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A case of endometrioid carcinoma of the prostate is reported in which the initial symptom was hematuria. The patient slowly developed a painless priapism, and the tumor ultimately became generalized despite orchiectomy.
A modified Winter's procedure with trocar which was used for 7 patients with priapism is presented. Complete detumescence was resumed in 5 of 7 patients. Cavernosaphenous shunt was used for only 2 patients. Two patients had postoperative impotence.
High-flow priapism is a quite uncommon event. The disease should be suspected on the basis of a referred trauma and/or by means of some laboratory findings. Nevertheless selective arteriography remains the only examination able to give us the final diagnosis. Autologous clot embolization allows complete resolution of the problem.
Trazodone, an antidepressant with antianxiety effects, has been available in the United States since March 1982. Since then 11 cases of priapism, five requiring surgical procedures, have been reported. The authors present one of the latter cases.
A case of priapism following prolonged intravenous nutrition is reported. The small amounts of heparin as received by our patient would tend to minimise a risk of hypercoagulability. However, the administration of intravenous feeding agents and the concomitant metabolic acidosis may have enhanced this risk.
Between 1982 and 1994 13 patients have needed surgery for priapism persisting after conservative measures using the technique described by Quackel.
Pulmonary hypertension is prevalent in adult patients with sickle cell disease and is strongly associated with early mortality and markers of hemolysis, in particular, serum lactate dehydrogenase (LDH). Intravascular hemolysis leads to impaired bioavailability of nitric oxide (NO), mediated by NO scavenging by plasma oxyhemoglobin and by arginine degradation by plasma arginase. We hypothesized that serum LDH may represent a convenient biomarker of intravascular hemolysis and NO bioavailability, characterizing a clinical subphenotype of hemolysis-associated vasculopathy. In a cohort of 213 patients with sickle cell disease, we found statistically significant associations of steady-state LDH with low levels of hemoglobin and haptoglobin and high levels of reticulocytes, bilirubin, plasma hemoglobin, aspartate aminotransferase, arginase, and soluble adhesion molecules. LDH isoenzyme fractionation confirmed predominance of LD1 and LD2, the principal isoforms within erythrocytes. In a subgroup, LDH levels closely correlated with plasma cell-free hemoglobin, accelerated NO consumption by plasma, and impaired vasodilatory responses to an NO donor. Remarkably, this simple biomarker was associated with a clinical subphenotype of pulmonary hypertension, leg ulceration, priapism, and risk of death in patients with sickle cell disease. We propose that LDH elevation identifies patients with a syndrome of hemolysis-associated NO resistance, endothelial dysfunction, and end-organ vasculopathy.
Priapism is a rare but serious adverse effect of psychotropic drugs resulting from their peripheral alpha-adrenoreceptor blocking action. Two patients developed this during treatment with oral phenothiazines: one was treated surgically with a venous shunt, and the second case resolved after intracavernosal injection of an alpha-adrenoreceptor stimulating drug.
A 59-year-old man experienced priapism five days after taking neuroleptics and abnormal liver function after 28 days. These side-effects are possibly explained as hypersensitivity reactions to the drug.
Priapism is defined as a prolonged penile erection that fails to subside despite orgasm. It is a medical emergency which should be diagnosed and treated early to preserve erectile function and avoid corporal fibrosis resulting from anoxia of the corporal tissue. Decompression is usually successful with no permanent damage if treatment is provided within 12 hours of onset.
A 69-year-old patient was referred with priapism of the corpora cavernosa and the corpus spongiosum. Blood aspiration, irrigation with heparin-saline solution and metaraminol injections proved unsuccessful. Surgical intervention was inadvisable in view of delayed coagulation. Complete detumescence was achieved after intracorporeal perfusion with streptokinase.
Of 18 patients treated for priapism by glando-cavernous anastomosis, 11 obtained complete relief. Follow-up examination of the 18 patients has shown normal erectile function in 11 cases. It would appear that the chance of preserving sexual function is greater the better the immediate result of the operation obtained and the earlier the patients are treated.
A 44-year-old man suspected of having transitional cell carcinoma (TCC) of the prostate was referred to our hospital. He had a painful semi-erect penis at his first visit. Then needle biopsy of the corpus cavernosum histologically revealed metastatic TCC. CT of the pelvis showed bilateral ureteral obstruction caused by the advanced tumor but no lymph node swelling was found. Under the diagnosis of prostatic TCC with penile metastasis, bilateral percutaneous nephrostomy followed by two courses of combination chemotherapy (IFEP regimen) was carried out, which resulted in the disappearance of priapism. Radical cystectomy with total penectomy was performed. The final pathological diagnosis was corrected to TCC of the urinary bladder with invasion to the prostate and metastasis of the corpus cavernosum and the right obturator lymph node. Enlargement of the prostate proved to be caused by glandular hyperplasia with atypical hyperplasia of the prostate gland. Three courses of adjvent IFEP chemotherapy was given post-operatively and he has been alive with no evidence of the disease for 10 months.
Three cases of posttraumatic, high-flow arterial priapism are reported. In each, targeted color flow sonography was performed, demonstrating the site of intracavernosal arterial-sinusoidal fistula. Two of the three lesions could only be detected with the use of color Doppler sonography, emphasizing its role in the noninvasive diagnostic imaging work-up of this disorder.
A man aged 32 with psychotic and depressive symptoms was treated with zuclopentixol and paroxetine, following which priapism developed. After puncture of coagulated blood from the corpora cavernosa urine retention developed and a suprapubic catheter had to be introduced temporarily for urine drainage. Zuclopentixol is an alpha 1-receptor blocker and paroxetine inhibits the hepatic enzyme P450-2D6 required for conversion of the two substances. Separately, and especially in combination, these substances cause a disturbance of the drainage from the corpora cavernosa leading to ischaemia and complications such as dysuria, urine retention, impotence, fibrosis of the corpora cavernosa and gangrene. Consequently, timely treatment is indicated.
Presentation of an exceptional case of priapism in an 82-year-old male, secondary to primary bilateral abscess corpus cavernosum. Diagnosis was reached through aspiration puncture and pus drainage, which also allowed the resolution of the condition. After a literature review, no similar case was found. This was a painful, long-lasting erection that resulted from corpus cavernosum repletion with purulent material instead of blood.
A 21-year-old male complained of persisting erection. A urethral balloon catheter had been for 3 weeks after indwelt urethral injury by a skateboard, and he was hospitalized because of penile erection persisting after removing the catheter. High flow priapism was suspected by intracavernous blood gas study and color Doppler ultrasound study. Selective internal pudendal arteriography revealed a leakage of contrast medium at the base of penis. He was treated with selective embolization of bilateral internal genital arteries using gelatin sponges and achieved detumescence. Normal potency was evident 3 months later by examining nocturnal penile tumescence.
Metastases to the penis from transitional cell carcinoma of the bladder are rare. In the literature about 300 cases of secondary penile malignancies were described; 35% out of these cases were from primary neoplasms of the bladder. The Authors describe a case of priapism secondary to penile metastases from a transitional cell carcinoma of the bladder.