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Alghalyini B, Zaidi ARZ, Atif K, Mosharraf N, Tamim H, Qureshi MN. Priapism Presentations in a Saudi Arabian Emergency Department: A Retrospective Study at a Tertiary Care Hospital. Healthcare (Basel) 2024; 12:1716. [PMID: 39273740 PMCID: PMC11394829 DOI: 10.3390/healthcare12171716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
OBJECTIVES To examine the distribution, clinical characteristics, and management of priapism in a Saudi Arabian tertiary care setting to provide a regional perspective. SUBJECTS AND METHODS This retrospective chart review included 29 male patients presenting with priapism at a tertiary care hospital in Riyadh, Saudi Arabia, from January 2011 to June 2023. Data were collected on patient demographics, clinical presentation, treatment modalities, and outcomes. RESULTS The study found recurrent episodes of priapism in many patients, with a significant number associated with hematological diseases, notably sickle cell disease. Most treatments involved non-surgical methods. A notable finding was the correlation between the duration of priapism episodes and the likelihood of hospital admissions, suggesting that prolonged episodes often required more extensive medical attention. CONCLUSIONS Priapism often presents as a chronic and recurrent condition requiring personalized management strategies. This study emphasizes the importance of recognizing regional occurrence patterns to enhance the management of priapism and suggests a need for further research in regions where this condition is less common.
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Affiliation(s)
- Baraa Alghalyini
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia
| | - Abdul Rehman Zia Zaidi
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Kanza Atif
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Noorah Mosharraf
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Hala Tamim
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- School of Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada
| | - Muhammad Nauman Qureshi
- Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia
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2
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Rajamohan N, Kapoor H, Khurana A, Nelson L, Ganesh HS, Khatri G, Nair RT. MR imaging of penile pathology and prostheses. Abdom Radiol (NY) 2024:10.1007/s00261-024-04417-2. [PMID: 39066812 DOI: 10.1007/s00261-024-04417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 07/30/2024]
Abstract
Penile MRI is a vital yet underutilized diagnostic tool that provides detailed information crucial for managing various penile pathologies. Due to its infrequent use, many radiology trainees lack confidence in interpreting these exams. This article reviews the anatomy, key technical considerations, and interpretive pearls for penile trauma, Peyronie's disease, priapism, penile neoplasms, prosthesis evaluation, and a few miscellaneous conditions. Through illustrative case examples, this review aims to enhance the understanding and proficiency of radiologists in performing and interpreting penile MRI in these clinical scenarios.
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Affiliation(s)
- Naveen Rajamohan
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA.
| | - Harit Kapoor
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Aman Khurana
- Department of Radiology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Leslie Nelson
- Department of Radiology, University of Wisconsin, Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Halemane S Ganesh
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
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3
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Rosellen J, Hauptmann A, Wagenlehner F, Diemer T. [Priapism]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:566-572. [PMID: 38653788 DOI: 10.1007/s00120-024-02338-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/25/2024]
Abstract
Priapism is defined as penile erection lasting more than four hours that is unrelated to sexual arousal. Priapism is classified based on the oxygenation of the penile tissue into ischemic and non-ischemic subtypes. As the most common form, ischemic priapism is usually associated with pain and carries a significant risk of permanent loss of erectile function; thus, rapid intervention is necessary. Initial therapy consists of corporal aspiration and injection of sympathomimetic agents. If detumescence is not achieved, a cavernosal shunt is necessary. Non-ischemic priapism is less common than the ischemic type and is usually the result of perineal trauma. In this subtype, there is usually no pain and treatment is initially conservative. Recurrent (stuttering) priapism is a variant of the ischemic subtype, but is self-limiting and usually occurs during sleep with a duration of less than three to four hours. In the case of prolonged erection, therapy is analogous to that of the ischemic subtype.
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Affiliation(s)
- Jens Rosellen
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland.
| | - Arne Hauptmann
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland
| | - Florian Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland
| | - Thorsten Diemer
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland
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4
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Naelitz BD, Khooblall PS, Parekh NV, Vij SC, Rotz SJ, Lundy SD. The effect of red blood cell disorders on male fertility and reproductive health. Nat Rev Urol 2024; 21:303-316. [PMID: 38172196 DOI: 10.1038/s41585-023-00838-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/05/2024]
Abstract
Male infertility is defined as a failure to conceive after 12 months of unprotected intercourse owing to suspected male reproductive factors. Non-malignant red blood cell disorders are systemic conditions that have been associated with male infertility with varying severity and strength of evidence. Hereditary haemoglobinopathies and bone marrow failure syndromes have been associated with hypothalamic-pituitary-gonadal axis dysfunction, hypogonadism, and abnormal sperm parameters. Bone marrow transplantation is a potential cure for these conditions, but exposes patients to potentially gonadotoxic chemotherapy and/or radiation that could further impair fertility. Iron imbalance might also reduce male fertility. Thus, disorders of hereditary iron overload can cause iron deposition in tissues that might result in hypogonadism and impaired spermatogenesis, whereas severe iron deficiency can propagate anaemias that decrease gonadotropin release and sperm counts. Reproductive urologists should be included in the comprehensive care of patients with red blood cell disorders, especially when gonadotoxic treatments are being considered, to ensure fertility concerns are appropriately evaluated and managed.
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Affiliation(s)
- Bryan D Naelitz
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Prajit S Khooblall
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Neel V Parekh
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Seth J Rotz
- Department of Paediatric Hematology and Oncology, Cleveland Clinic Children's Hospital, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Scott D Lundy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
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5
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Raheem OA, Alkassis M, Iwuala R. Comment on: current opinions on the management of prolonged ischemic priapism: does penoscrotal decompression outperform corporoglanular tunneling? Int J Impot Res 2024; 36:295-296. [PMID: 38514868 DOI: 10.1038/s41443-024-00876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Omer A Raheem
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL, USA.
| | - Marwan Alkassis
- The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL, USA
| | - Rosemary Iwuala
- Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA
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Stenberg R, Sun J, Makowski B, Krizo J. Ultrasound guidance for real-time management of acute ischemic priapism. Am J Emerg Med 2024; 79:230.e3-230.e5. [PMID: 38553386 DOI: 10.1016/j.ajem.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/16/2024] Open
Abstract
Ischemic priapism is a relatively uncommon genitourinary condition that, if left untreated, can lead to permanent erectile dysfunction. Detumescence should ideally be attained within the first 36 h of onset to avoid irreversible fibrosis and necessary surgery. Opportunities to practice medical management of this condition are scarce, and the risk of iatrogenic injury of vessels, nerves, and urethra can be significant if performed blind. Visualizing these structures through ultrasonography can reduce the risk of injury and aid in the confirmation of drug delivery. This novel utilization of ultrasound guidance in active treatment can help improve physician confidence and success in managing this rare and urgent condition. To our knowledge, this is the first report of point-of-care ultrasound-guided penile nerve block used to manage pain associated with priapism. We present a 44-year-old male presenting with a painful erection lasting for eight hours. Penile doppler ultrasound was performed concurrent with medical management of priapism, with successful detumescence and discharge.
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Affiliation(s)
- Robert Stenberg
- Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, OH, United States of America
| | - James Sun
- Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, OH, United States of America
| | - Brian Makowski
- Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, OH, United States of America
| | - Jessica Krizo
- Department of Health Sciences, Cleveland Clinic Akron General, Akron, OH, United States of America.
