Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment İschemic Priapism: A Single-Center Experience

BackgroundIschemic priapism (IP) is a urologic emergency that requires early intervention. The main aim of IP treatment is to relieve the cavernosal pressure and provide erectile function.AimThe aim of this study was to determine the correlation between preoperative risk factors (patient’s age, duration of priapism, preoperative erectile function) and postoperative erectile dysfunction (ED).MethodsThis retrospective study consisted of 25 patients diagnosed with refractory IP between 2009–2017. The diagnosis of IP was confirmed by medical history, physical examination, and cavernosal blood gas analysis. All of the patients underwent the T-shunt procedure ± tunneling after a failed initial intervention.ResultsThe mean age at the time of the IP diagnosis was 46.84 years (range 23–77). The average follow-up time of the study population was 40.4 months (range 3–114), and the median time from the occurrence of IP to surgery was 58 hours (range 24–240). In all cases, rapid resolution of the erection was achieved with the T-shunt ± tunneling procedure. In 1 patient, priapism recurred after 12 hours. Postoperative ED was reported by 16 (84.21%) patients, with degrees of mild, mild to moderate, and severe in 6, 1, and 9 of these cases, respectively. During the follow-up, the mean International Index of Erectile Function–5 (IIEF-5) score was 12.68 (range 5–23). Only 3 (15.78%) patients achieved successful sexual intercourse without any treatment. 6 (31.5%) patients required the aid of phosphodiesterase type 5 inhibitors, and 1 (5.26%) patient required the aid of a vacuum erection device. The 9 (47.36%) patients with severe ED failed to respond to medical treatment and were considered candidates for a penile implant. According to Kendall’s tau-b correlation coefficient analysis, there was a positive correlation between the preoperative and postoperative IIEF-5 scores (P = .005), whereas the patient’s age and duration of priapism were negatively correlated with the postoperative IIEF-5 score (P = .016 and P = .046, respectively).Clinical ImplicationsTreatment options of IP should be discussed with patients in terms of both preoperative erectile function and the duration of priapism.Strengths & LimitationsThe small sample size and retrospective nature of this study were the main limitations.ConclusionsDespite high success and low complication rates of T-shunt surgery, the rate of undisturbed erectile function is only 14.6%. The patient’s age, the existence of preoperative ED, and the duration of priapism are associated with postoperative IIEF-5 scores.Ortaç M, Çevik G, Akdere H, et al. Anatomic and Functional Outcome Following Distal Shunt and Tunneling for Treatment ?schemic Priapism: A Single-Center Experience. J Sex Med 2019;16:1290–1296.     

Penile emergencies

The penis is a very sensitive organ and even minor injury or discomfort may cause a patient to seek emergency evaluation. Emergency practitioners must be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis, namely ischemic priapism, paraphimosis, and entrapment injury. Any penile trauma should be considered an emergency until proven otherwise. This article discusses emergent penile complaints in adults, with emphasis on the most serious and common conditions.     

Priapism as a feature of claudication of the cauda equina

A case is reported of a man 60 years of age with degenerative stenosis of the lumbar canal at the L3–4 level and lumbar arachnoiditis, whose symptoms of claudication of the cauda equina were accompanied by uncomfortable involuntary erections. All symptoms were relieved by surgical decompression.     

Priapism and Fabry disease: A case report

A 10-year-old boy presented with priapism of 10h duration which after unsuccessful conservative measures, was relieved by a saphenocorporeal shunt. A4-year history of intermittent vague aching of fingers and toes accompanied by lowgrade fever was reported. Fabry disease was confirmed by the lack -galactosidase acitivity in serum and leucocytes. Other characteristic features of Fabry disease were not present. The condition was also diagnosed in his 14-year-old brother and suspected in his maternal grandfather who died at the age of 49 from renal failure of unknown aetiology.     

Priapisme induit par la chlorpromazine: A propos de deux cas

Priapism is a rare but serious side effect seen with many α-adrenergic antagonists, including both typical and atypical antipsychotics.We report here two cases of priapism associated with chlorpromazine. The first one concerns a young man who was admitted for a manic episode in the context of bipolar disorder. The second one was admitted for behaviour disorders. Upon admission, treatment was begun with chlorpromazine. They presented a priapism. The immediate decision was to stop the antipsychotic agents and to adress both patients in the Urologic Surgery department. They were treated with aspiration and irrigation of the corpora cavernosa with intracavernous injection of sympathomimetic drugs followed by a surgical distal cavernoglanular shunt.This study illustrates two cases of priapism associated with chlorpromazine. It is a urologic emergency. This iatrogenic effect of the chlorpromazine is rare but has to be known by the clinicians to prevent the erectile side-effects.     

