patient with an unusual form of priapism is described. Only the corpora cavernosa proximal to the suspensory ligament were erect. A well defined membrane was found in each corpus cavernosum at the penoscrotal junction, separating turgid and flaccid erectile tissue. When these membranes were removed the erect proximal corpora drained into the flaccid distal corpora and the entire penis remained flaccid 6 weeks later.
A 10-year-old white boy is described in whom priapism developed as a complication of parotitis without orchitis. Medical study failed to reveal any other etiology. The syndrome was assumed to be related to a mumps virus. Treatment by corpora cavernosa-spongiosum shunt relieved the acute symptoms as well as preserved the patient's ability to have an erection.
We report the cases of 2 patients with partial segmental priapism. The patients presented with pain, a perineal mass, and proximal segmental corporal thrombosis. Treatment consisted of a proximal corpus cavernosal-spongiosum shunt. Diagnostic considerations, literature review, and treatment options are discussed.
High-flow priapism is a rare entity, which is typically diagnosed with the help of either color flow Doppler ultrasound or arteriogram. In the case presented, both of these diagnostic modalities were unsuccessful in uncovering a vascular lesion. The patient underwent an empiric selective embolization of the left pudendal artery followed by a repeat angiogram of the right because of persistent tumescence. This procedure uncovered a previously unseen arteriolacunar fistula, which was treated successfully with a second selective embolization.
We report our successful treatment of arterial priapism by means of radiologic selective transcatheter embolization of the internal pudendal artery using an absorbable gelatin sponge (Spongel).
A double-blind, placebo-controlled crossover study was conducted in 11 patients with stuttering attacks of priapism and homozygous sickle-cell (SS) disease. Stilboestrol 5 mg daily was better than the placebo in preventing attacks.
We present a 41 years old male, treated with trazodone because of depression. He was seen at our Andrology unit for a 72 hours evolutioned priapism. We review the literature and submit this paper for publication because it is an uncommon pathology.
We report on the case of a post-traumatic high-flow priapism in a 14 year-old boy, which was confirmed by cavernous blood gas measurement color flow Doppler sonography, and arteriography. It was successfully treated with superselective embolization of the right internal pudendal artery, resulting a clear disappearance of cavernus rigidity.