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Sil S, Mohan AK, Negi G, Banerjee P, Kaur D, Mittal A, Jain A. Therapeutic Leukocytapheresis to relieve priapism due to leukostasis in CML patients: Our experience in a tertiary care centre. Transfus Clin Biol 2024; 31:36-40. [PMID: 37944664 DOI: 10.1016/j.tracli.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Hyperleukocytosis in leukemic patients may cause tumour lysis syndrome, disseminated intravascular coagulopathy, and leukostasis, resulting in decreased tissue perfusion and increasing the risk of mortality. Since the myeloid blasts are larger than lymphoid blasts and are less deformable, complications of leukostasis are seen more frequently in myeloid leukemia. Priapism is a less common complication associated with leukostasis in leukaemia patients that should be treated as soon as possible to avoid ischemic injuries. Although chemotherapeutic drugs such as hydroxyurea and imatinib are used to treat hyperleukocytosis in CML patients, leukocytapheresis (LCP) can achieve rapid cytoreduction. Prophylactic LCP could not offer any advantage over aggressive chemotherapy, but therapeutic leukocyte depletion has a proven role in patients having symptomatic leukostasis due to high tumour burden. Three patients with ischaemic priapism were reported at our institute's emergency department, where detumescence could not be achieved by distal shunting or aspiration with phenylephrine instillation. The procedure of therapeutic LCP was performed in all three patients on an emergency basis, which resolved painful priapism by rapid cytoreduction.
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Affiliation(s)
- Suhasini Sil
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Aswin K Mohan
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Gita Negi
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Pradip Banerjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
| | - Daljit Kaur
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India.
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences Rishikesh, India
| | - Ashish Jain
- Department of Transfusion Medicine, All India Institute of Medical Sciences Rishikesh, India
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8
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Tabei SS, Baas W, Brooks A, Kim EH, Smith Z, Murphy GP. Malignant priapism: case report and update on management protocols. Transl Androl Urol 2023; 12:1607-1613. [PMID: 37969781 PMCID: PMC10643380 DOI: 10.21037/tau-23-327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/01/2023] [Indexed: 11/17/2023] Open
Abstract
Background Malignant priapism, a rare disease with only about 500 reported cases to date, consists of persistent erection secondary to invasion or metastasis of a primary neoplasm. While treatment guidelines for priapism in non-malignant cases have been established, there is currently no guideline for treating malignant priapism. Herein, we describe three cases of malignant priapism and suggest a step-by-step approach for clinical management. Case Description This study reports three cases of malignant priapism resulting from advanced genitourinary cancers. All patients experienced a sub-acute progression of penile pain and ultimately underwent palliative penectomy, resulting in sustained symptom relief. Conclusions Treatment of malignant priapism needs to be individualized to the needs of the patient. No matter the primary or secondary nature of the disease, current data suggest that malignant priapism is associated with poor outcomes and emphasis should be put on palliative care. Similar to previous cases, our cases died shortly after the diagnosis of malignant priapism. Conventional procedures such as shunting may not necessarily provide symptom relief in these patients. Although new radiation techniques have shown favorable outcomes, penectomy should be considered the last resort in clinical management. Revisions to the existing management guidelines for priapism are necessary to address its occurrence in malignant contexts.
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Affiliation(s)
- Seyed Sajjad Tabei
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Wesley Baas
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anthony Brooks
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Eric H. Kim
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Zachary Smith
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gregory P. Murphy
- Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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9
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Zouari M, Krichen E, Ben Saad N, Kraiem N, Rhaiem W, Mhiri R. Idiopathic High-Flow Priapism. ARCHIVES OF IRANIAN MEDICINE 2023; 26:604-605. [PMID: 38310418 PMCID: PMC10862088 DOI: 10.34172/aim.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/06/2023] [Indexed: 02/05/2024]
Affiliation(s)
- Mohamed Zouari
- Department of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Emna Krichen
- Department of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Nesrine Ben Saad
- Department of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Najoua Kraiem
- Department of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Wiem Rhaiem
- Department of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Riadh Mhiri
- Department of Pediatric Surgery, Hedi-Chaker Hospital 3029 Sfax, Tunisia
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
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10
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Abebe SY, Goldsby E, Renbarger K, Hall G. Assessment of Stuttering Priapism in Individuals with Sickle Cell Disease. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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11
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Li G, Liu Y, Wang HY, Du FZ, Zuo ZW. High-flow priapism due to bilateral cavernous artery fistulas treated by unilateral embolization: A case report. World J Clin Cases 2023; 11:225-232. [PMID: 36687183 PMCID: PMC9846992 DOI: 10.12998/wjcc.v11.i1.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 12/09/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND High flow priapism (HFP) is a rare type of priapism. Perineal trauma is the most common cause of HFP. Trauma-induced penile artery injury may lead to an arterial-cavernosal fistula, whereas persistent irregular arterial blood flow entering the corpora cavernosum can cause a persistent penile erection. The routine treatment of HFP focuses on addressing the abnormal penile erectile status and avoiding post-treatment erectile dysfunction. Interventional embolization is an important therapeutic modality for HFP, and bilateral embolization therapy is currently the most commonly used technique for patients with bilateral cavernous artery fistulas; however, unilateral embolization therapy has yet to be reported.
CASE SUMMARY Herein, we report of the case of a 26-year-old Chinese male who presented with a persistent abnormal erection for 12 h after perineal impact injury. Medical history, cavernous arterial blood gas analysis and radiological examinations led to a diagnosis of HFP caused by bilateral cavernous artery fistulas. We performed routine conservative treatment (compression therapy and ice application) for the patient after admission; however, 10 d later, his symptoms had not been relieved. After completion of the preoperative workup, right (severe side) selective perineal artery embolization was performed; the left cavernous artery fistula was left untreated. After postoperative continuation of conservative treatment for 72 h, the patient experienced complete penile thinning. The patient had no symptoms of erectile dysfunction over a follow-up period of 12 mo.
CONCLUSION Compared with bilateral cavernous artery fistula embolization, we believe that unilateral cavernous artery fistula embolization can achieve positive clinical efficacy and reduce the risk of postoperative erectile dysfunction secondary to penile ischemia.
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Affiliation(s)
- Guo Li
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Yi Liu
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Hao-Yang Wang
- Department of Nuclear Medicine, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Fei-Zhou Du
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
| | - Zhi-Wei Zuo
- Department of Radiology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
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Dorosiev E, Mladenov B, Stoev I, Velev D, Georgiev S. Priapism in an otherwise healthy man with SARS-CoV-2: case report and literature review. Folia Med (Plovdiv) 2022; 64:1016-1019. [PMID: 36876562 DOI: 10.3897/folmed.64.e71053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
COVID-19 disease causes acute respiratory infection - pneumonia. It is associated with an increased risk of complications such as hypercoagulopathy, which leads to thromboses. We present a case of a young man presenting with typical SARS-CoV-2 symptoms (fever, cough, fatigue, and dyspnea), who experienced ischemic priapism, most probably due to thrombosis of penile vessels caused by the novel coronavirus infection. After prompt treatment of the priapism with punctures and irrigation, lasting penile detumescence was achieved. However, despite younger age, lack of serious comorbidities and administration of anticoagulants, priapism was followed by a fatal pulmonary embolism some days later.
