Etilefrine for the prevention of priapism in adult sickle cell disease

Priapism is a common complication of sickle cell disease (SCD) that could lead to erectile dysfunction and psychosocial problems. Treatment of established fulminant priapism is usually not satisfactory. It is therefore important to prevent this complication of SCD. The alpha-adrenergic agonist etilefrine (50-100 mg/d) produced a good clinical response in 13 of 18 (72%) adults who have recurrent priapism; 17 had SCD and one sickle cell trait. After a follow-up of 1-48 months, none of the 18 people on etilefrine developed hypertension or sexual dysfunction. Similar efficacy and safety profiles of the drug have been reported previously.     

Sexual function after highly selective embolization of cavernous artery in patients with high flow priapism: long-term followup

PURPOSE: We present 15 cases of high flow priapism treated by selective embolization and evaluate erectile function at long-term followup. MATERIALS AND METHODS: Between 1995 and 2001, 15 patients underwent highly selective embolization of the cavernous artery for high flow priapism. Trauma was reported by 12 of the 15 patients, and no etiologic causes were evident in the other 3. The fistula was unilateral in 13 patients and bilateral in 2. All patients underwent embolization during arteriography. Erectile function was determined using the International Index of Erectile Function (IIEF) at followup after an average of 55 months (range 18 to 93). RESULTS: Postoperative color Doppler ultrasonography showed no recurrence in 11 patients (73%). Repeat pelvic angiography with selective embolization was required at 1 month postoperatively in 3 patients (20%). In 1 case (7%) 3 consecutive embolizations were not conclusive and a surgical operation was required. The IIEF results showed that sexual function was in the normal range in 80% of patients. Three patients (20%) reported a slight change in the quality of erection. Mean postoperative IIEF score was 26.3 (range 18 to 30). CONCLUSIONS: Highly selective embolization of the fistula is an effective and safe treatment option for high flow priapism because it ensures a high level of preservation of pretreatment erectile function.     

Priapism following splenectomy in an unstable hemoglobin: Hemoglobin Olmsted β141 (H19) Leu→Arg

We report a case of severe priapism occurring in a patient with an unstable hemoglobin, Hb Olmsted (β141 Leu→Arg). This is a rare hemoglobin variant, which until now has been reported only once. The clinical course of the 12-year-old boy was characterized by severe hemolytic anemia leading to splenectomy and cholecystectomy at the age of 3.5 years. The priapism occurred 8 years after splenectomy, during a hemolytic febrile episode and required aspiration of the corpora cavernosa. This report raises the question of the benefit of splenectomy in patients suffering from a chronic hemolytic anemia such as that due to an unstable hemoglobin. This treatment lowers the frequency and the severity of acute hemolytic attacks, but several cases of vascular complications have been reported after splenectomy. © 1996 Wiley-Liss, Inc.     

Priapism in the newborn: management and review of literature

Priapism is a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is broadly classified into two types: (i) ischaemic priapism (veno-occlusive) (low-flow), (ii) nonischaemic priapism (arterial) (high-flow). We report the case of a newborn presenting with priapism on the first day of life and also review published data on the management and follow-up of this condition.     

反复发作缺血性阴茎异常勃起(1例报告并文献复习)

目的探讨反复发作缺血性阴茎异常勃起的临床特点。方法分析复发性阴茎异常勃起1例,结合相关文献复习。结果反复发作夜间阴茎异常勃起16个月患者,临床检查确诊为复发性缺血性异常勃起,采用5a还原酶抑制剂保列治联合5羟色胺再摄取抑制剂左洛复治疗5d后,异常勃起未复发。继续服用保列治治疗,随访4个月异常勃起无复发,勃起功能正常。结论复发性缺血性阴茎异常勃起临床罕见,采用5a还原酶抑制剂联合5羟色胺再摄取抑制剂治疗具有一定的效果。     

膀胱癌转移至阴茎致异常勃起1例报告(附文献复习)

目的提高对转移性阴茎癌致异常勃起的认识。方法回顾1例转移性阴茎癌致异常勃起的处理过程,结合文献复习,分析发病情况、发病机理、临床特征、诊断、治疗及预后。结果1例阴茎持续痛性勃起10d、有膀胱癌手术史的患者,先接受阴茎、尿道海绵体分流术,术后症状无明显改善,2周后行阴茎全切除术。术后病理示阴茎中移行细胞癌浸润。影像学检查提示肝转移癌及肺转移癌可疑。4个月后患者死于全身衰竭。结论顽固性阴茎异常勃起结合膀胱癌病史,应考虑到膀胱癌的阴茎转移,阴茎全切除术是缓解症状的有效方法,但预后较差。