Extranodal NK/T‐cell lymphoma with leukaemic presentation

Priapism due to sickle cell disease is a common but less well characterized complication of the disorder. It represents a “medical emergency” with the key determinant of outcome being the duration of penile ischaemia and time to detumescence of <4 h associated with a successful treatment outcome. Management can be outpatient‐based and consists of pre‐emptive strategies for early stuttering attacks based on prior health education of the association between the 2 disorders, non pharmacological management, outpatient penile aspiration and irrigation with or without instillation of alpha and beta adrenergic agonists for acute episodes and secondary prophylaxis to prevent the high rates of recurrences. The evidence to recommend medical prophylaxis is sparse but based on a consensus of experts and small phase 2 or III clinical trials. A clearer understanding of the molecular mechanism(s) involving normal and dysregulated erectile physiology, scavenger haemolysis and nitric oxide pathway paves way for the use of phosphodiesterase type 5 inhibitors in medical prophylaxis of stuttering attacks. These agents will need to be studied in multi‐centre randomized phase III trials before they become standard of care. A multidisciplinary team approach is required to enhance “sexual wellness” and prevent erectile dysfunction in this sexually vulnerable group.     

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.     

Partial priapism secondary to tamsulosin: a case report and review of the literature

Partial priapism is also called partial segmental thrombosis of the corpus cavernosum. It is a rare pathology, and its aetiology, physiopathology and treatment are still not completely understood. To our knowledge, partial priapism due to alpha blockers has not been reported previously in the literature. In this study, a successfully treated case of partial priapism occurring after the usage of alpha blocker is presented and discussed in light of the related literature.     

A rare entity: idiopathic priapism in a newborn and review of the literature

Priapism is a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is an important medical condition, which requires evaluation and may require emergency management. This condition occurs very infrequently in paediatrics outside of the sickle-cell population and is exceedingly rare in newborns. The evaluation and management of neonatal priapism can be challenging for paediatricians, neonatologists and paediatric urologists alike given the lack of experience with this condition, its poorly understood pathophysiology and the absence of well-established guidelines. We present a case of idiopathic neonatal priapism because of its rarity and review of the literature.     

Nonischaemic priapism associated with selective serotonin‐3 receptor antagonist

Priapism is a rare but severe urological emergency of erection of penis in the absence of physical and psychological sexual stimulation. Priapism is often idiopathic and is commonly associated with medications and underlying medical or traumatic causes. In this report, we present a case of a 70‐year‐old White Caucasian man who developed priapism after the administration of ondansetron, which is a selective serotonin type‐3 (5‐HT3) receptor antagonist. This case is unique, because, to date, there are only two presented cases in literature. The objective of this case report is to highlight the importance of recognising the possibility of priapism with ondansetron because this condition is not commonly seen in clinical practice to be associated with ondansetron and may go unrecognised. Also, potential pathophysiological mechanisms involved in the development of ondansetron‐induced priapism are presented.     

Unsatisfactory outcomes of prolonged ischemic priapism without early surgical shunts: our clinical experience and a review of the literature

Ischemic priapism is a rare occurrence which can cause severe erectile dysfunction (ED) without timely treatment. This retrospective study reports our experience in treating prolonged ischemic priapism and proposes our further considerations. In this paper, a total of nine patients with prolonged ischemic priapism underwent one to three types of surgical shunts, including nine Winter shunts, two Al-Ghorab shunts and one Grayhack shunt. During the follow-up visit (after a mean of 21.11 months), all patients'' postoperative characters were recorded, except one patient lost for death. Six postoperative patients accepted a 25-mg oral administration of sildenafil citrate. The erectile function of the patients was evaluated by their postoperative 5-item version of International Index of Erectile Function Questionnaire (IIEF-5), which were later compared with their premorbid scores. All patients had complete resolutions, and none relapsed. The resolution rate was 100%. Seven patients were resolved with Winter shunts, one with an Al-Ghorab shunt and one with a Grayhack shunt. The mean hospital stay was 8.22 days. There was only one urethral fistula, and the incidence of postoperative ED was 66.67%. Four patients with more than a 72-h duration of priapism had no response to the long-term phosphodiesterase type 5 (PDE-5) inhibitor treatment. These results suggest that surgical shunts are an efficient approach to make the penis flaccid after prolonged priapism. However, the severe ED caused by prolonged duration is irreversible, and long-term PDE-5 inhibitor treatments are ineffective. Thus, we recommend early penile prosthesis surgeries for these patients.     

Quantitative functional outcomes of the conservative management of partial segmental thrombosis of the corpus cavernosum

The low incidence of partial segmental thrombosis of the corpus cavernosum (PSTCC) means its management is guided by isolated case reports. Erectile function is an important outcome that has not been described quantitatively in the literature. We present two cases of PSTCC managed conservatively. Although both patients reported resolution of local symptoms, formal analysis of sexual function at follow-up review has revealed that only one achieved complete recovery.     

精神药物所致阴茎异常勃起16例文献分析

目的探讨精神药物所致阴茎异常勃起的一般规律和特点,为临床合理用药提供参考。方法检索中国期刊全文数据库及万方数据库报道的16例精神药物所致阴茎异常勃起病例,对患者的年龄、原患疾病、既往史及药物过敏史、引起阴茎异常勃起的药物及剂量、发生阴茎异常勃起的时间、处理及预后等进行统计与分析。结果精神药物所致阴茎异常勃起16例病例中,引起阴茎异常勃起的精神药物以抗精神病药物及抗抑郁药居多。阴茎异常勃起出现时间服药后最短1h,最长为6年,用药1个月内发生者占68,75％。16例患者均停用致病药物,经局部冷敷、阴茎海绵体穿刺减压和血管活性药物局部注射、阴茎海绵体灌洗术、阴茎海绵体开窗减压、阴茎头阴茎海绵体分流术等处理,阴茎异常勃起在5h-10d恢复,其中2例（12．5％）后遗勃起功能障碍。结论临床医师、药师应了解精神药物所致阴茎异常勃起的规律和特点,加强用药监测,及时发现、及时处理。     

静脉阻塞性阴茎异常勃起17例诊治分析

目的:探讨静脉阻塞性阴茎异常勃起的诊断和治疗方法。方法:回顾性分析17例静脉阻塞性阴茎异常勃起患者的诊治方法。结果:17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。经保守、海绵体抽吸、海绵体内注射药物及手术治疗后,17例患者中11例异常勃起完全消退,5例部分消退,1例因阴茎肿瘤治疗无效。随访2~6个月,其中3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静脉阻塞性阴茎异常勃起有诊断价值,早期及正确应用海绵体注射药物和阴茎海绵体-尿道海绵体分流术是治疗静脉阻塞性阴茎异常勃起的可靠方法。