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Affiliation(s)
- Emil Dorosiev
- Clinic of Urology, NI Pirogov UMHATEM, Sofia, Bulgaria
| | | | - Ivan Stoev
- Clinic of Urology, NI Pirogov UMHATEM, Sofia, Bulgaria
| | - Dimiter Velev
- Clinic of Urology, NI Pirogov UMHATEM, Sofia, Bulgaria
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13
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Idris IM, Burnett AL, DeBaun MR. Epidemiology and treatment of priapism in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:450-458. [PMID: 36485155 PMCID: PMC9820196 DOI: 10.1182/hematology.2022000380] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Ischemic priapism is a common but underrecognized morbidity affecting about 33% of adult men with sickle cell disease (SCD). The onset of priapism occurs in the prepubertal period and tends to be recurrent with increasing age. Significantly, priapism is associated with an unrecognized high burden of mental duress and sexual dysfunctions. The diagnosis of priapism is clinical. Many episodes of priapism will resolve spontaneously, but when an episode lasts longer than 4 hours, the episode is considered a urologic emergency requiring quick intervention with either corporal aspiration or shunt surgery. Only 3 randomized clinical trials (stilbesterol, ephedrine or etilefrine, and sildenafil) have been conducted for secondary priapism prevention in SCD. All 3 trials were limited with small sample sizes, selection biases, and inconclusive results after completion. The current molecular understanding of the pathobiology of priapism suggests a relative nitric oxide (NO) deficiency secondary to chronic hemolysis in SCD and associated phosphodiesterase type 5 dysregulation. We posit an increase in NO levels will restore the normal homeostatic relationship between voluntary erection and detumescence. Currently, 2 randomized phase 2 trials (1 double-blind, placebo-controlled trial and 1 open-label, single-arm intervention) are being conducted for secondary priapism prevention in men at high risk for recurrent priapism (NCT03938454 and NCT05142254). We review the epidemiology and pathobiology of priapism, along with mechanistic therapeutic approaches for secondary prevention of priapism in SCD.
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Affiliation(s)
- Ibrahim M. Idris
- Department of Haematology, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
| | | | - Michael R. DeBaun
- Vanderbilt-Meharry Sickle Cell Disease Center of Excellence, Vanderbilt University Medical Center, Nashville, TN
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14
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van der Velde MGAM, Tiellemans SMB, de Lil H, Nieuwenhuizen L. The value of leukapheresis for treatment of priapism as presenting feature of chronic myeloid leukemia-Case report and review of literature. EJHAEM 2022; 3:1100-1115. [PMID: 36467799 PMCID: PMC9713041 DOI: 10.1002/jha2.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 06/17/2023]
Abstract
Priapism is a rare presenting feature of chronic myeloid leukemia (CML) in male patients. Treatment aims to relieve symptoms and to prevent erectile dysfunction. Several treatment modalities exist, however no standard treatment is recommended. We evaluated literature concerning different treatment approaches and evaluate the value of leukapheresis in treatment of priapism. The literature search resulted in 57 included articles, consisting of 53 studied patients. Patients had a mean age of 25.3 years, average time from onset to presentation at the hospital was 2 days, and mean white blood cell (WBC) count was 344 × 109/L. Most patients (67.9%) were treated with a combined approach (different modalities were radiological, urological, and oncological treatment). Twelve patients, with a mean WBC count of 365 × 109/L, received leukapheresis. Only two of them reported erectile dysfunction after treatment. Priapism is an urological emergency requiring urgent multidisciplinary treatment. We highlight the importance of local urological therapy combined with systemic therapy for CML. Therapeutic leukapheresis should be applied when available and with no other contraindications.
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Affiliation(s)
- Marleen G. A. M. van der Velde
- Department of Internal MedicineMáxima MCVeldhoven/EindhovenThe Netherlands
- Department of Health Services ResearchCAPHRI School for Public Health and Primary CareAging and Long Term Care, MaastrichtLimburgThe Netherlands
| | | | - Heleen de Lil
- Department of Internal MedicineMáxima MCVeldhoven/EindhovenThe Netherlands
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15
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Hammad MAM, Soltanzadeh Zarandi S, Barham DW, Yafi FA. Update on Treatment Options for Stuttering Priapism. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Purpose of Review
There is a paucity of peer-reviewed evidence to guide medical management of stuttering priapism. The purpose of this review is to summarize the current understanding regarding the pathophysiology of priapism and management options for stuttering priapism.
Recent Findings
Conducting large-scale, randomized, placebo-controlled trials that elucidate the optimal treatment of stuttering priapism is challenging. Therefore, recent treatment guidelines are based upon small case series, retrospective studies, and expert opinions. Nonetheless, multiple compounds from various drug classes have shown promise in treating stuttering priapism, and a few pharmacotherapies such as Crizanlizumab are currently under active investigation.
Summary
Stuttering priapism is an under-investigated disorder with a complex pathophysiology. Currently, there is no wildly adopted universal therapeutic strategy. Further research is warranted to identify the appropriate treatment of stuttering priapism and to determine the long-term side effects of current pharmacotherapies.
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Stuttering Priapism in a Dog—First Report. Vet Sci 2022; 9:vetsci9100518. [PMID: 36288131 PMCID: PMC9611137 DOI: 10.3390/vetsci9100518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary A 5-year-old recently castrated male Doberman dog presented for prolonged erection of one week’s duration with associated pain and dysuria. This was the fourth episode within a year. Each episode was associated with an unusual event, which was stressful for the dog. Castration performed two months prior to the final episode did not prevent recurrence. Due to tissue necrosis, penile amputation and urethrostomy had to be performed. To our knowledge, this case is the first report of a stuttering priapism in a dog. Stuttering priapism, also called recurrent or intermittent priapism, is a particular type of ischemic priapism described in humans that is characterized by repeated episodes of prolonged erections. Abstract A 5-year-old recently castrated male Doberman dog presented for prolonged erection of one week’s duration with associated pain and dysuria. This was the fourth episode within a year. Each episode was associated with an unusual event, which was stressful for the dog. Castration performed two months prior to the final episode did not prevent recurrence. Due to tissue necrosis, penile amputation and urethrostomy had to be performed. The dog recovered fully. Prolonged erection that persists beyond or that is unrelated to sexual stimulation is called “priapism”. This term refers to the Greek god Priapus, a god of fertility, memorialized in sculptures for his giant phallus. In humans, depending on the mechanism involved, priapism is classified as nonischemic or ischemic. Because prognosis and treatment are different, priapism must be determined to be nonischemic or ischemic. Nonischemic priapism is a rare condition observed when an increase in penile arterial blood flow overwhelms the capacity of venous drainage; it is often associated with penile trauma, and does not require medical intervention. Ischemic priapism is associated with decreased venous return. In humans, ischemic priapism accounts for 95% of cases, the majority of which are idiopathic. Ischemic priapism is a urological emergency; simple conservative measures such as aspiration of blood from the corpora cavernosa and intracavernosal injection of an adrenergic agent are often successful. Stuttering priapism, also called recurrent or intermittent priapism, is a particular form of ischemic priapism reported in humans that is characterized by repetitive episodes of prolonged erections. Management consists of treating each new episode as an episode of acute ischemic priapism, and preventing recurrence with oral medications such as dutasteride and/or baclofen, gabapentin, or tadalafil. To the authors’ knowledge, this case is the first report of stuttering priapism in a dog.
