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PubMed1999

[Partial priapism. Case report and review of the literature of diagnostic and therapeutic measures].

Partial priapism is a rare condition which has been previously reported in the literature only in eight cases. Unlike the typical case of priapism, patial priapism generally shows erection only of the proximal corpora cavernosa. In most of the cases a well defined membrane separated the proximal erected and the distal flaccid part of the corpus. The origin of the fibrous membrane is not clear. Usually a painful segmental thrombosis of the corpora cavernosa was found proximal the membrane. Until 1985 diagnosis and therapy of this entity have principially involved invasiv methods. Later computed tomography (CT) and magnetic resonance (MR) were used for noninvasive imaging and conservative management was elected. We report a case of partial priapism and review the diagnostic and therapeutic procedure in the previous literature.

Adult↗
PubMed2002

Superselective embolization with coils in high-flow priapism.

Priapism can be divided into "low-flow" veno-occlusive priapism and, especially in children, rare "high-flow" arterial priapism. We report a 5-year-old boy who developed arterial priapism after blunt perineal trauma that was successfully treated by superselective embolization with microcoils.

Angiography↗
PubMed2000

Posttraumatic high-flow priapism: treatment with selective embolisation.

Priapism is an uncommon problem in childhood. Most of the reported cases are in boys with sickle-cell disease or leukaemia. It occurs as a result of venous outflow obstruction, resulting in engorgement of the corpora cavernosa, and is termed "low-flow" priapism. In a small group of children priapism is due to uncontrolled arterial inflow, usually as a result of direct trauma. The authors report a case of posttraumatic arterial priapism in a child, successfully treated with selective embolisation of the internal pudendal artery. Recognition of this distinct entity is important, as it carries a good prognosis when appropriately treated.

Angiography, Digital Subtraction↗
PubMed1981

Priapism in children with leukemia.

A case of priapism in a child with chronic granulocytic leukemia is presented, and the English literature is reviewed. While common in adult leukemia patients, priapism is rare in children with these neoplasms. Sludging of blood in the corpora cavernosa is almost universally accepted as the mechanism behind the development of painful and persistent erection in these patients. Permanent fibrosis of the cavernosal tissue may not occur in leukemic priapism as it does in other than chronic granulocytic leukemia. Therapy directed toward the priapism is almost uniformly unsuccessful. However, the painful erection will resolve spontaneously in a matter of days with proper treatment of the leukemic process.

Child↗
PubMed1985

Priapism: review of 34 cases.

One hundred ninety-seven cases of priapism have been recorded in the medical files of Charity Hospital Louisiana in New Orleans from 1938-1982. One hundred seventy-two adults and 25 children were registered in this series. Ninety-three per cent of the patients with priapism were black, and 86 patients of this group underwent 93 surgical procedures. The cases of 34 patients treated between July 1, 1981, and December 31, 1982, were thoroughly reviewed. Sixteen patients had a previous history of priapism. Average delay between onset of symptoms and presentation to the hospital for treatment was thirty hours. Sickle cell screens were obtained in 28 patients and were positive in 17. Twenty-nine patients were initially treated conservatively, with 17 priapisms eventually resolving, but the remaining 12 patients required surgical intervention. Overall, 50 per cent of the 34 patients had surgery. All of the surgical cases resolved satisfactorily with the Winter procedure. Complications with this procedure were uncommon, but postoperative bandaging was the chief cause of morbidity. Follow-up for at least six months revealed comparable sexual potency (80-83%) in either conservatively or surgically managed patients.

Adult↗
PubMed1985

Implantation of penile prostheses in patients impotent after priapism.

Review of recent implantations of penile prostheses done at Duke University Medical Center reveals 6 patients implanted for impotence secondary to priapism. Of these 6 patients, 5 had sickle cell anemia-induced priapism and 1 had idiopathic priapism. One patient had implantation of an inflatable prosthesis later followed by a semirigid prosthesis, 3 had implantation of a semirigid prosthesis, and 1 had an unsuccessful attempt at implantation of a semirigid prosthesis. The 5 patients with successful implantation have obtained satisfactory postoperative coital function. We believe that penile prostheses are beneficial in patients with impotence secondary to priapism. The degree of fibrosis encountered suggests that a semirigid prosthesis is more favorable, since the inflatable prosthesis may not overcome corporeal rigidity.

Adult↗
PubMed2004

Emergency evaluation and treatment of priapism.

