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.     

Delayed adverse vascular events after splenectomy in hereditary spherocytosis

Summary.  Background: It is probable that the variety and frequency of delayed adverse vascular events after splenectomy are underappreciated. Splenectomy is performed for a wide variety of conditions, and delayed postsplenectomy hazards are not often studied. Objective: To estimate the relative risk of adverse vascular events in members of hereditary spherocytosis families who have or have not had a splenectomy. Methods: Members of families in which hereditary spherocytosis exists were systematically questioned about adverse vascular events. Results: The cumulative incidence of arterial and venous events at age 70 years was greater in persons who had undergone a splenectomy for spherocytosis (arterial, 22% females, 32% males; venous, 20% females, 19% males) than in affected persons who did not undergo splenectomy (arterial, 3% females, 2% males; venous, 6% females, 4% males) or non-affected family members (arterial, 10% females, 17% males; venous, 4% females, 12% males). Affected subjects who undergo splenectomy are at greatly increased risk of arterial events as compared to affected subjects who do not undergo splenectomy [arterial, hazard ratio (HR) 7.2, 95% confidence interval (CI) 2.8–17.2; venous, HR 3.3, 95% CI  1.1–9.8]. Conclusion: There is a significant, long-lasting, increased risk of adverse arterial and venous thromboembolic events after splenectomy performed for hereditary spherocytosis. A review of the literature indicates that this is also true when splenectomy is performed for several other indications.     

阴茎异常勃起临床研究

目的　探讨阴茎异常勃起的诊断与治疗。方法　对 13例阴茎异常勃起的诊治进行回顾性分析。结果　低血流量型 12例 ,保守治疗治愈 7例 ,行改良的Winter分流术治愈 5例 ,高血流量型 1例保守治疗治愈。结论　早期区分异常勃起的类型对确定治疗方案至关重要 ;低血流量型发病时间 <12h治疗以保守为主 ,12～ 2 4h者保守治疗无效者行改良的Winter分流术 ,>2 4h者主张及时行Winter分流术 ,高血流量型首选保守治疗。     

Post-traumatic high flow priapism: A case report

A case of post-traumatic high flow priapism in a 32-year-old man is reported. The diagnosis was based on cavernous blood gas analysis and left internal pudendal arteriography. He was treated by unilateral super-selective embolization of the fistula with coils and gelatin sponge. At 1 month after embolization, erectile function had recovered, as demonstrated by measurement of nocturnal penile tumescence.     

Genetic polymorphisms associated with priapism in sickle cell disease

Priapism occurs in 30-45% of male patients with sickle cell disease (SCD), but the possible influence of genetic risk factors on the incidence of priapism is not well understood. We examined genetic polymorphisms in 199 unrelated, adult (>18 years), male patients with Hb SS and Hb Sbeta(0)-thalassaemia, 83 (42%) of whom reported a history of priapism. Candidate genes for association with priapism were identified based on their involvement in adhesion, coagulation, inflammation and cell signalling. Additionally, we examined genes involved in nitric oxide biology (NOS2, NOS3, SLC4A1), as well as polymorphisms in the klotho (KL) gene, which has previously been associated with priapism. Strong evidence of association was found for single nucleotide polymorphisms in transforming growth factor-beta receptor, type III (TGFBR3) (rs7526590; P = 0.00058), aquaporin (AQP1) (rs10244884; P = 0.00068), integrin alphav (ITGAV) (rs3768780; P = 0.00090), and the A1 subunit of coagulation factor XIII (F13A1) (hcv1860621; P = 0.00156). Associations with TGFBR3, AQP1, and ITGAV remained significant after adjusting for multiple testing, using the Benjamini-Hochberg procedure. Our data suggest that genes involved in the TGFbeta pathway, coagulation, cell adhesion and cell hydration pathways may be important in risk for priapism.     

右旋美托嘧啶用于静脉麻醉诱导后阴茎勃起的治疗与分析

目的：观察右旋美托嘧啶对全麻诱导后发生阴茎异常勃起治疗的有效性。方法：随机选择我院择期手术全身麻醉诱导后,外科医生行留置导尿术时发生阴茎勃起,5min内未自行消失的患者23例,按序贯法随机分为三组分别处理。C组：无特殊处理;D1组：静脉联合泵注右旋美托嘧啶0.5μg﹒kg-1﹒h-1;D2组：静脉联合泵注右旋美托嘧啶1μg﹒kg-1﹒h-1,直至阴茎疲软,分别记录完全疲软时间。结果：D2组勃起时间较C、D1两组明显缩短(P < 0.05),C、D1两组勃起时间比较未见明显统计学差异(P > 0.05)。结论：全麻诱导后患者发生阴茎异常勃起时,采用静脉泵注较大剂量右旋美托嘧啶（1μg﹒kg-1﹒h-1）可获得快速显著的治疗效果。     

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.     

Acenocoumarol associated priapism: report of a case

We report on a 20-year-old man presenting with priapism while receiving oral acenocoumarol for the treatment of deep vein thrombosis. To the authors' knowledge, it is the first reported case of acenocoumarol-associated priapism.     

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.     

Priapism in a non-black with sickle cell anemia associated with α-thalassemia

Sickle cell anemia, the most prevalent type of hemoglobinopathy, appears almost exclusively in blacks. Since the first report of sickle cell anemia in a Caucasian by Cooley and Lee in 1929 [1], additional cases have been reported, mainly from Mediterranean countries, the Persian Gulf, and India [2]. Several cases were also found among Arabs in Israel with a relatively benign clinical course [3, 4]. The present report describes a unique case of sickle cell anemia associated with α-thalassemia in a non-black young adult. The diagnosis was made at the age of 23 years. Severe priapism was almost the first manifestation of the disease and subsided following transfusion of five units of packed red blood cells.