高血流量性阴茎异常勃起10例临床诊分析

目的 探讨外伤后阴茎异常勃起的诊治方法 及其预后.方法 外伤后阴茎异常勃10例,年龄26～42岁.平均32岁;阴茎无痛持续性勃起＞4 h,呈半勃起状态.给予性刺激后硬度增强;海绵体血气分析呈动脉血样特征.彩超发现一侧阴茎海绵体动脉较对侧呈局限性扩张,最宽处约0.8 cm,血流速度增快,探及低速高阻动脉频谱,未发现双侧海绵体动脉扩张,诊断为阴茎海绵体动脉瘘;经保守治疗无效后再行超选择性阴部内动脉造影和栓塞治疗术,有2例存在双侧海绵体动脉瘘.结果 经介入治疗后异常勃起的阴茎逐渐恢复痿软悬垂状,24～48h完全变软,2～4周后逐渐有晨勃,3～6月后恢复性交,勃起硬度与术前无明显改变,Rigiscan测定和阴茎勃起多参数定量分析均正常;随访1～3 a,无硬结发生,勃起后阴茎无明显偏曲和疼痛,能够满意完成性生活,射精后能够完全疲软,有2例性生活持续时间变短,性交频率减少.结论 根据典型病史、体征和海绵体血气分析可初步诊断,彩色多普勒超声及阴茎海绵体动脉血管造影检查有极高的诊断价值,选用可吸收性物质进行超选择性阴部内动脉栓塞术是目前治疗本病的最佳方案,安全有效,远期预后良好.     

阴茎头阴茎海绵体分流术治疗药物性阴茎异常勃起6例

目的 提高阴茎异常勃起的治疗水平。方法回顾性总结1996年6月～1999年7月间6例因海绵体内注射药物引起阴茎异常勃起的病例,全部采用阴茎头阴茎海绵体分流术治疗。结果5例采用winter法一次成功,1例采用AL-Ghorad法治愈,术后发生阳萎2例。结论阴茎头阴茎海绵体分流术治疗阴茎异常勃起安全有效,可作为该病的首选方法。     

Phoneutria nigriventer spider toxin Tx2-6 causes priapism and death: A histopathological investigation in mice

Phoneutria nigriventer spider bite causes priapism, an effect attributed to the peptide toxins Tx2-5 and Tx2-6 and involving nitric oxide. Tx2-6 (MW = 5287) is known to delay the inactivation of Sodium channels in the same fashion as many other venom toxins. In the present study we evaluated the i.p. dose that induces priapism and the other symptoms in mice. Animals killed by the toxin or crude venom (0.85 mg/kg) were autopsied and a pathological study of brain, lung, kidney, liver and heart was undertaken using standard techniques. The same protocol was employed with animals injected with crude venom. Results showed that priapism is the first sign of intoxication, followed by piloerection, abundant salivation and tremors. An i.p. injection of about 0.3 μg/kg induced only priapism with minimal side-effects. The most remarkable histological finding was a general vascular congestion in all organs studied. Penis showed no necrosis or damage. Lungs showed vascular congestion and alveolar hemorrhage. Heart showed also sub-endothelial hemorrhage. Brain showed only a mild edema and vascular congestion. Results obtained with crude venom closely resemble those of purified toxin. We conclude that Tx2-6 have profound effects on the vascular bed especially in lungs and heart, which may be the cause of death. Interestingly brain tissue was less affected and the observed edema may be attributed to respiratory impairment. To the best of our knowledge this is the first histopathological investigation on this toxin and venom suggesting a possible cause of death.     

阴茎异常勃起患者心理状况分析及护理对策

目的 了解阴茎异常勃起患者的心理健康状况,探讨其相关因素,为针对性的护理提供参考.方法 采用SCL-90症状自评量表和自行设计的调查问卷对25例阴茎异常勃起患者进行问卷调查,分析其心理状态及相关的影响因素.结果 阴茎异常勃起患者在躯体化、人际关系、抑郁、恐怖、焦虑、敌对、精神病性等因子分均高于国内常模（P＜0.05）;不同年龄、学历的患者,心理健康水平存在差异;阴茎异常勃起患者最常见的10项症状为阴茎肿痛、活动不便、感到自己的身体有严重问题、过分担忧,精神紧张、排尿困难、难以入睡、担心亲属瞧不起、神经过敏,心中不踏实、担心预后阳痿、感到难为情,羞愧心理.结论 阴茎异常勃起患者在躯体疾病的基础上,还存在不同程度的严重的社会心理问题,提示对患者加强心理护理十分重要.