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Moussa M, Abou Chakra M, Papatsoris A, Dellis A, Peyromaure M, Barry Delongchamps N, Bailly H, Roux S, Yassine AA, Duquesne I. An update on the management algorithms of priapism during the last decade. Arch Ital Urol Androl 2022; 94:237-247. [PMID: 35775354 DOI: 10.4081/aiua.2022.2.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 01/29/2023] Open
Abstract
Priapism is a persistent penile erection lasting longer than 4 hours, that needs emergency management. This disorder can induce irreversible erectile dysfunction. There are three subtypes of priapism: ischemic, non-ischemic, and stuttering priapism. If the patient has ischemic priapism (IP) of less than 24-hours (h) duration, the initial management should be a corporal blood aspiration followed by instillation of phenylephrine into the corpus cavernosum. If sympathomimetic fails or the patient has IP from 24 to 48h, surgical shunts should be performed. It is recommended that distal shunts should be attempted first. If distal shunt failed, proximal, venous shunt, or T-shunt with tunneling could be performed. If the patient had IP for 48 to 72h, proximal and venous shunt or T-shunt with tunneling is indicated, if those therapies failed, a penile prosthesis should be inserted. Non-ischemic priapism (NIP) is not a medical emergency and many patients will recover spontaneously. If the NIP does not resolve spontaneously within six months or the patient requests therapy, selective arterial embolization is indicated. The goal of the management of a patient with stuttering priapism (SP) is the prevention of future episodes. Phosphodiesterase type 5 (PDE5) inhibitor therapy is considered an effective tool to prevent stuttering episodes but it is not validated yet. The management of priapism should follow the guidelines as the future erectile function is dependent on its quick resolution. This review briefly discusses the types, pathophysiology, and diagnosis of priapism. It will discuss an updated approach to treat each type of priapism.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut.
| | - Mohamad Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut.
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens.
| | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens; Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens .
| | - Michael Peyromaure
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Nicolas Barry Delongchamps
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Hugo Bailly
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Sabine Roux
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Ahmad Abou Yassine
- Internal Medicine, Staten Island University Hospital, Staten Island, NY.
| | - Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
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Malinga DM, Laher AE, McDowall J, Adam A. Coronavirus disease 2019 (COVID-19) and priapism: An unexplored association. Curr Urol 2022; 16:55-62. [PMID: 35789564 PMCID: PMC9245531 DOI: 10.1097/cu9.0000000000000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/16/2022] [Indexed: 01/11/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has an established impact on multiple organ systems, including the vascular and urogenital systems. Vascular effects may include venous thromboembolic disease, which could theoretically be a precursor to priapism-a urological emergency defined as an abnormal condition of prolonged penile erection lasting >4 hours. To better explore this association, we critically appraised all the published COVID-19 cases associated with priapism. Materials and methods After PROSPERO registration (CRD42021245257), a systematic search of Google Scholar, Scopus, Embase, Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Index Medicus, and Cochrane Database of Systematic Reviews was performed using specific search terms. The following study metadata were extracted: age, requirement for respiratory support, cavernous blood gas findings, management of priapism, and patient outcomes. Results Fifteen single-patient case reports were included in this review. Of these, all of the patients presented with ischemic priapism, 9 patients (60.0%) were >60 years of age, 4 (26.7%) reported more than a single episode of priapism, 11 (73.3%) presented with pneumonia, 8 (53.3%) required mechanical ventilation, D-dimer was elevated in 5 of the 6 (83.3%) patients in whom this was reported, and among the 13 patients in whom mortality was reported, 4 (30.8%) died. Conclusions Early reports suggest a prognostic relationship between COVID-19 and coexisting priapism. However, owing to commonalities in their pathophysiology and the small dataset reported in the literature, the probable association between COVID-19 and priapism is still theoretical. Further research is needed to confirm this association.
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Affiliation(s)
- Dominic Mpumelelo Malinga
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdullah E. Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jared McDowall
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Adam
- Division of Urology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Rahoui M, Ouanes Y, Kays C, Mokhtar B, Mrad Dali K, Sellami A, Ben Rhouma S, Nouira Y. Erectile function outcomes following surgical treatment of ischemic priapism. Ann Med Surg (Lond) 2022; 77:103696. [PMID: 35638068 PMCID: PMC9142696 DOI: 10.1016/j.amsu.2022.103696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
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Abstract
Patients presenting to the emergency department with priapism require immediate evaluation and treatment. Priapism is a urological emergency that carries the risk of erectile dysfunction if not managed in a timely manner. Therefore, it is important for providers to be able to identify and manage these patients emergently. Priapism has various causes, and knowing the difference between high-flow and low-flow priapism will help determine the appropriate patient management. Although the prevalence of priapism is thought to be low, there have been increasing reports over the years linked to new drugs used for the treatment of erectile dysfunction (Roghmann et al., 2013). For this reason, it is imperative that providers understand the etiology behind the different causes of priapism. Using a case of drug-induced priapism as an exemplar, this article discusses the epidemiology, etiology, and management of priapism conditions.
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Ischemic Priapism Progressing to Penile Gangrene in a Patient with COVID-19 Infection: A Case Report with Literature Review. Case Rep Med 2022; 2022:8408216. [PMID: 35178095 PMCID: PMC8847035 DOI: 10.1155/2022/8408216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 01/21/2023] Open
Abstract
Priapism is considered a rare disorder and even more rare when it occurs as a complication of COVID-19. To the best of our knowledge, only eight studies have reported priapism as a complication of COVID-19. Here, we report the case of a 66-year-old male with COVID-19 who presented with neglected priapism for three days. On local examination, penile erection was apparent in association with blackened areas on the glans penis extending to the midpenile shaft denoting penile gangrene. A clear line of demarcation was noticed at the midpenile shaft. Penile duplex was performed, showing no blood flow in both cavernosal arteries. Penile aspiration was performed, and the cavernosal blood sample showed evidence of ischemic priapism. Given the presence of penile gangrene extending to the midshaft of the penis and the poor general condition of the patient, the decision was made to perform partial penectomy and suprapubic tube placement. We recommend the establishment of a guideline for the diagnosis and prevention of thrombotic diseases in patients with COVID-19 infection as there is increasing evidence of COVID-19-related thrombotic manifestations.
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Kashfi S, Loloi J, Statnii I, Arifi B, Sharma S. Gabapentin-Induced Priapism. Cureus 2022; 14:e21241. [PMID: 35174036 PMCID: PMC8841069 DOI: 10.7759/cureus.21241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 11/12/2022] Open
Abstract
Priapism is defined as an erection that lasts longer than four hours, is unrelated to sexual interest or stimulation, and is unrelieved by orgasm. The ischemic subtype is a urologic emergency and is often caused by medication side effects, most notably selective serotonin reuptake inhibitors and trazodone. We present the case of ischemic priapism thought to be caused by the recent initiation of gabapentin.
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Boonchai S, Sangkhathat S, Laochareonsuk W, Attawettayanon W. Stuttering priapism in a pediatric patient with pheochromocytoma-induced thrombocytosis. Urol Ann 2022; 14:283-287. [PMID: 36117795 PMCID: PMC9472302 DOI: 10.4103/ua.ua_118_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 10/16/2021] [Indexed: 11/24/2022] Open
Abstract
Priapism is an erection of more than 4 h without sexual stimulation. Ischemic priapism may lead to irreversible erectile dysfunction after a long-lasting period. Stuttering priapism is characterized by a pattern of recurrence that may progress to an unrelenting ischemic crisis, which is a urological emergency. Few reports have revealed that priapism is associated with essential thrombocythemia. The reactive thrombocytosis is uncommonly manifested by pheochromocytoma and rarely causes thrombotic events even if the platelet count is extremely high. We presented priapism related to reactive severe thrombocytosis in a 12-year-old male with pheochromocytoma. The cornerstone of care was prompt medical and surgical intervention by a multidisciplinary team approach to save life and preserve erectile function.
