Stuttering priapism--a review of the therapeutic options

Introduction: Priapism is a urological emergency which is commonly classified into low‐flow and high‐flow priapism. Immediate intervention is required for low‐flow cases as the development of ischaemia ultimately leads to long‐term erectile dysfunction. Stuttering or recurrent priapism is less well understood. This subtype is characterised by short‐lived painful erections and is commonly encountered in patients with sickle cell disease. Methods: A systematic review of the treatment options available for stuttering priapism is presented combined with our own experience in managing this condition over a period of 25 years. Results: Although numerous medical treatment options have been reported, the majority are through small trials or anecdotal reports. Conclusions: Stuttering priapism is a condition which is still not well understood and there is no standardised algorithm for the management of this condition. A multicentre randomised trial is required to evaluate the treatment options.     

异常勃起的局部注射治疗及其治愈后勃起功能的探讨(附31例报道)

目的:探讨去甲肾上腺素阴茎海绵体注射治疗异常勃起的效果及长时间异常勃起经治疗后对其勃起功能的影响。对象与方法:应用去甲肾上腺素0.5mg 海绵体注射治疗31例36次异常勃起。异常勃起发生时间为 7～120小时,平均 23.7小时,并对 27例作了随访。结果:全部治愈,近期内无明显不良后果。除 4例失访外,其余 27例作了 8个月～11年(平均 5.4年)的随访。患者短期内勃起功能与发病前无显著差别。但在6个月后,异常勃起超过36小时的11例中有9例发生勃起功能障碍(82％)和4例发生海绵体纤维化(36％)。而在36小时以内的16例中只有5例有勃起功能障碍(36.25％,x~2=4.78,P<0.05)。结论:海绵体内注射去甲肾上腺素是治疗异常勃起有效而安全的方法。超过36小时的异常勃起可能导致勃起功能障碍。其原因与海绵体的纤维化可能有一定的关系。     

藻酸双酯钠致阴茎异常勃起2例报告并文献复习

【目的】探讨藻酸双酯钠（PSS）致阴茎异常勃起的治疗方法与效果。【方法】报告2例PSS致异常勃起的患者诊治过程并复习文献。【结果】1例经行阴茎海绵体冲洗3日后,症状完全改善;另1例在外院经3次阴茎海绵体冲洗及行阴茎头体分流术后症状无改善,给予再次行阴茎海绵体头体分流术＋阴茎海绵体隧道术,术后次日阴茎勃起完全消失。【结论】对PSS致阴茎异常勃起时间在6～8h内给予保守治疗,若PSS致阴茎异常勃起超过24h,应行阴茎头体分流术＋阴茎海绵体隧道术,以防止海绵体坏死纤维化,最大限度地保护患者的勃起功能。     

以阴茎异常勃起为首发症状的白血病5例并文献复习

目的 :探讨阴茎异常勃起为首发症状的白血病的诊断和治疗原则。方法 :回顾性分析了 5例首诊入住泌尿外科 ,以阴茎异常勃起为首发症状的白血病患者的临床资料。结果 :5例阴茎异常勃起均为慢性粒细胞白血病所致 ,均伴有不同程度的脾肿大和血象异常。1例阴茎尿道海绵体分流 ,1例阴茎海绵体切开 ,3例行海绵体抽吸冲洗术。1例海绵体部分纤维化 ,勃起功能障碍 ,余 4例均取得了较好疗效。结论 :以阴茎异常勃起为首发症状的白血病误诊率高。对白血病性阴茎异常勃起应采用综合方法治疗 ,化疗是主要的治疗措施 ,阴茎持续勃起时间长者应尽早行外科处理。     

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.     

Self-administered intraurethral chlorpromazine: an unusual cause of priapism

Priapism is a prolonged, painful penile erection unaccompanied by sexual desire and not alleviated by ejaculation. The etiologies of priapism are numerous and diverse. Priapism can be a serious adverse effect of psychotropic medications. The case of a 36-year-old man who demonstrated priapism, 48 hours after inserting a crushed chlorpromazine tablet into the urethral meatus of his penis, is reported. Priapism induced by this route of drug administration has not been previously described. The pathophysiology and treatment of priapism are reviewed.     

阴茎异常勃起的急诊诊治10例分析

目的:探讨阴茎异常勃起的急诊诊断和治疗方法。方法:回顾性分析10例阴茎异常勃起患者的临床资料。结果:治疗后消退10例,复发2例,勃起功能障碍3例。结论:临床表现、血气分析和彩色多谱勒检查能明确诊断和分型。阴茎海绵体穿刺抽吸冲洗术,阴茎头—阴茎海绵体分流术及介入治疗是治疗低血流量型和高血流量型阴茎异常勃起的重要方法。     

Embolization for massive urethral hemorrhage

Priapism is the term given to a prolonged, painful penile erection, unaccompanied by sexual desire. Most cases of priapism occur as a result of engorgement of the cavernous body of the penis due to intrinsic or extrinsic venous outflow obstruction, which is termed veno-occlusive priapism. However, in a small number of patients, the cause is related to uncontrolled arterial inflow due to trauma and resultant laceration of cavernosal arteries. This form of disease has been termed high-flow priapism and usually occurs in association with genitoperineal trauma. Most incidents of high-flow arteriogenic priapism result from genitoperineal trauma, such as that caused by sliding on a wooden bar or falling astride a ladder. We experienced a patient with a high-flow priapism due to urethral trauma caused by a misplaced Foley catheter. The treatment consisted of superselective arterial embolization of the bilateral internal pudendal arteries using metallic microcoils, which resulted in the subsequent detumescence of the penis with no complications. This case showed that bilateral arteriocavernosal fistulae can be successfully treated by superselective arterial embolization.     

