Appendicitis and low-flow priapism in children

Priapism is a sustained erection that is maintained for over 4 hours in the absence of sexual stimulation [Postgrad Med J. 2006;82(964):89-94; J Urol. 2003;170:1318-1324]. Distinction is made between low- and high-flow variants [J Urol. 2003;170:1318-1324; Cardiovasc Intervent Radiol. 2002;25(4):326-329]. Low-flow priapism (LFP) and acute appendicitis are rarely associated. Including ours, there are 4 cases reported in the literature, all of which have occurred in children. The complications of LFP are potentially serious and include loss of the phallus altogether. Treatment of LFP is should be prompt and is the same irrespective of the etiology.     

Successful treatment of low-flow priapism associated with phenothiazine therapy

We present a case of low-flow priapism that was successfully treated. A 21-year-old man with a history of schizophrenia was admitted with a painful complete erection. He had taken propericiazine, phenothiazine derivatives, before hospitalization and was treated with a glandular-cavernosal shunt (El-Ghorab's procedure). Currently, he is able to have erections without any changes in his quality of life.     

阴茎尿道海绵体分流和隧道术治疗低流量型阴茎异常勃起超48 h患者的经验

目的探讨阴茎尿道海绵体分流+隧道术治疗超48 h的低流量型阴茎异常勃起的临床治疗和术后护理经验。 方法5例低流量型阴茎异常勃起超48 h的患者,排除手术禁忌证后行阴茎尿道海绵体分流+隧道术,术后医护密切配合,通过抗凝、抗雄激素以及基于赋能教育理论的Milk技术——鼓励患者与家属参与疾病管理,采用Milk技术促进阴茎血液循环,定时评估阴茎勃起硬度,进行围手术期护理,尽量恢复阴茎海绵体动脉血流。 结果手术均顺利完成,5例患者治疗后阴茎均能逐渐疲软,疼痛缓解,住院3 d内均顺利出院,出院后1个月内异常勃起均消除,术后随访6~12个月,1例患者能维持3级勃起硬度,能完成性交,1例患者能维持2级勃起硬度,3例患者仅能维持1级勃起硬度,均不能完成性交。 结论阴茎尿道海绵体分流+隧道术治疗超48 h的低流量型阴茎异常勃起是安全有效的,Milk技术为促进阴茎术后血液循环恢复提供了一种新的途径,值得临床进一步推广,鉴于此5例阴茎异常勃起患者异常勃起病程长,性功能恢复比例不高,性功能恢复治疗有待进一步研究。     

Insights of priapism mechanism and rationale treatment for recurrent priapism

Priapism is defined as abnormal prolonged penile erection occurring beyond or unrelated to sexual interest. The disorder is enigmatic yet devastating because of its elusive etiology, irreversible erectile tissue damage, and resultant erectile dysfunction （ED）. Current management strategies suffer from a poor understanding of the pathophysiology, especially at the molecular level. The traditional treatments are based more on empirical rather than evidence-based knowledge. The outcomes for restoration of normal erectile function are poor, especially for stuttering priapism. Therefore, it is critical to understand priapism from a molecular level, to formulate treatment strategies and to establish rational prevention strategies for high-risk populations, such as sickle cell disease （SCD） patients and cases of the stuttering variant. This review focuses on the recent advances at the molecular level in priapism and penile erection, and applies the recent knowledge to the treatment of stuttering priapism.     

A modification of Winter's shunt in the treatment of pediatric low-flow priapism

Purpose

Cavernous shunt operations available for treating priapism are frequently unsuitable for children owing to high chances of persistent venous leak that results in postoperative erectile dysfunction. In this article, a modification of Winter's shunt, which is suitable for treating low-flow priapism in children, is described.

Methods and patients

Using a large bore needle, multiple punctures were made in the tip of corpora cavernosa through the glans. The needle tracks functioned as temporary cavernoglandular fistula thereby, causing detumescence. This modified technique was used in 7 children all of whom had ischemic priapism. The age range was 9 months to 17 years, and the mean duration of symptom was 11 hours (range, 5-20 hours).

Results

In all the patients, priapism was successfully relieved by the modified technique. Immediate recurrence of priapism was noted in only one patient. In 5 patients for whom adequate follow-up details are available, postprocedure penile erection was confirmed either by self-reporting or by observation. There were no major complications.

