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PubMed1990

Traumatic laceration of intracavernosal arteries: the pathophysiology of nonischemic, high flow, arterial priapism.

Two forms of priapism are known to occur. The more common type, veno-occlusive priapism, presents with a prolonged painful erection, and it is characterized by ischemia and pooling of blood within the corpora cavernosa. The less common form, high flow priapism, is characterized by lack of pain and ischemia. The pathophysiology of this disorder is poorly understood and the treatment is unclear. We report 2 cases of nonischemic priapism, one of which occurred after blunt perineal trauma and the other after intracavernosal self-injection with papaverine and phentolamine. Based on our 2 cases as well as a review of the literature (5 cases), we propose that the pathophysiological mechanism of this disorder is unregulated arterial inflow into the corpora, classify it as arterial priapism, and describe a diagnostic and therapeutic algorithm for its management.

Adult↗
PubMed2003

Tricorporal priapism in a patient with metastatic esophageal cancer.

Tricorporal priapism refers to priapism involving the corpora cavernosa and spongiosum. It is exceedingly rare and, depending on the etiology, may be difficult or impossible to treat. We present a case of tricorporal priapism in a patient with metastatic esophageal cancer and complete thrombosis of all venous vasculature below the level of the renal veins. Ultimate management consisted of comfort measures and minimizing the risk of infection. In this case of tricorporal ischemic priapism, the recognized treatment options for ischemic priapism were not applicable, because no viable shunt targets were available. The treating urologist should be aware of this potential clinical entity and be prepared to offer conservative management.

Abdominal Neoplasms↗
PubMed2003

Cocaine and ephedrine-induced priapism: case reports and investigation of potential adrenergic mechanisms.

OBJECTIVES: To investigate the direct effect of ephedrine and cocaine on neurogenic contraction of penile trabecular smooth muscle. We also provide three case reports of patients who developed priapism secondary to using either cocaine or nonprescription weight loss formulations containing ephedrine. The use/abuse of cocaine has been associated with priapism. In addition, anecdotal evidence suggests that priapism may result from ephedrine use. However, the effects of cocaine and ephedrine on adrenergic regulation of cavernosal tissue and the potential role of sympathetic dysregulation in the development of priapism have not been studied. METHODS: Isolated rabbit penile cavernosal tissue strips in organ bath preparations were subjected to electrical field stimulation (EFS) at varying frequencies (5 to 40 Hz) in the absence or presence of ephedrine (60 microg/mL) or cocaine (10 microM). Tissues were then subjected to EFS every 30 minutes for up to 20 hours. RESULTS: Ephedrine and cocaine initially caused contractions in cavernosal tissue strips that persisted for several hours. EFS-induced contractions became attenuated over time in tissues treated with ephedrine or cocaine. Eventually, the contractile responses to EFS were not distinguishable from the basal tone, although the tissues remained responsive to exogenous phenylephrine. CONCLUSIONS: Functional activation of alpha-adrenergic receptors on trabecular smooth muscle does not appear to be impaired with prolonged cocaine or ephedrine exposure. However, chronic use of cocaine or ephedrine may deplete norepinephrine from sympathetic nerve terminals, leading to priapism.

Adrenergic alpha-Agonists↗
PubMed2003

Reperfusion of ischemic corporal tissue: physiologic and biochemical changes in an animal model of ischemic priapism.

OBJECTIVES: To assess the physiologic and biochemical changes resulting from ischemia and reperfusion. Effective therapy for ischemic priapism reestablishes corporal venous outflow and arterial inflow and results in increased corporal partial pressure of oxygen. Data are limited concerning reperfusion injury of ischemic erectile tissue associated with reactive oxygen species (ROS) and the potential role of ROS scavengers in the clinical therapy of ischemic priapism. METHODS: Anesthetized adult New Zealand white male rabbits (n = 7) were exposed to a low oxygen tension breathing gas to achieve hypoxia within the corpora cavernosa. This resulted in a mean systemic oxygen saturation of 60%. The pelvic nerve was electrically stimulated to induce penile erection, and the base of the erect penis was clamped. After varying durations of ischemia, the clamp was removed to allow reperfusion. We determined the intracavernosal oxygen tension, histologic changes, myeloperoxidase activity, and lipid peroxidation. RESULTS: Corporal partial pressure of oxygen progressively decreased as the duration of priapism increased. A statistically significant increase was noted in myeloperoxidase activity and lipid peroxidation with corporal reperfusion. Polymorphonuclear leukocyte infiltration was documented in the ischemic reperfused tissue. CONCLUSIONS: In the management of ischemic priapism, reperfusion causes erectile tissue injury owing to the presence of ROS. There is a need to investigate the utility of ROS scavengers and antioxidants in the management of ischemic priapism.