Safety and efficacy of blood exchange transfusion for priapism complicating sickle cell disease

Background : Priapism is unwanted painful penile erection that affects about 36% of boys and men with sickle cell disease (SCD) most of whom have sickle cell anemia. Clinically, priapism could be stuttering, minor, or major. The first two types are mild, last < 4 h, are usually treated at home, have good prognosis with normal sexual function. The major type of priapism lasts >4 h, associated with severe pain, requires hospitalization; often does not respond to medical treatment and may require shunt surgery. Untreated major priapism and surgical intervention often cause impotence. In this study, we report our 15‐year experience in treating adult patients with SCD and major priapism with blood exchange transfusion after being refractory to other medical therapies. Methods : Adult male African Americans patients with SCD and major priapism were enrolled in this study and followed for 15 years. A Haemonitics V‐50 machine was initially used for whole blood exchange and was later replaced with Cobe Spectra machine for RBC exchange. Results : We used 239 blood exchanges requiring 1,136 RBC units. We maintained a post‐exchange hemoglobin level of about 10 g/dL and hemoglobin S level < 30%. None of the patients had any neurological complications such as headache, seizures, neurological deficits, or obtundation post‐exchange. Conclusion : Together, the data indicate that blood exchange transfusion for the treatment of patients with SCD and major priapism is efficacious and safe. J. Clin. Apheresis 31:5–10, 2016. © 2015 Wiley Periodicals, Inc.     

阴茎异常勃起患者住院期间心理体验的质性研究

目的探索阴茎异常勃起患者住院期间的内心,的感受和真实体验,为临床护理人员对阴茎异常勃起患者在住院期间进行心理护理提供参考。方法采用深度访谈形式,收集10例个案的资料进行分析、整理和归纳出主题。结果由于受疾病的性质、心理压力及治疗过程的影响,患者住院期间真实体验为3大主题：负性心理反应、负性生理反应、情感的变化。结论阴茎异常勃起患者有特殊的内心的感受和心理需求,护理人员应及早开展个性化、针对性的护理措施,降低患者的负性心理、生理、情感应激水平,促进患者身心健康的恢复,以提高患者对婚姻的满意度和生活质量。     

A minimally invasive temporary cavernoso-saphenous shunt in the management of priapism after failed conservative treatment

Abstract Priapism is an urological emergency with detrimental consequences, if not managed expeditiously. Though a rare condition with an incidence between 0.3 and 1.5 per 100,000 population, its management options are limited and decision making could be challenging. We present a case of late presenting priapism for which the initial routine clinical care (aspiration, intracavernosal injection, and distal shunt) failed to relieve erection. Subsequently, the patient was successfully treated by a temporary cavernoso-saphenous shunt using carotid shunt and repeated heparin flushes. This novel surgical treatment offers an alternate method of relieving priapism, avoiding the long-term undesired effects associated with permanent proximal shunts such as cavernoso-venous grafts. Moreover, interval flushes (and/or repeated aspirations) with heparin ensures patency of this new shunt during the perioperative period. The patient recovered without any complications and the shunt was removed after one week. He has regained partial erection, however refused to have further treatment. Temporary cavernoso-saphenous shunt using carotid shunt offers an alternate option of management of priapism in patients with failed initial conservative treatment and distal shunts.     

Assessment of Stuttering Priapism in Individuals with Sickle Cell Disease

Stuttering priapism is a rare and underinvestigated urologic condition reported in individuals with sickle cell disease (SCD). SCD is the most common cause of stuttering priapism. Stuttering priapism, also known as recurrent or intermittent priapism, manifests as transient, repetitive, painful episodes of prolonged erections with intermittent periods of detumescence without sexual stimulation. The tumescence or erection can result in ischemic damage to the corporal tissues. A detailed history and physical examination are paramount for interprofessional management. The nurse practitioner is in a key position to assist individuals with SCD in identification, prevention, and management of stuttering priapism.     

A minimally invasive temporary cavernoso-saphenous shunt in the management of priapism after failed conservative treatment

Abstract

Priapism is an urological emergency with detrimental consequences, if not managed expeditiously. Though a rare condition with an incidence between 0.3 and 1.5 per 100,000 population, its management options are limited and decision making could be challenging. We present a case of late presenting priapism for which the initial routine clinical care (aspiration, intracavernosal injection, and distal shunt) failed to relieve erection. Subsequently, the patient was successfully treated by a temporary cavernoso-saphenous shunt using carotid shunt and repeated heparin flushes. This novel surgical treatment offers an alternate method of relieving priapism, avoiding the long-term undesired effects associated with permanent proximal shunts such as cavernoso-venous grafts. Moreover, interval flushes (and/or repeated aspirations) with heparin ensures patency of this new shunt during the perioperative period. The patient recovered without any complications and the shunt was removed after one week. He has regained partial erection, however refused to have further treatment. Temporary cavernoso-saphenous shunt using carotid shunt offers an alternate option of management of priapism in patients with failed initial conservative treatment and distal shunts.     