Conclusion

This technical modification of the classical Winter's shunt appears to be a useful alternative in the management of pediatric low-flow priapism. A high chance of retaining erectile capacity after this technique is a significant advantage. Further clinical studies are required to confirm the observations of this preliminary report.     

Effectiveness of the caverno-dorsal vein shunt (Barry shunt) on prolonged ischaemic priapism and its effect on the post-operative long-term erectile function

Ischaemic priapism is the most common form of priapism and requires urgent treatment. In this study, we evaluated the effectiveness of the caverno-dorsal vein shunt on resolution of ischaemic priapism and on the post-operative long-term erectile function in patients presenting with priapism. The study included 10 patients admitted to our hospital for priapism between 2010 and 2018. The median age of the patients was 31 (24–66) years. The median priapism time was 13.5 (7–38) hours. The blood gas measurements were taken from the corpus cavernosum, and the drainage of the corpus cavernosum was performed as an emergency intervention. Then, the corpus cavernosum was irrigated with 0.01% adrenaline 5 times in 20-min intervals. The caverno-dorsal vein shunt procedure was performed in cases without regression of priapism. Two months after, the operation shunt was closed. Detumescence occurred in all patients. Eight of 10 patients maintained their erectile function. In 2 patients, severe erectile dysfunction occurred at post-operative 2 months following a priapism attack and penile prosthesis implantation was performed in these 2 patients. Our study showed that caverno-dorsal vein shunt procedure is effective in providing detumescence and maintaining potency in cases with ischaemic priapism. In our opinion, caverno-dorsal vein shunt can be considered as the first treatment of choice for refractory low-flow priapism.     

低流量型阴茎异常勃起的诊治分析

目的 探讨低流量型阴茎异常勃起的临床特点和治疗方法,提高急诊处理水平.方法 低流量型阴茎异常勃起患者12例,年龄19～47岁,平均28岁.病程6～24h 9例,24～72h 2例,1例持续168h.阴茎海绵体内注射血管活性药物致异常勃起6例,白血病3例,口服药物所致1例,不明原因者2例.结合文献分析其治疗方法和预后.结...     

Treating stuttering priapism

Stuttering priapism is an uncommon recurrent form of ischaemic priapism consisting of episodes of unwanted, painful erections that typically last for <3 h. It occurs repeatedly with intervening periods of detumescence. If these episodes are not treated, it may evolve into a classic ischaemic priapism and eventually lead to irreversible corporal fibrosis with permanent erectile dysfunction. A comprehensive literature search was conducted in August 2010 using the PubMed database, MEDLINE and generic search engines. The search terms used to source information on this topic were, stuttering priapism (44 hits) and recurrent priapism (161 hits). Although there are numerous publications on this topic the majority of them are small trials and case reports. We identified 117 case reports, 28 reviews, 37 anecdotal reports, 22 small size clinical trials and one in vitro work. Our understanding of the underlying pathophysiology of stuttering priapism has improved in recent years. Further multicentre randomized clinical trials are required to evaluate the efficacy of different treatment options and to define safe and effective management strategies for patients with low-flow recurrent priapism.     

9例阴茎异常勃起诊治体会

目的 探讨阴茎异常勃起的诊断和治疗方法.方法 回顾性分析9例阴茎异常勃起患者的诊治过程.结果 9例患者均通过病史、体检、海绵体抽吸血气分析及多普勒超声检查确诊.经镇静、局部冷敷、海绵体抽吸血液、海绵体内注射药物及手术等不同方法治疗后,8例缺血性阴茎异常勃起患者中5例完全消退,3例部分消退;1例非缺血性阴茎异常勃起患者部分消退.5例随访6个月,其中4例出现ED.结论 阴茎海绵体血气分析、海绵体彩色多普勒检查对阴茎异常勃起有重要诊断价值,早期及正确应用海绵体注射药物和阴茎海绵体尿道海绵体分流术加术中冲洗是治疗缺血性阴茎异常勃起的可靠方法,但是由于大多数病人持续勃起时间较长,ED的发生率偏高.     

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.     

