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An 18-year-old unmarried man, who had shown arterial priapism caused by mild perineal trauma sustained during skate-boarding, has been successfully treated by autologous clot embolization at the common penile artery. He was able to have a normal erection and ejaculate 5 d after embolization.
The cavernosospongiosal shunt operation is an effective method of treatment of priapism. Experience with five cases has led the writers to suggest early operation, avoidance of needle aspiration and the use of steroids.
Fourteen patients with priapism have been treated over the last 12 years. Two patients had a recurrence 2 and 5 years after the primary incident. Abuse of alcohol (often combined with psychotropic drugs) and the use of antihypertensive drugs were the most prominent aetiological factors. Three out of 9 patients treated conservatively and 5 out of 6 patients treated with a shunt procedure have preserved their erection ability. Our results indicate that conservative treatment is not justified and that a shunt procedure should be performed with the least possible delay.
Priapism is a rare condition in childhood; the majority of reported cases are in boys with sickle cell disease, where conservative management is often appropriate. Our experience with 4 cases, with differing aetiologies, and a review of the literature highlight the need for aggressive therapy when conservative measures fail.
Prostaglandin E1 (PGE1) was used for diagnostic and therapeutic purposes in 149 men with erectile dysfunction over a period of 20 months (February 1987-October 1988). The intracavernous application of PGE1 in varying doses resulted in an erection sufficient for sexual intercourse in 79% of cases. In order to differentiate between vascular and non-vascular impotence, 5 micrograms PGE1 were found to be a sufficiently high and safe dose for the first intracavernous injection. Local discomfort, ranging from mild to severe pain after injection, was recorded in 40% of patients. A significant difference in severe side effects was found between arterial, venous and non-vasculogenic impotence, the highest incidence of local pain occurring in non-vasculogenic patients. The most striking result was the occurrence of 4 cases of priapism, all in the non-vascular group, 1 of these occurring after the injection of only 5 micrograms PGE1.
Priapism occurred in a stallion after the administration of acetylpromazine. When conservative measures failed, the corpus cavernosum penis (CCP) was drained and irrigated, and a vascular shunt between the erectile bodies was created. Subsidence of erection resulted, but subsequently, the stallion was unable to retract or erect the penis. The stallion was castrated and the penis was surgically retracted into the sheath.
We present a case of priapism caused by the alpha adrenoreceptor blocking action of a butyrophenone. The problem was solved surgically performing a cavernousspongiosum fistula.
Abscesses of the prostate are infrequently encountered now as a result of effective antibiotics. The clinical diagnosis remains difficult. Herein we report an unusual case of a prostate abscess presenting as priapism. The diagnosis and management of the case is discussed, and the literature is reviewed.
The paper reports 6 cases of priapism with subsequent protrusion and paresis after neuroleptanalgesia and anaesthesia in horses. Five were ultimately treated by amputation of the penis but the sixth horse is responding satisfactorily to conservative treatment at the time of writing. Causative factors, preventive measures and possible methods of treatment are discussed.
A case is reported of a 35 year old man who sustained an injury to the perineum in a cycling accident which resulted in a traumatic priapism. After confirmation of the diagnosis by Doppler sonography and angiography, therapeutic selective arterial embolisation was followed by successful detumescence of the penis and subsequent return of normal erectile function. It is suggested that percutaneous embolisation of the lacerated cavernosal artery is a safe and effective minimally invasive treatment for this uncommon condition.
The case of an elderly man with priapism as his only symptom is presented. The importance of clinical signs and simple investigations to make a diagnosis of aortocaval fistula associated with abdominal aortic aneurysm are discussed.
Disturbance of autonomic function is an unusual feature of compression of the cauda equina. A 61 year old man who had complete occlusion of the lumbar spinal canal with compression of the cauda equina from a large centrally prolapsed disc, had spontaneous priapism, precipitated by walking and relieved by resting. This symptom was comparable to claudication by compression of cauda equina. It subsided completely after surgical removal of a prolapsed L4-5 disc.
The painful pathological condition of the penis, priapism, is usually associated with serious destructive changes which lead to impotence if treatment is with-held or delayed. Conservative therapy is slow, uncertain and usually ineffective. Early surgical decompression of the corpora cavernosa, repeated if necessary, is essential if impotence is to be averted. Two unusual cases of this condition recently seen at the University College Hospital, Ibadan, in which treatment had been delayed for periods previously thought to be too long for recovery are herein presented and the management described. It is advised that failure of the initial surgical operation calls for early re-operation to establish a new shunt.
High flow arteriogenic priapism is uncommon and usually occurs after trauma to the genitoperineal area. The onset of prolonged erection can be delayed and is often relatively pain free. Arteriography in this case illustrated the causative bilateral arteriocavernosal fistulae and pseudoaneurysms. Treatment consisted of staged bilateral superselective metallic microcoil embolisations, resulting in prompt detumescence. There were no complications. The patient had normal erectile function six months later. Recent concerns about erectile dysfunction with the bilateral use of permanent metallic coils appear to be unfounded.
We report on a 10-year-old boy who presented with painless priapism 11 days after blunt perineal trauma. Examination by color flow Doppler sonography demonstrated an arteriovenous fistula, which was confirmed by penile arteriography. Complete detumescence of the penis developed following superselective embolization with Ethibloc.
We present a 40-year-old man with malignant priapism secondary to urethral squamous cell carcinoma. Magnetic resonance imaging revealed the tumor originating from the bulbous urethra, extending into the penile urethra and corpora spongiosa and cavernosa. A penile biopsy confirmed poorly differentiated squamous cell carcinoma of the urethra. Despite administration of systemic chemotherapy, the prognosis of the patient has worsened due to the extensive metastatic disease.
We present the first case of priapism following radical prostatectomy. A 66-year-old man with normal erections underwent radical retropubic prostatectomy with unilateral nerve sparing. Pathology showed a pT2c pN0 Gleason score 3 + 3 = 6 prostate cancer and the postoperative course was uneventful. Ten days after surgery he recognized a spontaneous painful penile erection without sexual stimulation which occurred in a standing position and disappeared in a supine position. These episodes recurred several times during the next 3 weeks and then completely vanished. Pathophysiologically, we postulate intermittent position-depending venous obstruction due to local hematoma or thrombosis.
A case report of a 27-year-old male with segmental priapism of the left proximal corpus cavernosum is presented. Treatment consisted in evacuation and irrigation of the corpus.