The dreadful and the deadly erection—Malignant priapism from renal cell carcinoma

Penile metastasis of renal cell carcinoma is a rare occurrence. We report a case in a 44-year-old man who presented with malignant priapism as the first sign of recurrence of renal cell carcinoma. Although invasive procedures have a limited role in survival benefits, we performed a total penectomy to alleviate pain and provide a better quality of life.     

Partial thrombosis of the corpus cavernosum: should we dig deeper into coagulopathy disorders?

Partial thrombosis of the corpus cavernosum, also known as partial priapism is a rare condition. The condition is known to be unilateral, and its aetiology is not well known. Usually, symptoms are pain and perineal mass and Magnetic Resonance is needed to confirm the diagnosis. In most cases the treatment is conservative with anticoagulation therapy. We present a case of partial thrombosis of the corpus cavernosum with a Factor V Leyden mutation.     

A new cause of ischaemic priapism: Synthetic cannabinoids

Priapism is a urological emergency that needs early intervention and may lead to irreversible cavernosal damage. Ischaemic priapism is the most common type, which is frequently idiopathic and commonly associated with haematological diseases, medications or recreational drugs. Synthetic cannabinoids (SCs) have been increasingly used all over the world, particularly among young‐adult population. SCs can cause severe adverse effects on several organ systems. However, there are no studies in the literature which have stated the possible relationship between using of SCs and priapism. We present a case of 28‐year‐old man who was diagnosed with a 58‐hr lasting priapism after regular administrations of SCs. The priapism did not resolve neither after applying aspiration with irrigation nor shunt surgery. Finally, penile prosthesis implantation was performed as last treatment option. The SCs have been increasingly used among young population in recent years; therefore, new SC‐related ischaemic priapism cases might be encountered in the emergency departments.     

The use of high‐resolution magnetic resonance imaging in the management of patients presenting with priapism

Study Type – Diagnosis (exploratory cohort)
Level of Evidence 2b OBJECTIVE To investigate the use of magnetic resonance imaging (MRI) of the penis during an episode of priapism and assess the viability of the corpus cavernosum (CC) smooth muscle, as prolonged ischaemic priapism is associated with a high rate of long‐term erectile dysfunction (ED), and the viability of CC smooth muscle influences the subsequent management in ischaemic priapism. PATIENTS AND METHODS The study was set in a single centre based in a large university teaching hospital. We investigated the correlation of T2‐weighted gadolinium‐ enhanced MRI with the histology from CC biopsies in the same patients. In all, 38 patients (mean age 42 years) presenting with priapism over a 3‐year period had MRI of the penis. The scans were reported by two dedicated uro‐radiologists who graded the MR images as showing viable or nonviable erectile tissue. One pathologist assessed the CC biopsies for necrosis. The findings were then correlated. Where no biopsies were taken a clinical follow‐up was used to assess erectile function. RESULTS In 23 patients undergoing both a CC biopsy and MRI, the sensitivity of MRI in predicting nonviable smooth muscle was 100%. In a further 10 patients MRI showed nonviable CC smooth muscle, but no biopsy was taken in these patients; on clinical follow‐up all of these patients subsequently developed ED. In a further five patients the imaging showed viable smooth muscle and these patients subsequently maintained erectile function on clinical follow up. CONCLUSIONS Penile MRI provides an accurate imaging method to assess smooth muscle viability in patients presenting with priapism.     

Priapism – a review of the medical management

Priapism is characterised by the presence of prolonged, often painful penile erection in the absence of a sexual stimulus. This rare condition has a range of aetiologies, but is most common following self-administration of injection therapy for impotence. Priapism may be classified into high- and low-flow states. Low-flow priapism is an emergency ischaemic condition requiring prompt recognition and treatment to avoid devastating long-term complications of erectile dysfunction. Wide-ranging medical therapies are covered in this review. Diagnostic and treatment algorithms are suggested in light of the current available literature.     

A pathophysiology-based approach to the management of early priapism

Priapism is a rare condition that involves persistent penile erection for greater than 4 h. Distinct variants exist, each with unique characteristics. Ischemic priapism is a painful medical emergency that may occur as a result of veno-occlusion leading to hypoxia and tissue death. Recurrent bouts of ischemic priapism, or stuttering priapism, require treatment for individual attacks as well as long-term prevention. Non-ischemic priapism is associated with trauma and may be managed conservatively. Recent advances into the pathophysiology of priapism have allowed the development of treatment algorithms that specifically target the mechanisms involved. In this review, we outline the basics of smooth muscle contraction and describe how derangement of these pathways results in priapism. A pathophysiological approach to the treatment of priapism is proposed with duration-based algorithms presented to assist in management.     

Priapism secondary to penile metastasis: A report of two cases and a review of the literature

Malignancy metastasis to the penis is an uncommon clinicopathological entity. We present two cases of malignant priapism following penile metastasis, in which the diagnosis was established by core needle biopsy of the corpus cavernosum. Primary tumors were urothelial carcinoma of the urinary bladder in one case (the patient having concomitant high-grade prostatic adenocarcinoma) and prostatic adenocarcinoma in the other. The clinicopathological features of 51 previously reported cases of penile metastasis in the recent literature are reviewed. J. Surg. Oncol. 1998:68:51–59. © 1998 Wiley-Liss, Inc.     

阴茎异常勃起16 例的诊断与治疗

目的正确选择阴茎异常勃起的诊治方案。方法阴茎异常勃起患者16例，其中血管活性药物所致11例，会阴外伤所致1例，原因不明4例。经体检、阴茎彩色超声、海绵体血气分析等检查后给予阿拉明海绵体注射及海绵体减压等治疗。结果14例为低流量型异常勃起，2例为高流量型，经及时处理后，异常勃起均缓解。随访1～36个月，勃起功能减退5例，11例患者勃起功能无显著改变，无明显阴茎海绵体纤维化。结论彩色超声和海绵体血气分析等检查有助于阴茎异常勃起准确及时的诊断。海绵体减压和阿拉明注射适用于大多数患者。