Penile metastasis from lung cancer.

A case of metastatic tumor of the penis from lung cancer is reported. The patient, who had received a right pneumonectomy 17 months previously for a squamous cell carcinoma of the lung, complained of urinary retention and painful erection of the penis. He underwent an emergency suprapubic cystostomy. Twenty days after the procedure, he died of disseminated lung carcinoma. The autopsy demonstrated massive metastasis to the penis from squamous cell carcinoma of the lung. Penile metastasis from lung cancer is a very rare condition and only 14 cases of this secondary carcinoma have been reported.     

Surgical Management of Resistant Priapism

We report a 31 year old patient, presented with painful erection since 48 hours. There was no known predisposing factor on history and examination. Surgery for priapism is rarely indicated nowadays but conservative management failed to achieve detumescence in our case. So Winter’s shunt surgery was done which failed then a formal shunt was created between corpora cavernosa and spongiosum which also failed to achieve detumescence. After 4 days - a formal left side cavernosa saphenous shunt procedure was done and detumescence achieved within 24 hrs .Follow up showed good results.     

Medical management of ischemic stuttering priapism: a contemporary review of the literature

Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process with little information on the pathophysiology of this erectile disorder. Complications from this disorder are devastating due to the irreversible erectile damage and resultant erectile dysfunction (ED). Stuttering priapism, though relatively rare, affects a high prevalence of men with sickle-cell disease (SCD) and presents a challenging problem with guidelines for treatment lacking or resulting in permanent ED. The mechanisms involved in the development of priapism in this cohort are poorly characterized; therefore, medical management of priapism represents a therapeutic challenge to urologists. Additional research is warranted, so we can effectively target treatments for these patients with prevention as the goal. This review gives an introduction to stuttering priapism and its clinical significance, specifically with regards to the patient with SCD. Additionally, the proposed mechanisms behind its pathophysiology and a summary of the current and future targets for medical management are discussed.     

Priapism as the presenting feature of renal cell carcinoma

We describe a case of renal cell carcinoma with metastasis to the penis clinically presenting with priapism. Six such cases found in the literature are reviewed. Neoplastic disease is far advanced in these cases and therapy is only palliative.     

Persistent Erection (Priapism) for Months with Concomitant Infertility in Rats due to Protein-Energy-Malnutrition

Monatelange Erektion (Priapismus) mit konsekutiver Infertitität bei Ratten als Folge von Protein-Energie-Mangelernährung
Wachsende, männüche Sprague Dawley Ratten wurden 22 Wochen lang mit einer halbsynthetischen, 9% Rohprotein enthaltenden Diät gefüttert, wobei Kasein (Kontrollgruppe; I) oder Weizenbrotkruste (Gruppe II) die alleinigen Proteinquellen darstellten. Das Kontrollfutter in reduzierter Menge, in Anlehnung an den Futterverzehr der Krusten-Ratten, wurde einem dritten Kollektiv verfüttert (pair-fed-Gruppe; III). Nach 6 Versuchswochen zeigten sich in den Gruppen II und III erste pathomorphologische Genitalveränderungen, die sich in einer monatelangen Erektion manifestierten. Bei 97% der Krusten-Ratten, 67% der isoenergetisch gefütterten Kasein-Ratten, jedoch bei keinem Kontrolltier entwickelte sich am Ende des Beobachtungszeitraums eine Dauererektion. Nach der 15. Versuchswoche erzielten die pair-fed-Ratten 17%, die Krusten-Ratten nur 5% des Gewichtszuwachses der Kasein-Kontrollgruppe. Im Reproduktionstest mit gesunden weibl. SD-Ratten erwies sich nur 1 von 6 Krusten-Ratten als zeugungsfähig, nach anschließender 5wöchiger ad lib. Kasein-Wiederauffütterung konnte eine 83% Fertilität beobachtet werden. Der Pathomechanismus der nutritiv induzierten Dauererektion wird auf die ausgeprägte marastische Stoffwechsellage zurückgeführt, bedarf jedoch weiterer Aufklärung.     

Medical and surgical management of priapism

Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Pathologically and clinically, two subtypes are seen-the high flow (non-ischaemic) variety and the low flow (ischaemic) priapism. The low flow type is more dangerous, as these patients are susceptible to greater complications and the long term recovery of erectile function is dependent on prompt and urgent intervention. Many of the causes of priapism are medical, including pharmacological agents, and as such, priapism should be considered as a medical and surgical emergency.     

An alternative noninvasive approach for the treatment of high-flow priapism in a child: duplex ultrasound-guided compression

We are presenting a 5-year-old boy with a traumatic high-flow priapism developed after a straddle injury and successfully treated by compression and simultaneous monitoring with a duplex ultrasound probe. We believe that this may be an alternative method against conventional treatment modalities including conservative follow-up, sympathomimetic drug administration, percutaneous embolization of the fistula, and surgical ligation.     

Idiopathic priapism treated with inhalation of amyl nitrite

Presented is a case of idiopathic priapism that was successfully treated with inhalation of amyl nitrite. Routine treatment measures had failed. The same patient presented on several other occasions in a similar fashion. Each time amyl nitrite was successful. An investigation for diseases known to be associated with priapism proved negative. Due to the frequency of recurrences, definitive surgical management was offered. The patient refused and has been lost to follow up.     

Follow-up of sickle cell disease patients with priapism treated by hydroxyurea

Hydroxyurea is one of the most successfully used therapies for sickle cell disease. Results of many clinical trials point to hydroxyurea administration for patients with frequent painful crises and acute chest syndrome. Priapism is one of the complications that could be prevented by hydroxyurea, but there are few reports demonstrating the results. Since November 1993, hydroxyurea has been used in our clinic for preventing priapism in patients with stuttering or major attacks who are still capable of achieving intercourse on demand. Five patients were enrolled in the study, and 4 cases benefited by this treatment. After the initial treatment for the acute attack, all five patients developed stuttering priapism. Hydroxyurea was then introduced at the initial dose of 10 mg/kg, and as the hydroxyurea dosage increased, the number or length of priapism episodes decreased. One to two months after the maximal dose (20-35 mg/kg) was introduced, the episodes disappeared. In two patients, we were forced to administer over 30 mg hydroxyurea/kg to abort the episodes, and, in another patient, 25 mg/kg was necessary. All patients present normal sexual activity. Hydroxyurea was discontinued in two patients, but stuttering priapism reappeared. Hydroxyurea was then re-introduced, and priapism disappeared. One patient, using 20 mg hydroxyurea/kg, had a 6-year remission of priapism after hydroxyurea administration; however, he experienced stuttering priapism, 1 month before a major attack, that progressed to impotence. During that month, he did not seek medical attention. In conclusion, the data here presented suggests that hydroxyurea may prevent priapism attacks in sickle cell disease, probably at higher doses than usually prescribed for painful crisis prevention.     

Propofol and priapism

Propofol-induced priapism in a 25-year-old male confirmed by rechallenge is reported for its rarity and to create awareness among practitioners, because propofol is used frequently in India for the induction and maintenance of anesthesia or sedation. The probable mechanisms are highlighted. Because propofol causes low-flow priapism, early alleviation is essential to minimize and/or avert the long-term complications.