Animals↗
PubMed1985

Priapism resulting from fluphenazine hydrochloride treatment reversed by diphenhydramine.

A chronic schizophrenic patient received 30 mg fluphenazine hydrochloride (Prolixin) PO and developed priapism. Urological examination and subsequent urological workup was negative, indentifying fluphenazine hydrochloride as the cause of the priapism. During the period of priapism evaluation, the patient developed a severe extrapyramidal reaction that was treated with diphenhydramine (Benadryl) 50 mg IV push. There was remission of the extrapyramidal reaction in three minutes followed by resolution of the priapism. The rationale for the treatment of antipsychotic drug-induced priapism with anticholinergic drugs is discussed.

Adult↗
PubMedDate not supplied

[Resolution of a case of arterial priapism secondary to bilateral arteriocavernous fistula with selective embolization using reabsorbible material].

Priapism is defined as persistent erection without sexual stimulus. The new classifications make a distinction between venooclusive low flow priapism, isquemic and arterial high flow priapism, non isquemic. The perineal or penis trauma are responsible the most of cases arterial priapism, formation of an arteriocavernous fistula. The diagnosis is clinical, blood gas analysis and colour Doppler ultrasonography of the corpora cavernosa confirmed the diagnosis. The arteriography with selective embolization constitutes a safe and effective therapeutic method. We report one case of arterial priapism secondary to bilateral arteriocavernous fistula resolved with selective embolization using reabsorbible material.

Absorbable Implants↗
PubMed2001

Heparin-induced priapism.

Heparin-induced priapism constitutes a special form of pharmaco-induced prolonged erection, but the pathophysiological principles are not yet definitely clear. Heparin-induced antiplatelet-antibodies may lead to the aggregation of thrombocytes and thus alter the penile blood flow leading to low-flow priapism. Alternatively, this condition may be explained by initial high-flow priapism that later turns into ischemic priapism. The question remains whether hemorrhage with subsequent organisation of the hematoma and late fibrosis constitutes a pathogenetic factor. Besides this pathogenetic discussion, this paper presents the differential diagnosis of priapism as well as diagnostic and therapeutic procedures.

Adult↗
PubMed2003

Priapism pathophysiology: clues to prevention.

Priapism, in which penile erection persists in the absence of sexual excitation, is an enigmatic yet devastating erectile disorder. Current endeavors to manage the disorder suffer from a poor fundamental knowledge of the etiology and pathogenesis of priapism. These endeavors have remained essentially reactive, which commonly fail to avert its pathological consequences of erectile tissue damage and erectile disability, not to mention its psychological toll. The role of preventative management seems paramount with respect to priapism. As a prerequisite to formulating prevention strategies, gaining understanding of its pathogenic features and likely pathophysiologic mechanisms is viewed to be quite important. This review combined an analysis of clinicopathologic reports as well as a summary of clinical and basic science investigations on the subject to date. These assessments support the basic classification of priapism into low-flow (ischemic) and high-flow (nonischemic) hemodynamic categories, resulting from venous outflow occlusion and unregulated arterial overflow of the penis, respectively. In addition, consistent with the hypothesis that dysregulative physiology of penile erection accounts for some presentations of priapism, several plausible molecular mechanisms influencing the functional state of the erectile tissue are discussed. Current progress in the field suggests prevention possibilities using androgenic suppressive therapy, adrenergic agonist therapies, and effectors of the nitric oxide-dependent erection regulatory pathway in the penis. New ideas for prevention may emerge from targeting molecular mechanisms involved in regulating erectile tissue function.

Humans↗
PubMed2000

Post-traumatic arterial priapism in the child: a study of four cases.

The authors report four cases of arterial priapism in the child, a rare condition since only 13 cases are described in the literature. High-flow priapism follows perineal or penile injury with damage to a cavernosal artery and formation of an arteriosinusoidal fistula. The onset may be immediate but more often occurs after a few days. Arterial priapism is painless, as the corpora cavernosa are less tumescent in the anterior third of the penis. The clinical appearance and circumstances of onset suggest the diagnosis. Doppler ultrasound is the complementary investigation of choice, confirming and localising the fistula. Various methods of treatment have been proposed. Injections of alphastimulant seem ineffective in most cases and are not without danger. Surgery, which is potentially damaging, has been used only in the adult. Most authors propose embolising with resorbable material the artery which feeds the fistula. However, priapism may resolve spontaneously in less than three weeks, as occurred in our cases, without recurrence or subsequent erectile dysfunction. We thus consider the condition may initially be managed by observation alone, with recourse to embolisation if priapism does not resolve after a period of time which however remains to be defined.