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Affiliation(s)
- Sarayuth Boonchai
- Department of Surgery, Division of Urology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Surasak Sangkhathat
- Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Wison Laochareonsuk
- Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Worapat Attawettayanon
- Department of Surgery, Division of Urology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla, Thailand,Address for correspondence: Dr. Worapat Attawettayanon, Department of Surgery, Division of Urology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. E-mail:
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Stuttering Priapism in a Teenage Boy: Lesson to be Learnt. J Pediatr Hematol Oncol 2021; 43:e1118-e1119. [PMID: 33235144 DOI: 10.1097/mph.0000000000001998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/08/2020] [Indexed: 01/15/2023]
Abstract
Untreated priapism can lead to ischemic damage of the penis and impotence. This case report describes a 14-year-old boy who presented with a history of priapism for 2 months, which was undiagnosed, ridiculed, and ignored even by medical practitioners. The underlying etiology was later identified to be chronic myeloid leukemia. Despite the usage of multimodal treatment, it took 7 days for control of priapism. The young boy is now left with an erectile dysfunction. The case highlights that priapism in children is a medical emergency needing aggressive evaluation and treatment.
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KÖLÜKÇÜ E, PARLAKTAŞ BS, ULUOCAK N, DERESOY F, KATAR M, UNSAL V. Dapsone can be a new treatment option for reducing the detrimental effect of priapism. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.963439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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John J, Mngqi N, Kesner K. Priapism after spinal cord injury - a case report and review of the literature. Ther Adv Urol 2021; 13:17562872211039107. [PMID: 34422113 PMCID: PMC8371740 DOI: 10.1177/17562872211039107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/27/2021] [Indexed: 11/15/2022] Open
Abstract
Involuntary unwanted erections are extremely rare after spinal cord injury (SCI). A
sudden loss of sympathetic tone to the pelvic vasculature following SCI causes an increase
in the parasympathetic tone and uncontrolled arterial blood flow into the penile
sinusoidal spaces. When occurring immediately after an acute SCI, it is generally
self-limiting and settles within a few hours. In contrast, recurrent, unwanted erections
in patients with chronic SCI are more unpredictable in frequency and duration and may
require treatment. We present a case of recurrent involuntary unwanted erections in a
patient with chronic SCI after a stab wound to his neck and review the pathophysiology and
available management options.
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Affiliation(s)
- Jeff John
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, 5200, South Africa
| | - Noma Mngqi
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
| | - Ken Kesner
- Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa
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Priapism in patients with hemolytic disorders: a nationwide retrospective cohort study. Ann Hematol 2021; 100:1947-1951. [PMID: 34136949 DOI: 10.1007/s00277-021-04577-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
Priapism is a persistent, painful erection, which can lead to permanent penile damage and reduced quality of life. Patients with sickle cell disease have an increased risk of priapism which has been related to chronic hemolysis. This study investigates the prevalence of priapism in all major hereditary and acquired forms of hemolytic disorders. Patients with hemolytic disorders were identified in the nationwide Danish Hemolysis Cohort. Each patient was age-sex-matched with 50 comparisons from the general population without hemolysis. We identified the episodes of hospital-registered priapism events for both patients with hemolysis disorders and comparisons in the Danish National Patient Register between 1977 and 2016. We identified 4181 male patients with hemolytic disorders and 205,994 male comparisons, with 2,294,027 person-years of total observation time. Totally, 101 episodes of priapism occurred during follow-up period. Six episodes of priapism were recorded in three patients with a hemolytic disorder, all affected by sickle cell disease. Two of these patients had verified genotype HbSS. The incidence rate for first priapism in sickle cell disease was 432.8 per 100,000 person-years [95% CI: 139.6; 1341.8] versus 0.84 per 100,000 person-years [95% CI 0.54; 1.32] in comparisons. Using a large nationwide cohort, we found that only sickle cell disease is associated with priapism among patients with hemolytic disorders. The incidence rate of priapism in patients with sickle cell disease was lower than previously reported.
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Lawton LD. Emergency department management of ischaemic priapism. Emerg Med Australas 2021; 33:555-558. [PMID: 33759342 DOI: 10.1111/1742-6723.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022]
Abstract
This article reviews the pathophysiology of acute ischaemic priapism, as well as the role of medications as an adjunct to definitive treatment. A clear procedure for aspiration is described.
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Affiliation(s)
- Luke D Lawton
- Emergency Department, Townsville University Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, James Cook University, Townsville, Queensland, Australia
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30
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Matz A, Ambinder D, Spencer E, Phillips J, Wong NC. Review of Priapism Litigation in the United States. Urology 2021; 156:169-172. [PMID: 33992665 DOI: 10.1016/j.urology.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/20/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To review medical malpractice trends and to identify the most common claims filed against medical providers for the management of patients with priapism. METHODS Using the Westlaw legal database, a search was done for the keyword "priapism" between July 1, 1980 and July 1, 2020. Cases were evaluated for plaintiff demographics, reasons for filing claims, management outcomes, legal verdicts and awards and further categorized based upon the timing of the alleged malpractice. RESULTS Alleged negligence during the pre-management period was cited in 30 cases. Administration of psychotropic medications was the most common reasons for filing pre-management claims 22/56 (39.3%). Delay in care accounted for 18/56 (32.1%) and complications of surgery were 5/56 (8.9%) of claims. The majority of the completed cases were in favor of the defendants (39/47; 83.0%). There was no association between type of health care provider or timing of alleged malpractice and ultimate verdict. CONCLUSIONS Prescribing psychoactive medications without warning of the adverse effect profile is the most common reason for claims filed against providers with trazodone as the leading medication. Medical providers should ensure that patients are well informed of this adverse effect prior to prescription. Regardless, the majority of medical malpractice cases carry a verdict in favor of the defendant.
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Affiliation(s)
| | - David Ambinder
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - Evan Spencer
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - John Phillips
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - Nathan C Wong
- Department of Urology, Westchester Medical Center, Valhalla, NY.
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Barbaro K, Midgley J. Priapism, a symptom of claudication of the cauda equina in spinal stenosis. Musculoskelet Sci Pract 2021; 52:102337. [PMID: 33549525 DOI: 10.1016/j.msksp.2021.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022]
Abstract
Priapism is defined as a persistent penile erection in the absence of sexual arousal. This symptom has been documented in patients with spinal stenosis although it is considered a rare finding. The European Association of Urology guidelines on priapism [Salonia et al., 2014] list cauda equina syndrome and spinal stenosis as causative factors for ischemic priapism although the literature describing this phenomenon appears sparse. Priapism can be a rare symptom of lumbar spine stenosis/transient cauda equina compression. This presentation is complex and believed to be a parasympathetic mediated autonomic disorder. This article discusses the relationship between spinal stenosis, cauda equina syndrome and priapism using available literature. Greater awareness of this clinical finding may help clinicians in their clinical decision making. In patients with suspected cauda equina syndrome, subjective enquiry regarding the symptom priapism may add to the patients overall clinical picture.