Propofol-induced priapism, a case confirmed with rechallenge

OBJECTIVE: To report a case of propofol-induced priapism. CASE SUMMARY: A 17-year-old male receiving propofol for induction of anesthesia during a cardiac ablation procedure developed priapism that required medical intervention and discontinuation of propofol. The priapism developed after a total propofol dose of 550 mg, lasted for 2 hours, and resolved immediately following medical intervention. The following day, the patient underwent a transesophageal echocardiogram and received a total propofol dose of 40 mg throughout the procedure. He again developed priapism, which resolved within one hour without medical intervention. DISCUSSION: Priapism experienced by this patient is considered to be drug-induced because of the temporal relationship, recurrence with rechallenge, and dose-response relationship. Using the Naranjo probability scale, we determined that propofol was a highly probable causative agent of priapism in this patient. CONCLUSIONS: Although, as of April 4, 2006, this adverse effect has not been previously reported, there is a strong correlation of propofol to priapism in this patient. Clinicians should be aware of this adverse effect.     

Priapism as a presentation of T-cell acute lymphoblastic leukaemia in a child

We report a case of a child who presented to the ED with priapism. This was the initial presentation of T-cell acute lymphoblastic leukaemia (ALL). To our knowledge, this is the first report of a child with T-cell ALL presenting with priapism. This case demonstrates the importance of identifying the underlying cause of priapism, as it directly impacts on both initial and ongoing management.     

High-flow priapism complicating ischemic priapism following iatrogenic laceration of the dorsal artery during a Winter procedure

We report a case of a patient who developed high-flow priapism following a Winter procedure performed for the treatment of low-flow ischemic priapism. During the creation of bilateral cavernosal-glandular shunts, the tip of the left dorsal artery was accidentally lacerated. A fistula developed through the shunt between the torn artery and the cavernosal sinusoids of the tip of the left corpus cavernosum. Gray-scale and Doppler sonography and angiography allowed diagnosis and guided the therapeutic approach.     

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.     

Pre-embolization evaluation of high-flow priapism: magnetic resonance angiography of the penis

Purpose

High-flow priapism is often a sequela of perineal trauma resulting in an arteriocavernosal fistula (ACF) between a cavernosal artery and lacunar spaces of the penis. We report our experience utilizing magnetic resonance angiography (MRA) in addition to color Doppler Sonography (CDS) in the workup and treatment planning of 4 patients with high-flow priapism.

Methods

All patients had suspected high-flow priapism diagnosed by clinical exam and CDS and underwent MRA of the penis prior to sub-selective arterial embolization (SSAE) of the feeding vessel(s).

Results

While CDS is valuable in diagnosing and lateralizing high-flow priapism, it does not provide clear anatomic delineation of the number and origin of feeding vessels. MRA provided demonstration of the fistula, demonstrated bilateral ACF supply in 2 patients, and afforded three-dimensional display of the feeding vessels which facilitated pre-embolization planning.

Conclusions

In all four cases, MRA was an effective tool for displaying arterial and venous anatomy, localizing the ACF, and planning subsequent SSAE. MRA influenced management in two out of 4 patients by demonstrating bilateral feeding vessels to their ACFs that required bilateral SSAE.     

高流量性阴茎异常勃起的彩色多普勒与实时超声造影表现

目的通过研究高流量性阴茎异常勃起的彩色多普勒与实时超声造影表现,探讨其血流动力学变化和发病机制。方法观察6例高流量阴茎异常勃起患者的海绵体、窦状隙及海绵体动脉的超声表现,寻找假性动脉瘤部位。实时超声造影检查动脉瘘口,确定血液的高流入方式,分析阴茎海绵体的血流动力学变化。结果高流量性阴茎异常勃起的表现为：阴茎海绵体肿大,回声减低;窦状隙扩张,彩色血流信号增多;海绵体动脉呈高速低阻型血流频谱;假性动脉瘤形成,内可见涡流及喷射状血流信号。实时超声造影可直观显示瘘口处的喷射状血流,以及造影微泡流入阴茎海绵体的顺序,治疗后再次行超声造影可直观显示动静脉瘘和侧支循环形成。结论彩色多普勒超声和实时超声造影可明确高流量性阴茎异常勃起的诊断。     

Idiopathic segmental thrombosis of the corpus cavernosum as a cause of partial priapism

Idiopathic segmental thrombosis of the corpus cavernosum as a cause for partial priapism is an uncommon event. Diagnosis and treatment in the past have principally involved invasive methods. We present a case in which both conventional invasive methods and noninvasive imaging were used.