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A cause of nasal obstruction in sickle cell anaemia not previously described in the literature is presented. The pathophysiology is the same as in priapism because of the similarities in the vascular arrangement of the turbinate and the penis. Various treatment options are considered but the best results were achieved by surgical reduction of the inferior turbinates.
In this article, a 9-year-old boy with arterial priapism is presented. The patient was managed with the conservative measures including imipramine hydrochloride and a favorable outcome was achieved after 2 months of follow-up. The pathophysiology, diagnostic tools and treatment alternatives are discussed.
BACKGROUND: A 46-year-old man presented with erectile dysfunction following a blunt perineal injury sustained 1 year previously. Oral phosphodiesterase type 5 inhibitors failed to improve his erections. The remainder of the patient's history, physical examination and laboratory tests were unremarkable except for a moderate tenderness in the left perineum and some 'fullness' in the corpora cavernosa during physical examination. INVESTIGATION: Physical examination, color duplex ultrasound of the penis and perineal area and Sexual Health Index for Men questionnaire. DIAGNOSIS: Non-ischemic priapism due to a ruptured left helicine artery, intermittent penile turgidity and erectile dysfunction. MANAGEMENT: Open suture ligation of the helicine artery and imbrication of the pseudocapsule.
Prolonged erection is a rare problem in urology but it must be treated effectively. The most common etiological factor is intracavernosal vasoactive agent injection for diagnosis or treatment of erectile dysfunction. The aim of this study was to evaluate the efficacy of intracavernosal adrenalin injection alone in the treatment of priapism. Nineteen patients with prolonged erection were evaluated. Seventeen out of the 19 prolonged erections were due to intracavernosal vasoactive agent injection and the remaining two were idiopathic. In all cases 2 ml adrenalin (1/100 000) was injected in each cavernosal body. In the patients who did not respond to the first injection, repeated adrenalin injections were performed at 20 min intervals. Blood pressure and heart rate were monitored during the injections. Detumescence was achieved in ten (53%) patients after the first injection. Repeated adrenalin injections (2-5 injections) were required in nine patients and eight (42%) of them achieved detumescence. Only one (5%) patient who had 26-h prolonged erection could not achieve detumescence. There was no significant difference in blood pressure and heart rate during the monitoring of the patients when compared to the initial values. No standard treatment method has yet been described for prolonged erection. Repeated aspirations and irrigations for treatment of prolonged erection are problematical applications both for patients and urologist. Intracavernosal adrenalin injection alone can be used with high efficacy and safety for the treatment of prolonged erection especially in patients with a short duration of erection.
High-flow priapism is characteristically diagnosed on clinical findings: a prolonged, non-painful erection with a delayed onset that develops after a penile or perineal trauma. If conservative measures fail arteriography is indicated, which shows a blush of extravasating contrast from an arterio-cavernous fistula (rarely, as in our case bilateral) that can be treated by embolization. The embolic agent is gelfoam or a microcoil. Bilateral embolization is indicated when unilateral treatment does not result in detumescence of the penis. When the embolization is done highly selective the risk of complications is low and the results on erectile function are good.
Priapism is an undue and sustained erection in the absence of sexual stimulus. In the elderly population drug induced, thromboembolic and malignant aetiologies are common. This report demonstrates that in elderly demented patients, penile prosthesis should be considered in the differential diagnosis of such a condition. A plain X-ray of the pelvic region incorporating the penis could prove very useful, particularly in the absence of a proper history.
The effects of hypoxia (pO2: 50 mmHg), acidosis (pH: 6.9) or glucopenia (absence of glucose) in vitro on the tone of the rabbit corpus cavernosum were investigated. The recovery of smooth muscle contractility following exposure to these conditions was also assessed. Hypoxia, acidosis or glucopenia alone or in combination showed a sustained reduction in the tone. Reperfusion of tissue strips showed complete recovery of smooth muscle tone for all conditions except when hypoxia and glucopenia were combined or when hypoxia, glucopenia and acidosis were used in combination. Incomplete recovery of tone was associated with a significant reduction in tissue ATP concentrations and an increase in the number of TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling)-positive nuclei. This indicates that following reversal of hypoxia, acidosis and glucopenia, failure of conventional alpha-adrenergic agonists to produce tumescence in low flow priapism is associated with irreversible smooth muscle cell dysfunction, which is linked to ATP reduction and smooth muscle cell death.
We are reporting the first case of priapism due to a sacrococcygeal chordoma metastasis treated with radiation therapy as palliative treatment.
A case of post-traumatic high flow priapism in a 32-year-old man is reported. The diagnosis was based on cavernous blood gas analysis and left internal pudendal arteriography. He was treated by unilateral super-selective embolization of the fistula with coils and gelatin sponge. At 1 month after embolization, erectile function had recovered, as demonstrated by measurement of nocturnal penile tumescence.
We present a case of low-flow priapism that was successfully treated. A 21-year-old man with a history of schizophrenia was admitted with a painful complete erection. He had taken propericiazine, phenothiazine derivatives, before hospitalization and was treated with a glandular-cavernosal shunt (El-Ghorab's procedure). Currently, he is able to have erections without any changes in his quality of life.
A case of juvenile priapism is presented following cortisone and penicillin treatment for a traumatic lesion of the oesophagus. Increased coagulability from such treatment is discussed as causative factor. The importance of early surgical intervention is stressed and the methods of choice presented.
Priapism occurred as a result of leukostasis due to an extreme rise in leukocyte count (503,000/microliter, 96% lymphocytes) in a 46-year-old man with chronic lymphatic leukaemia. In addition to surgical treatment, anticoagulant administration and cytostatic treatment several courses of lymphapheresis were performed using a cell separator. This latter procedure quickly reduced the number of lymphocytes and improved the patient's operability.
The authors report a rare case of high flow priapism due to a bilateral arteriosinusoidal fistula conservatively treated. Twenty months after the treatment the patient claimed to have a normal sexual activity.
We report a case of recurrent priapism in a boy. There were no recurrences during or after oral treatment with Bricanyl (terbutaline).
We describe a case of a 9-yr-old child with sickle cell disease complicated by abdominal vaso-occlusive crisis and priapism. Both complications were successfully treated with a combination of epidural local anesthetics and morphine.
Two cases of high-flow priapism that occurred after blunt perineal trauma and lasted for 35 days (case 1) and 40 days (case 2) were successfully treated by embolization of the lacerated cavernous arteries with autologous clots. Cavernous arterial blushes were demonstrated on selective internal pudendal arteriograms in both cases. Case 1 with left cavernous arterial laceration restored 80% of premorbid erectile function with successful intercourse 4 months after superselective embolization. In case 2 with bilateral cavernous arterial lacerations, premorbid erectile function was fully resumed 2 months after bilateral embolization of the cavernous arteries at intervals of 15 days. None developed local or systemic complications.
A case of spontaneous intermittent priapism in a patient with spinal canal stenosis is presented. Erection, as well as intermittent neurogenic claudication and urinary incontinence were provoked by physical exertion, mainly walking. The symptoms completely resolved after decompressive lumbar laminectomy.
Male Sprague Dawley rats were fed ad lib. semi-synthetic diets, containing 9% casein-protein (I) or 9% bread crust-protein (II), and the control diet in restricted amounts (III), respectively. After 6 weeks persistent erections were observed in groups II and III. 93% of the crust-fed animals and 67% of the pair-fed-group developed priapism within 22 weeks. All persistent erections disappeared after an ad lib. casein-refeeding period.