Arteries↗
PubMed2004

Treatment of priapism in pediatric patients with sickle cell disease.

PURPOSE: The available treatment options for priapism in pediatric (1-21 years of age) patients with sickle cell disease (SCD) are reviewed. SUMMARY: Priapism is a complication of SCD that receives little attention, yet it is a particularly bothersome issue for many pediatric patients. Numerous therapeutic options have been attempted, including diethylstilbestrol, gonadotropin-releasing hormone analogues, various adrenergic agonists, and hydroxyurea. Few agents have actually been examined in a controlled clinical trial, making it difficult for practitioners to treat this complication. It is our recommendation that treatment should be conservative initially, with the patient being encouraged to urinate, exercise, increase his fluid intake, and take oral analgesics. If the episode of priapism persists beyond 2 hours, the patient should report to the emergency department for i.v. hydration and analgesics. If the episode persists beyond 4 hours, intracavernosal aspiration and instillation of an alpha-agonist should be performed and repeated as needed. If the priapism remains for longer than 12 hours, surgery should be considered for shunt placement. CONCLUSION: There is little evidence available regarding the definitive treatment of priapism, which affects a large number of pediatric patients with SCD. It is quite clear that more research is needed to determine what the best treatment options are for patients with this condition. Health care providers should educate their patients with SCD about the condition. Education, combined with more research of treatment options, may help patients avoid the damaging social, psychological, and medical implications of this bothersome and often embarrassing complication of SCD.

Anemia, Sickle Cell↗
PubMed1999

Idiopathic priapism.

Idiopathic priapism is rarely seen in children. Two children with idiopathic priapism are presented, followed by a detailed discussion of priapism. Particular attention is paid to idiopathic priapism. Additionally, an algorithm for diagnosing and managing children presenting with priapism is presented.

Adolescent↗
PubMed2005

Association of single nucleotide polymorphisms in klotho with priapism in sickle cell anaemia.

The complications of sickle cell disease are probably determined by genes whose products modify the pathophysiology initiated by the sickle haemoglobin mutation. Priapism, one vaso-occlusive manifestation of sickle cell disease, affects more than 30% of males with the disease. We examined the possible association of single nucleotide polymorphisms (SNPs) in 44 candidate genes of different functional classes for an association with the occurrence of priapism. One hundred and forty-eight patients with sickle cell anaemia and incident or a confirmed history of priapism were studied, along with 529 controls that had not developed priapism. Polymorphisms in the KLOTHO gene (KL; 13q12) showed an association with priapism by genotypic [reference SNP cluster identifier number (rs)2249358; odds ratio (OR) = 2.6 (1.4-5.5); rs211239; OR = 1.7 (1.2-2.6)] and haplotype analyses [rs211234 and rs211239; OR = 2.3 (1.5-3.4)]. These findings may have broader implications in sickle cell disease, as KL encodes a membrane protein that regulates many vascular functions, including vascular endothelial growth factor expression and endothelial nitric oxide release.

Adult↗
PubMed1999

New aspects in the treatment of priapism.

Recent advances in the understanding of erectile physiology have improved the prompt diagnosis and treatment of priapism. During initial assessment, the physician must distinguish between veno-occlusive low flow (ischemic) and arterial high flow (nonischemic) in order to choose the correct treatment option for each type of priapism. Patient history, physical examination, penile haemodynamics and corporeal metabolic blood quality assist the distinction between static and dynamic priapism. Normally, priapism is effectively treated with intracavernous vasoconstrictive agents or surgical shunting. However, when these two methods fail, subsequent treatment procedures are a matter for debate. Alternative options, such as intracavernous injection of methylene blue or selective penile arterial embolization, for the management of high and low flow priapism are described and a survey of current treatment modalities is presented.

Adult↗
PubMed1986

Priapism and dialysis.