Priapism is a fairly uncommon presentation to the Emergency Department, but when it does present, it represents a true urologic emergency. Prompt treatment will decrease the risk of permanent sequelae including impotence. Treatment should be based on etiology and follow an organized approach. Various cases will arise when conservative management will not remedy the priapism and more aggressive measures will be needed, particularly if emergent urological consultation is not available. This article reviews the causes of priapism and systematically reviews techniques and procedures used to manage and treat priapism.

Adrenergic alpha-Agonists↗
PubMed2004

Idiopathic stuttering priapism: recovery of detumescence mechanism with temporal use of antiandrogen.

We report a case of idiopathic stuttering priapism in a 56-year-old Japanese man. We treated his recurrent priapism in stepwise fashion by withdrawal of the alpha/beta-blocker he used for hypertension, administration of low doses of an antiandrogen and baclofen, and finally by increasing the dose of antiandrogen, which lowered his testosterone to the castration level and was effective in preventing priapism. After 6 months of antiandrogen treatment, his erectile function gradually recovered to the baseline level, and he had no recurrence of priapism during the following 6 months without any medication.

Baclofen↗
PubMed1998

Post-traumatic arterial priapism: colour Doppler examination and superselective arterial embolization.

PURPOSE: To evaluate selective embolization for management of post-traumatic priapism and colour Doppler sonography for the diagnosis of the causative lesion and for planning embolization. MATERIALS AND METHODS: Six male patients with post-traumatic priapism underwent selective angiography and embolization. Colour Doppler sonography with grey-scale was performed in all six patients before angiography. RESULTS: Selective angiography showed intracavernosal arteriovenous fistulas in all patients and pseudoaneurysm of the cavernosal artery (or common penile artery) in three patients. After successful embolization, detumescence was achieved in all patients. Colour Doppler sonography enabled localization and characterization of the lesion causing priapism in four patients. Grey-scale ultrasonography showed the dilated cavernosal sinuses in all patients. CONCLUSION: Angiography with selective embolization is safe and effective method to correct post-traumatic priapism. Colour Doppler sonography with grey scale is a useful preangiographic study, as it allows for characterization and localization of the causative lesion except lesions at the proximal cavernosal or distal penile artery near the symphysis pubis.

Adult↗
PubMed1993

Chronic priapism secondary to a traumatic arteriovenous fistula of the corpus cavernosum.

A 30-year-old man presented with a 7-month history of chronic partial priapism and sexual dysfunction following blunt perineal trauma. Duplex penile ultrasound confirmed high flow priapism and color flow Doppler ultrasound diagnosed an arteriovenous fistula within the left corpus cavernosum. This lesion was corrected via corporeal exploration and ligation of the artery feeding the fistula. The use of color flow Doppler ultrasound to diagnose this unusual condition obviated the need for angiographic studies. This rare condition of posttraumatic priapism may be diagnosed by noninvasive means. The pathophysiology, diagnosis and treatment of posttraumatic priapism and review of the literature are discussed.

Adult↗
PubMed1992

Clozapine-associated priapism: a case report.

Priapism is a recognized side effect of antipsychotic therapy. Recently, new agents known as atypical antipsychotics, such as clozapine, have been introduced with the intent of ameliorating psychosis without the extrapyramidal side effects associated with standard antipsychotic therapy. Priapism has not been observed previously with atypical antipsychotic therapy. We report a case of veno-occlusive priapism associated with the use of clozapine. This priapistic episode was complicated by the development of recurrent post-ischemic priapism.

Adult↗
PubMed1986

Priapism: a refined approach to diagnosis and treatment.

The recent introduction of intracorporeal injections of papaverine and phentolamine for the diagnosis and treatment of impotence has resulted in an increased incidence of iatrogenic priapism. Based on our research into penile hemodynamics we propose a refined approach to all types of priapism. Intracorporeal blood gas and pressure monitoring should be used to differentiate ischemic (low flow) from nonischemic (high flow) types. Most cases of papaverine-induced or phentolamine-induced priapism will respond to aspiration alone or in combination with intracorporeal instillation of a diluted alpha-adrenergic agent. In spontaneous priapism alpha-adrenergic agents can be tried first if patients have only mild or no ischemia. In patients with severe ischemia stagnant blood should be evacuated and a shunt procedure should be performed to allow metabolic replenishment of tissue. Intracorporeal pressure monitoring will help to determine the size and number of shunts needed to re-establish corporeal circulation.