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Affiliation(s)
- Karl Barbaro
- Musculoskeletal Department, York Teaching Hospital NHS Foundation Trust, York, United Kingdom.
| | - James Midgley
- Musculoskeletal Department, York Teaching Hospital NHS Foundation Trust, York, United Kingdom.
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Joice GA, Liu JL, Burnett AL. Medical treatment of recurrent ischaemic priapism: a review of current molecular therapeutics and a new clinical management paradigm. BJU Int 2021; 127:498-506. [PMID: 33606327 DOI: 10.1111/bju.15370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the current molecular therapeutics in the medical treatment of recurrent ischemic priapism (RIP). To propose a stepwise clinical management paradigm for the treatment of RIP. METHODS We performed a literature search using the PubMed database for the terms 'recurrent ischemic priapism' and 'stuttering priapism' up until December 2020. We assessed pre-clinical and clinical studies regarding medical management of RIP and molecular pathophysiology. Case series and randomized trials were evaluated by study quality and patient outcomes to determine a potential clinical management scheme. RESULTS Recent research has fostered an improved understanding of the underlying molecular pathophysiology of RIP that has paved the way forward for developing new therapeutic agents. Medications targeting neurovascular, hormonal and haematological mechanisms associated with RIP show great promise towards remedying this condition. A host of therapeutic agents operating across different mechanistic directions may be implemented according to a clinical management scheme to potentially optimize RIP outcomes. CONCLUSION RIP remains a medically neglected condition with current management focused on treating the acute condition rather than modulating the course of disease. Continued research into the molecular mechanisms of RIP and standardized clinical pathways can improve the quality of care for patients suffering from this condition.
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Affiliation(s)
- Gregory A Joice
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James L Liu
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arthur L Burnett
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Koyuncu E, Taşoğlu Ö, Orhan A, Özbudak Demir S, Özgirgin N. Recurrent priapism in spinal cord injury: A case report. J Spinal Cord Med 2021; 44:331-333. [PMID: 31074709 PMCID: PMC7952053 DOI: 10.1080/10790268.2019.1613781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Context: Recurrent priapism is characterized by repetitive episodes of erections which are unrelated to sexual interest or stimulation. It is extremely rare in patients with spinal cord injury (SCI). There are a number of conservative agents used in the treatment.Findings: We describe the case of a 20-year-old male with cervical-5 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A tetraplegia as a result of a diving accident 2 years ago. He declared that the recurrent penile erections occurred up to 15-20 times day and night every day and lasted up to 20 min each time unrelated to sexual interest or stimulation. He was prescribed baclofen 10 mg, twice daily. The frequency and duration of erections decreased to 3-5 times/day lasting for about 5 min each and the patient reported a high treatment satisfaction.Conclusion: The presentation of this case is to remind clinicians this rare but distressing condition of recurrent priapism seen in men with complete spinal cord lesions and to summarize the use of medications, most commonly baclofen, to alleviate the condition.
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Affiliation(s)
- Engin Koyuncu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey,Correspondence to: Engin Koyuncu, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Türkocağı Sokak, No:3, Sıhhiye, Altındağ, Ankara, Turkey; Ph: +903123103230; Fax: +903123118054;
| | - Özlem Taşoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Ali Orhan
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Sibel Özbudak Demir
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Neşe Özgirgin
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
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Kang KS, Lee MS, Kim DR, Kim YH. The Role of Interventional Radiology in Treatment of Patients with Acute Trauma: A Pictorial Essay. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:347-358. [PMID: 36238738 PMCID: PMC9431953 DOI: 10.3348/jksr.2020.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/01/2020] [Accepted: 07/11/2020] [Indexed: 12/05/2022]
Abstract
Acute trauma is a common cause of mortality in individuals aged < 40 years. As organ preservation has become important in treating trauma patients, the treatment is shifting from surgical management to non-operative management. A multidisciplinary team approach, including interventional radiology (IR), is essential for the optimal management of trauma patients, as IR plays an important role in injury evaluation and management. IR also contributes significantly to achieving the best clinical outcomes in critically ill trauma patients. This pictorial essay aims to present and summarize various interventional treatments in trauma patients requiring critical care.
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Affiliation(s)
- Kyung Sik Kang
- Department of Radiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Mu Sook Lee
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University, School of Medicine, Daegu, Korea
| | - Doo Ri Kim
- Department of Radiology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Young Hwan Kim
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University, School of Medicine, Daegu, Korea
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Silverman ML, VanDerVeer SJ, Donnelly TJ. Priapism in COVID-19: A thromboembolic complication. Am J Emerg Med 2021; 45:686.e5-686.e6. [PMID: 33551247 PMCID: PMC7775653 DOI: 10.1016/j.ajem.2020.12.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 01/22/2023] Open
Abstract
SARS-CoV-2 (COVID-19) infection is frequently associated with thromboembolic complications. In this case report, we describe the diagnosis and management of priapism as a thromboembolic complication of severe COVID-19.
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Affiliation(s)
- Matthew L Silverman
- Miami Valley Hospital, Wright State University Internal Medicine Residency, Weber CHE Building, 128 E. Apple St., 2nd Floor Dayton, OH 45409, United States of America.
| | - Seth J VanDerVeer
- Miami Valley Hospital, Wright State University Internal Medicine Residency, Weber CHE Building, 128 E. Apple St., 2nd Floor Dayton, OH 45409, United States of America
| | - Thomas J Donnelly
- Miami Valley Hospital, Pulmonary and Critical Care Consultants, 1520 S Main St. Ste 2, Dayton, OH 45409, United States of America
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Zhao H, Dallas K, Masterson J, Lo E, Houman J, Berdahl C, Pevnick J, Anger JT. Risk Factors for Surgical Shunting in a Large Cohort With Ischemic Priapism. J Sex Med 2020; 17:2472-2477. [PMID: 33208295 DOI: 10.1016/j.jsxm.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/10/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ischemic priapism is treated with a stepwise algorithm, but some patients may benefit from immediate shunt placement. AIM To identify risk factors for surgical shunt placement in a large series of patients with ischemic priapism. METHODS We identified all patients presenting to our institution with ischemic priapism from January 2010 to December 2018. Multivariable was performed to assess risk factors for surgical shunting. Receiver operating characteristic curve analysis (Youden Index) was used to assess which cutoff time for the duration of priapism was most predictive requiring shunting. OUTCOMES We assess risk factors for surgical shunting and what duration of priapism was most predictive of requiring a shunt. RESULTS We identified a total of 169 ischemic priapism encounters from 143 unique patients, of which 26 (15%) encounters resulted in a surgical shunt. Patients treated with a shunt had longer priapism durations than those without (median 36 vs 10 hours, P < .001). Independent predictors of a surgical shunt on multivariate logistic regression were the duration of priapism in hours (odds ratio: 1.05, 95% confidence interval: 1.02-1.10; P < .001) and history of prior priapism (odds ratio: 3.15, 95% confidence interval: 1.03-9.60; P = .045). Receiver operating characteristic curve analysis using priapism duration to predict the need for shunt generated an area under curve of 0.83. A duration of 24 hours correlated to a sensitivity of 0.77 and specificity of 0.90. CLINICAL IMPLICATIONS These results can be used to counsel future patients and assist in the decision-making process for providers. STRENGTHS & LIMITATIONS This is one of the largest series of priapism in the literature. Most (74%) of the priapism were due to intracavernosal injections so the results may not be generalizable to populations with different priapism etiologies. CONCLUSION In this study of 169 priapism encounters, we found that the priapism duration and history of prior priapism were independent predictors of surgical shunt placement. These results can aid urologists in the counseling and decision-making process of these challenging cases. Zhao H, Dallas K, Masterson J, et al. Risk Factors for Surgical Shunting in a Large Cohort With Ischemic Priapism. J Sex Med 2020;17:2472-2477.