阴茎异常勃起的诊断和治疗(附12例报告)

目的提高阴茎异常勃起的诊治水平。方法统计临床所见12例阴茎异常勃起患者，年龄20-62岁，平均44岁。持续勃起时间13-162h，平均25．4h。其中血管活性药物所致5例，膀胱癌转移至阴茎异常勃起1例，白血病1例，有外伤史者3例，不明诱因者2例。对异常勃起分型，治疗及预后进行分析。结果12例患者中9例为低流量型，3例为高流量型。随访2—26个月，9例低流量型患者中，5例经阴茎海绵体根部注射间羟胺2—6mg，必要时在阴茎头及阴茎海绵体根部置9号针头灌注肝素化生理盐水对冲治愈，其中2例发生勃起功能障碍（ED）；2例行阴茎海绵体与阴茎头血管分流术治愈，其中一例术后出现ED；因白血病引起的阴茎异常勃起1例，膀胱癌转移至阴茎1例，预后均不佳。3例高流量型患者中1例行选择性阴部内动脉栓塞后治愈，无ED；2例行保守治疗出院，均有ED发生。结论详细的病史、海绵体血气分析和彩色双功能超声等检查有助于阴茎异常勃起准确及时的诊断。阴茎异常勃起如保守治疗无效，应立刻进行手术治疗。关键词阴茎异常勃起，诊断，治疗     

高流量性阴茎异常勃起的诊治(附3例报告)

目的 探讨高流量性阴茎异常勃起的诊断和治疗方法。方法 复习3例高流量性阴茎异常勃起，2例会阴部外伤所致，1例原因不明。行体检、血气分析、阴茎彩色超声、阴部内动脉血管造影等检查，并分别行阿拉明注射、穿刺放血、阴茎头．阴茎海绵体分流、明胶海绵动脉瘘栓塞等治疗。结果 2例明确诊断为高流量性阴茎异常勃起，右侧动脉瘘栓塞后勃起完全消失，随访短期内勃起功能恢复。1例诊断模糊，行分流手术后勃起不完全消退，随访2年内发生勃起功能障碍。结论 选择性阴部内动脉造影和栓塞治疗是高流量性阴茎异常勃起有效的诊治方法。     

脾腔分流联合断流术后门静脉系统血栓形成的临床分析

目的 探讨脾腔分流联合断流术治疗门静脉高压症术后门静脉系统血栓形成的临床特征,为防治提供线索.方法 回顾性分析接受脾腔静脉分流联合断流术治疗的110例门静脉高压症病人及接受断流术的92例病人术后门静脉血栓形成、诊治以及继发消化道再出血情况,并比较两种术式对门静脉系统血栓形成的影响.结果 联合手术组术后门静脉系统血栓发生率10.O%,再出血率3.6%,低于断流组的22.8%(P<0.05)和10.8%(P<0.05).结论 脾腔静脉分流联合断流术是减少门静脉系统血栓形成的理想术式,术后早期抗凝治疗对预防血栓形成具有重要意义.     

阴茎异常勃起的诊疗体会(附14例报告)

目的探讨阴茎异常勃起的诊断及治疗。方法回顾性分析14例阴茎异常勃起患者的诊治经过。结果通过体查、海绵体抽吸血气分析及多普勒超声扫描等方法,低流量型阴茎异常勃起13例,高流量型1例。经保守、海绵体抽吸、肾上腺素海绵体内注射治疗及手术处理,患者勃起均消退。随访3～16个月,5例出现勃起功能丧失。结论准确判断阴茎异常勃起的类型有助于治疗方式的选择,阴茎海绵体血气分析结合多普勒超声扫描有助于分类的判断；阴茎海绵体穿刺抽吸结合肾上腺素反复灌洗,是一种简单、有效和副作用较少的治疗异常勃起的方式。     

高流量性阴茎异常勃起1例报告及文献复习

目的通过病例报告及复习相关文献,探讨高流量性阴茎异常勃起的诊断及治疗。方法回顾性分析兰州军区兰州总医院近期收治的1例外伤后高流量性阴茎异常勃起患者的症状、体征、检查以及治疗、随访情况,结合既往报道的文献资料进行综述分析。结果患者入院后保守治疗无效,行超选择性阴部内动脉造影检查明确双侧阴茎海绵体动脉瘘,使用明胶海绵栓塞后治愈,随访6月患者恢复佳,无勃起功能障碍。结论通过典型的临床表现、阴茎海绵体血气分析以及彩色多普勒超声检查可初步诊断,而高选择性血管造影检查及栓塞术则为高流量性阴茎异常勃起的确定诊断及治疗的最常用及有效的方法。