Evaluation and management of priapism in a newborn: A case report and review of the literature

Idiopathic neonatal priapism is a rare and poorly understood phenomenon. The case of an otherwise healthy premature male newborn who was noted to have a persistent penile erection on the first day of life is presented. A Doppler ultrasound of the penis was performed, along with the first-ever cavernous blood gas analysis reported in a newborn. These investigations indicated that the presentation was consistent with nonischemic (arterial or high-flow) priapism. The patient was managed conservatively and the erection resolved fully on the sixth day of life. A review of the existing literature identified polycythemia as the most common identifiable cause of priapism in newborns, but the majority of cases are idiopathic. In most instances, observation alone is appropriate and spontaneous detumescence occurs. There are no published reports of erectile impairment following neonatal priapism, which suggests that this condition is relatively benign in the absence of other disease states.     

Priapism and cannabism: A case report and review of the literature

Priapism is classically defined as a partial or complete erection, abnormally prolonged in the absence of desire or sexual stimulation. Several classes of drugs as well as certain psychoactive substances (e.g. alcohol, cocaine, cannabis, etc.) are accused in the occurrence of priapism. In this article, we report a case of priapism in a 37-year-old adult admitted to the emergency department after cannabis use. The patient received emergency aspiration of blood by puncturing the corpora cavernosa, followed by intra-cavernous injection of ephedrine. The evolution has been good. This case relates a rare side effect resulting from the consumption of cannabis, which requires a rapid assessment and management to avoid complications.     

大鼠阴茎组织5-HT_2受体表达及其在糖尿病ED中变化的研究

目的:观察5-羟色胺2型受体(5-HT2R)在正常及糖尿病ED大鼠阴茎组织的表达及变化情况;观察糖尿病大鼠阴茎勃起功能的变化情况及阴茎海绵体病理损伤情况。方法:设立正常对照组(NC)及糖尿病组(DM)。在糖尿病造模后第4、8、12周进行APO诱导阴茎勃起试验,记录阴茎勃起次数及勃起阳性率。将12周DM组大鼠分为未发生ED组(NED)和ED组(DED)。取阴茎组织,免疫组化法测定5-HT2R的表达情况,光镜、透射电镜下观察大鼠阴茎组织病理改变。ELISA法测定血清5-HT含量。结果:1大鼠阴茎组织中5-HT2R的阳性染色分布在阴茎血管和海绵窦的内皮及平滑肌、神经纤维中。相对于血清5-HT浓度的增高,DM组大鼠阴茎5-HT2R表达较NC组明显下调(P<0.01);DED组5-HT2R表达下调较NED组更为显著(P<0.05)。2与NC组相比,DM组大鼠阴茎勃起功能明显下降。光镜、透射电镜下观察DED组大鼠阴茎海绵体存在明显病理损伤。结论:5-HT2R主要在阴茎血管和海绵窦的内皮及平滑肌、神经纤维中表达;5-HT及其2型受体在糖尿病性ED的发生中具有一定作用;糖尿病造成阴茎组织不可逆性病理损伤,严重影响大鼠阴茎勃起功能。     

Methylene blue as a means of treatment for priapism caused by intracavernous injection to combat erectile dysfunction

OBJECTIVE: The authors observed priapism as a side effect occuring during the intracavernous treatment of erectile dysfunction. Earlier priapism had been treated with an intracavernous injection of sympatomimetics; unfortunately several complications and contraindications were found. PATIENTS AND METHODS: Methylene blue was applied in the treatment of five patients. First a corpus cavernosum punction was performed and some blood was aspirated from the penis. Finally 100 mg of Methylthionin Chlorati was injected into the corpus cavernosum. RESULTS: A sufficient detumescence was observed in all of these cases. There were no complications. The method was applied effectively in two cases after an unsuccessful punction. CONCLUSION: The autors recommend intravenous methylene blue for the treatment of priapism. According to their experience this method is free of complications and as effective as a sympathomimetics treatment. As they think, it can be recommended in any manifestations of priapism because its force of action appears to be both chemically and biologically clear.     

使用间羟胺无效的阴茎异常勃起4例

报告了４例使用间羟胺阴茎海绵体注射治疗无效的阴茎异常勃起，分别采用抽吸放血法或海绵体穿刺灌洗法，以及阴茎－尿道海绵体分流术，白血病确诊后采用化学疗法。结果２例持续勃起时间在１３ｈ内的阴茎异常勃起恢复正常，１例慢性粒细胞白血病经化疗后，２７ｄ后疲软，但功能未能恢复，１例勃起７２ｈ以上未能恢复，出现海绵体纤维化。讨论了阴茎异常勃起的治疗效果同其类型、勃起持续时间、病因有密切关系，以及应当选择的治疗方法     

Staphylococcal septicaemia complicating intracavernosal autoinjection therapy for impotence in a man with diabetes.

Intracavernosal injection of vasoactive drugs is a safe, effective, and commonly used treatment for impotence in diabetic men. In prospective studies infection has rarely occurred. We report a case of life-threatening Staphylococcal septicaemia complicating this treatment in a 61-year-old man with Type 2 diabetes, probably due to a combination of an unsterile technique and drug-induced priapism. Infection is a potential risk in diabetic men using intracavernosal injection therapy and those offered it should be informed of the importance of a scrupulous sterile technique and the need to seek urgent medical help for decompression if an erection persists for more than 4-6 h.     

阴茎异常勃起的诊治流程：附6例报告

目的探讨阴茎异常勃起的规范诊治流程。方法回顾分析我院6例勃起时间超过24h,经保守治疗无效的患者,其中服用西地那非后性交所致1例,应用血管活性药物所致1例,会阴外伤所致1例,原因不明3例。给予海绵体血气分析、阴茎彩色多普勒超声检查,5例低流量型异常勃起患者行阴茎头阴茎海绵体分流术,1例高流量型异常勃起患者行选择性阴茎海绵体动脉栓塞术。结果6例患者持续勃起均消退,未见复发。随访2～24个月,5例低流量型阴茎异常勃起患者出现不同程度的海绵体纤维化或勃起功能障碍,1例高流量型阴茎异常勃起患者恢复正常。结论彩色多普勒超声、海绵体血气分析及选择性阴茎海绵体动脉造影等系统性检查是必要的,有助于阴茎异常勃起的准确诊断。对于低流量型异常勃起,早期的系统性诊治是避免术后海绵体纤维化、勃起功能障碍发生的关键。