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Affiliation(s)
- Hanson Zhao
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kai Dallas
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John Masterson
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric Lo
- Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Justin Houman
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Carl Berdahl
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joshua Pevnick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer T Anger
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Arrichiello A, Angileri SA, Buccimazza G, Di Bartolomeo F, Di Meglio L, Liguori A, Gurgitano M, Ierardi AM, Papa M, Paolucci A, Carrafiello G. Interventional radiology management of high flow priapism: review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020010. [PMID: 33245065 PMCID: PMC8023077 DOI: 10.23750/abm.v91i10-s.10233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/02/2020] [Indexed: 01/04/2023]
Abstract
Introduction: High-flow priapism is a persistent partial penile tumescence, related to high flow arterial blood into the corpora. It is much less common than the low-flow priapism, and history of trauma is the more common aetiology. In the treatment of high flow priapism, super-selective embolization is considered treatment of choice when conservative treatment fails as reported in the “European Association of Urology Guidelines on Priapism”, but there are only few series reporting the outcome, the efficacy of different embolic materials and these studies are uncontrolled and relatively small. Objectives: The aim of this study is to review the literature to outline the state of the art of this interventional treatment and to analyse the outcome of the different embolic agents. Methods: Through Medline database (via PubMed) we searched all the English-language published articles related to priapism. Keywords were chosen according to MeSH terms. We selected case-series from 1990 to 2020 including at least five cases of high-flow priapism. The variables extracted from the selected articles were: number of patients, mean age, diagnostic imaging modality, mono or bilateral involvement of the arteries, embolization material, technical success, clinical success, complications, recurrence rate and type of reintervention, mean follow up, onset of erectile dysfunction. Results: We analyzed 11 papers. A total of 117 patients, mean age of 30 years, were studied during a period of 8 to 72 months. Technical success average was 99%, varying from 93 to 100%. Clinical success average was 88%, varying from 56 to 100%. After two or more treatments, resolution of priapism was obtained in all patients. No major adverse events registered. Recurrence rate of 21% (25/117) was observed, and only 4 patients underwent surgery. A total of 17 patients (15%) developed erectile dysfunction (ED). We also created a subgroup analysis focusing on specific outcome with different types of materials. Technical success was very high, 100% for all materials except for PVA particles Clinical Success was at least 70% with all kind of material. Best result was obtained with gel-foam (89%) and the worse with PVA (70%). Conclusion: Our data suggested comparable outcomes using different types of materials. In line with the last evidences we suggest that the choice of the embolic material should be selected basing on the expertise of the operator, the characteristic of the fistula and characteristic of the patients. (www.actabiomedica.it)
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Affiliation(s)
- Antonio Arrichiello
- Postgraduation School in Radiodiagnostics, Univeristà Degli Studi di Milano, Milan, Italy.
| | - Salvatore Alessio Angileri
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Giorgio Buccimazza
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy Via Festa del Perdono 7, 20122, Milan, Italy.
| | | | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, Univeristà Degli Studi di Milano, Milan, Italy.
| | - Alessandro Liguori
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Martina Gurgitano
- Division of Radiology, IEO European institute of oncology IRCCS, Milan, Italy.
| | - Anna Maria Ierardi
- Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Maurizio Papa
- Azienda Socio Sanitaria Territoriale (ASST) Lodi, Department of Diagnostic, Complex Unit of Radiology, Lodi, Italy.
| | - Aldo Paolucci
- Operative Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Gianpaolo Carrafiello
- 1-Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy. 2-Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
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Marcu D, Iorga L, Mischianu D, Bacalbasa N, Balescu I, Bratu O. Malignant Priapism - What Do We Know About It? In Vivo 2020; 34:2225-2232. [PMID: 32871745 DOI: 10.21873/invivo.12033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022]
Abstract
Malignancy as an etiological factor involved in priapism pathogenesis is rare. Malignant priapism (MP) can arise as a result of penile tumor invasion, either from primary penile tumors or from metastatic penile tumors, or due to hematological malignancies. Non-urological penile metastases are associated with significant worse prognosis compared to urological penile metastases, the appearance of priapism in such cases affecting even more the prognosis and the survival of these patients. Patients diagnosed with hematological malignancies and priapism present significant higher survival rates compared to those who develop MP in the context of a non-hematological malignancy, this being related to the fact that hematological malignancies are more sensitive to chemo- and radiotherapy. Most malignant priapism cases are ischemic; therefore the management should be based on the initial steps of the IP therapeutic protocol. Considering the trigger factor that has led to the priapic event specific oncologic treatment can be added as well.
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Affiliation(s)
- Dragos Marcu
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucian Iorga
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania
| | - Dan Mischianu
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Academy of Romanian Scientists, Bucharest, Romania
| | - Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania .,Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | | | - Ovidiu Bratu
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Academy of Romanian Scientists, Bucharest, Romania
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Lam G, McCarthy R, Haider R. A Peculiar Case of Priapism: The Hypercoagulable State in Patients with Severe COVID-19 Infection. Eur J Case Rep Intern Med 2020; 7:001779. [PMID: 32789142 PMCID: PMC7417049 DOI: 10.12890/2020_001779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 01/14/2023] Open
Abstract
It is increasingly recognised that patients with severe COVID-19 infection have a significant risk of thromboembolic events. We describe a patient who rapidly deteriorated due to severe infection with COVID-19, and developed priapism in the last days of his life. We believe development of priapism may be associated with a prothrombotic state secondary to COVID-19 infection. This case report supports the widely reported increased incidence of thrombosis in patients with severe COVID-19 infection.
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Affiliation(s)
- Germain Lam
- General Internal Medicine, Withybush General Hospital, Haverfordwest, Pembrokeshire, United Kingdom
| | - Rowan McCarthy
- General Internal Medicine, Withybush General Hospital, Haverfordwest, Pembrokeshire, United Kingdom
| | - Rana Haider
- General Internal Medicine, Withybush General Hospital, Haverfordwest, Pembrokeshire, United Kingdom
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Metabolomic and molecular insights into sickle cell disease and innovative therapies. Blood Adv 2020; 3:1347-1355. [PMID: 31015210 DOI: 10.1182/bloodadvances.2018030619] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/11/2019] [Indexed: 12/19/2022] Open
Abstract
Sickle cell disease (SCD) is an autosomal-recessive hemolytic disorder with high morbidity and mortality. The pathophysiology of SCD is characterized by the polymerization of deoxygenated intracellular sickle hemoglobin, which causes the sickling of erythrocytes. The recent development of metabolomics, the newest member of the "omics" family, has provided a powerful new research strategy to accurately measure functional phenotypes that are the net result of genomic, transcriptomic, and proteomic changes. Metabolomics changes respond faster to external stimuli than any other "ome" and are especially appropriate for surveilling the metabolic profile of erythrocytes. In this review, we summarize recent pioneering research that exploited cutting-edge metabolomics and state-of-the-art isotopically labeled nutrient flux analysis to monitor and trace intracellular metabolism in SCD mice and humans. Genetic, structural, biochemical, and molecular studies in mice and humans demonstrate unrecognized intracellular signaling pathways, including purinergic and sphingolipid signaling networks that promote hypoxic metabolic reprogramming by channeling glucose metabolism to glycolysis via the pentose phosphate pathway. In turn, this hypoxic metabolic reprogramming induces 2,3-bisphosphoglycerate production, deoxygenation of sickle hemoglobin, polymerization, and sickling. Additionally, we review the detrimental role of an impaired Lands' cycle, which contributes to sickling, inflammation, and disease progression. Thus, metabolomic profiling allows us to identify the pathological role of adenosine signaling and S1P-mediated erythrocyte hypoxic metabolic reprogramming and hypoxia-induced impaired Lands' cycle in SCD. These findings further reveal that the inhibition of adenosine and S1P signaling cascade and the restoration of an imbalanced Lands' cycle have potent preclinical efficacy in counteracting sickling, inflammation, and disease progression.