Adult↗
PubMed1984

Familial idiopathic priapism: a case report.

Idiopathic priapism is a diagnosis made by exclusion of identifiable etiologies and is found in 43 to 58 per cent of the cases. We report a case of priapism that was investigated exhaustively and classified as idiopathic. In addition, 3 brothers also reported similar episodes of priapism. Although a common abnormality exists presumably, we were unable to define an etiology. Therefore, this case was designated as familial idiopathic priapism.

Adult↗
PubMed1981

Non-incisional therapy for priapism.

During a 4-year period 7 patients with priapism were managed successfully with a non-incision treatment program. Three were treated by hypotensive anesthesia with sodium nitroprusside, 2 by the Winter procedure (creating a temporary cavernospongiosum shunt) and 2 by combining hypotensive anesthesia and the Winter procedure. Causes of the priapism were pelvic infection in 1 patient, sickle cell trait in 2 and post-hemodialysis in 2. The cause was not known in 2 cases. Of the 7 patients 5 were potent before the onset of the priapism and remained so after treatment. No complications of therapy were noted and hospitalization averaged 1.4 days, with 5 patients being discharged the day after treatment. Our experience with these 7 patients indicates that creation of a vascular shunt by an operative technique may not be necessary to alleviate priapism.

Adult↗
PubMed1980

Transglandular cavernosum-spongiosum shunt for leukemic priapism in childhood.

Priapism is a complication rarely seen in childhood leukemia. Whatever the etiology the basic pathologic feature is obstruction to venous outflow from the corpora cavernosa. The cavernous bodies are erect but the glans penis and the corpus spongiosum usually remain soft. Various forms of treatment have been advocated for the management of this condition and have met with varying degrees of success. A boy with acute lymphocytic leukemia presented with priapism. Although radiation and chemotherapy induced prompt remission and dramatic decrease in leukocytosis, the priapism persisted. Resolution of the priapism was obtained using the transglandular cavernosum-spongiosum shunt.

Adolescent↗
PubMed1977

Priapism: evolution of management in 48 patients in a 22-year series.

The choice of an effective method to treat priapism is challenging because precise causes in the majority of patients have not been well defined. A review of 48 patients treated during a 22-year period shows evolution of a regimen of management that has yielded a high percentage of success. Idiopathic priapism and sickle cell disease accounted for 81 per cent of the subjects. An evaluation should include a medication history, a search for specific diseases, as well as a thorough physical examination to detect possible etiologic factors. The explanation for the frequent association of fever deserves further investigation. Initial therapy consisting of aspiration and irrigation, and intermittent pneumatic cuff compression should be undertaken for a trial period of 12 to 36 hours, repeating the aspiration 2 or 3 times if necessary. The failure of priapism to resolve after such treatment is an indication for a shunt operation. Patients with known etiology should be treated specifically for the primary disease and usually more conservatively for priapism. Resolution occurred in all patients and approximately 50 per cent regained sexual potency.

Adolescent↗
PubMed2000

Megalophallus as a sequela of priapism in sickle cell anemia: use of blood oxygen level-dependent magnetic resonance imaging.

Priapism is a common complication of sickle cell anemia. We report a little known sequela of priapism: painless megalophallus, with significant penile enlargement. The patient had had an intense episode of priapism 9 years previously and his penis remained enlarged. Blood oxygen level-dependent magnetic resonance imaging revealed enlarged, hypoxic corpora cavernosa. Megalophallus probably resulted from permanent loss of elasticity of the tunica albuginea due to severe engorgement during the episode of priapism. This sequela needs to be recognized by physicians because no intervention is necessary and sexual function seems to remain intact.

Adult↗
PubMed2002

Antiandrogens in the treatment of priapism.

Recurrent priapism in young men is a potentially devastating condition that may result in irreversible penile fibrosis. Hormonal manipulation using estrogens and gonadotropin-releasing hormone analogues has been successful in treating episodes of priapism refractory to other treatment forms, but it is associated with significant adverse effects, in particular the loss of libido and erectile function. We present 2 patients with sickle-cell disease and 1 patient with a spinal cord injury who had recurrent and refractory priapism. All 3 patients were successfully treated with low-dose antiandrogens without major side effects. Our observations suggest a role for antiandrogens in the treatment of men with refractory priapism that should be evaluated in the setting of a controlled study.

Adult↗