Ninety-three dialysis units located in the tri-state area were surveyed for the prevalence of priapism. Seventeen of 3,337 male patients experienced an episode of priapism. All of these episodes occurred either during or 2-7 h after dialysis, suggesting a cause-and-effect relationship. The use of heparin during dialysis seemed to play a role in its induction; none of the patients on peritoneal dialysis experienced priapism, and heparin was not used in their exchanges. Eleven of 17 patients also received androgen therapy which might have been a contributing factor. Additional considerations included dialysis-induced hypoxemia and acidosis which have been known to precipitate priapism in patients with sickle cell disease or trait. In our study, 2 of 10 patients, including our case report, were black males with sickle cell trait. The calculated prevalence in the male population is 1:196, and in blacks and Caucasians 1:128 and 1:293, respectively. Except for 2 cases of sickle cell trait in the 10 black males, no particular subpopulation at risk was identified. In view of the absence of a proven etiologic agent and the relatively low prevalence of priapism we do not recommend changes in dialysate, anticoagulant, or the use of androgen therapy.

Adult↗
PubMed1986

Treatment of post-traumatic priapism by intracavernous injection of alpha-stimulant.

A 6-year-old boy was seen for post-traumatic priapism which had been present for 4 days. Intracavernous injection of metaraminol was performed to reduce the arterial blood inflow of the penis. Within 30 min after the injection, the penis became flaccid, and the prognosis was good. Recently it was reported that there are two different types of priapism. Type 1 priapism is due to blood stasis. This type is well known and characterized by extremely hard corpora and painful penis. Type 2 is caused by increased arterial blood flow of penis. It differs clinically from type 1 by a more elastic consistency of the penis and the absence of pain. Generally the prognosis of type 2 priapism is favorable. In our case, the penis was relatively elastic and not painful. It was considered to be type 2 priapism.

Child↗
PubMedDate not supplied

Priapism in a patient treated with total parenteral nutrition.

Venous thrombosis is a common complication of total parenteral nutrition. We report a case of priapism in a 40-year-old man after administration of total parenteral nutrition for chronic idiopathic intestinal pseudo-obstruction. The patient received glucose, amino acids, and 20% fat emulsion; 12 hours after administration, the patient complained of a persistent, painful penile erection lasting 5 hours. Bilateral corpora cavernosa spongiosum shunts achieved immediate and sustained detumescence, but the patient remained impotent. There was no history of penile or pelvic trauma, hemoglobinopathy, coagulopathy, venous thrombosis, or leukemia. The medical literature describes seven other cases of priapism related to total parenteral nutrition. All of the patients received 20% fat emulsion; two patients developed priapism during the weekly infusion of fat emulsion. Among the multiple factors that can favor thrombosis and therefore priapism during total parenteral nutrition, fat infusion appears to be the most important. Three different mechanisms have been postulated: increase in blood coagulability, effects on red blood cells, and fat embolism. In this patient, platelet function was estimated in vivo by the levels of antiheparin platelet factor 4 and beta-thromboglobulin. These two parameters were both elevated before 20% lipid emulsion and were even higher after the 20% fat-emulsion infusion. Therefore, even if a direct thromboplastic effect is possible, 20% fat emulsion increases platelet activity, which was already high in our patient, and thereby favors priapism.

Adult↗
PubMed2002

Priapism associated with zuclopenthixol.

OBJECTIVE: To present a single case of zuclopenthixol-induced priapism and a literature review. CASE SUMMARY: We report the case of a 31-year-old patient hospitalized due to behavioral alterations and treated with oral zuclopenthixol, an antipsychotic from the thioxanthene family, who developed an acute, painful erection. DISCUSSION: The occurrence of priapism in our patient was related to zuclopenthixol. This adverse reaction is reported for the first time in a patient not concomitantly treated with other drugs associated with the appearance of priapism. The capacity of zuclopenthixol to induce priapism is thought to be due to its antagonist activity on alpha-adrenergic receptors. CONCLUSIONS: Priapism is an uncommon but potentially serious adverse effect of zuclopenthixol that practitioners, as with many other antipsychotics, should be aware of.

Adult↗
PubMedDate not supplied

Testosterone induced priapism in two adolescents with sickle cell disease.

Priapism is common in pubertal males with sickle cell disease, but the association between low-dose exogenous testosterone administration and priapism in such patients has not been well documented. Two adolescents with homozygous sickle cell disease (SCD) and delayed maturation with behavioral problems developed priapism about one week after receiving an intramuscular injection of testosterone enanthate. Neither had a previous history of priapism. We conclude that testosterone should not be administered to male patients with SCD because of the risk of inducing priapism and possible impotence.

Adolescent↗