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Zhang CD, Clark J, Greenlund LS. 36-Year-Old Man With Persistent Erection. Mayo Clin Proc 2020; 95:1059-1063. [PMID: 32299673 DOI: 10.1016/j.mayocp.2019.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/27/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Catherine D Zhang
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Jennifer Clark
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Laura S Greenlund
- Advisor to residents and Consultant in Community Internal Medicine, Mayo Clinic, Rochester, MN.
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Mishra K, Loeb A, Bukavina L, Baumgarten A, Beilan J, Mendez M, DiGiorgio L, Fu L, Carrion R. Management of Priapism: A Contemporary Review. Sex Med Rev 2020; 8:131-139. [DOI: 10.1016/j.sxmr.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/27/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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Carnicelli D, Bondil P, Habold D. Priapisme veineux aigu aux urgences : procédure fondée sur une revue systématique de la littérature. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le priapisme veineux aigu (PVA) est urgent en raison de séquelles érectiles éventuelles. Sa rareté et l’absence de procédure expliquent des traitements encore inégaux, peu normés.
Objectif : Optimiser la prise en charge initiale d’un PVA grâce à une procédure décisionnelle, adaptée aux urgentistes.
Matériel et méthode : Une revue systématique de la littérature recense les algorithmes schématisés ainsi que des articles de revue et mises au point récents. Les critères diagnostiques et thérapeutiques ont été analysés puis comparés pour vérifier s’ils répondaient aux besoins. La validation de cette procédure par des experts a été recherchée. Résultats : L’originalité de notre procédure réside dans sa cible (urgentistes), sa hiérarchisation, « Que faire ? Comment faire ? Quand faire ? Qui fait ? », de façon graduée et séquentielle via une chronologie détaillée, et une priorité donnée à la gazométrie caverneuse, fil conducteur de la prise en charge, facilement disponible. À cela s’ajoutent des tableaux, des check-lists (contexte étiologique et souffrance ischémique), des schémas descriptifs des traitements médicaux indiqués en première ligne (technique, matériel de ponction décompressive et d’injection intracaverneuse d’alpha-stimulant), critères de recours à l’urologue, suivi et hospitalisation. Cette procédure a été validée par le conseil scientifique du réseau nord-alpin des Urgences, le comité d’andrologie et médecine sexuelle de l’Association française d’urologie.
Conclusion : Facile à utiliser, cette procédure inédite répond à un réel besoin. Son appropriation et sa diffusion s’inscrivent dans une démarche qualité adaptée au parcours de soins du PVA en France afin de prévenir les séquelles érectiles de cette urgence affectant majoritairement des sujets jeunes.
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Kolukcu E, Kilic S, Parlaktas BS, Erdemir F, Unsal V, Atılgan D, Uluocak N. The effects of oxytocin on penile tissues in experimental priapism model in rats. Int Urol Nephrol 2018; 51:231-238. [PMID: 30515737 DOI: 10.1007/s11255-018-2046-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/24/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE This study aimed to demonstrate the effects of oxytocin on penile tissues in ischemia-reperfusion injury developed after priapism. METHODS Forty Wistar Albino strain male rats were divided into four groups. The control group (n = 10) was not intervened. In Group 2, a rat model of priapism was constructed and maintained for 1 h. In Group 3, reperfusion was ensured for 30 min following priapism. Rats in Group 4 rats were given oxytocin 30 min before the induction of reperfusion following priapism. All rats were penectomized, and adequate amounts of blood sample were drawn. Inflammation, vasocongestion, desquamation, and edema in penile tissue were scored between 0 and 3 points (0: normal, 1: mild, 2: moderate, 3: severe) to evaluate the severity of tissue damage. The activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and the levels of malondialdehyde (MDA), and nitric oxide (NO) in blood samples were determined spectrophotometrically. RESULTS In histopathological examination, statistically significant positive changes were detected in vasocongestion, inflammation, desquamation, and edema scores in Group 4 than in Group 2 and Group 3 (p < 0.001). Biochemical test results revealed that NO levels were significantly lower in Group 4 than in Group 3 (p < 0.001). Serum GSH-Px activities in Group 4 significantly increased when compared with the other groups 2 and 3 (p = 0.002, p = 0.001, respectively). There was no statistical difference among the groups regarding SOD activities and MDA levels (p > 0.05). CONCLUSIONS Oxytocin protected against priapism-induced ischemia-reperfusion injury developed in cavernosal tissue as observed based on histopathological and biochemical evidence. Although this is an experimental study, oxytocin can be thought as an alternative drug in the treatment of priapism.
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Affiliation(s)
- Engin Kolukcu
- Department of Urology, Tokat State Hospital, Tokat, Turkey.
| | - Sahin Kilic
- Department of Urology, Fethiye State Hospital, Fethiye, Mugla, Turkey
| | - Bekir Suha Parlaktas
- Department of Urology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Fikret Erdemir
- Department of Urology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Velid Unsal
- Mardin Artuklu University High School of Health and Central Research Laboratory, Mardin, Turkey
| | - Dogan Atılgan
- Department of Urology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Nihat Uluocak
- Department of Urology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
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Costa DO, Araújo FA, Xavier ASG, Araújo LDS, Silva UBD, Santos EA, Ferreira SL. Self-care of men with priapism and sickle cell disease. Rev Bras Enferm 2018; 71:2418-2424. [DOI: 10.1590/0034-7167-2017-0464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/17/2017] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To identify self-care demands of men with sickle cell disease and priapism and describe self-care measures in light of Orem's Self-Care Theory. Method: This is a descriptive exploratory study with qualitative approach conducted with nine men with a history of sickle cell disease and priapism. Data were analyzed using Orem's Self-Care Theory. Results: Some demands were identified: from universal self-care - difficulty in social interaction and solitude, changes in self-image, self-esteem and sexual activity; from development - the experience with priapism and little knowledge about the pathophysiology of the disease; regarding health deviations - pain crises. Conclusion: Orem's theory allowed to identify self-care demands, which are essential for the nursing care provided for men with priapism. Nursing has an essential role in the measures for the different demands presented.
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Abstract
INTRODUCTION Priapism is a rare yet time sensitive emergency with potentially significant morbidity. A novel task trainer was developed for corpus cavernosa aspiration and phenylephrine injection. The primary aim of this study was to assess model realism and usefulness for emergency medicine resident procedural education. Secondarily, an assessment of comfort level with the procedure before and after intervention was performed. METHODS A priapism model containing corpus cavernosa and spongiosum analogs was constructed. The models and evaluation forms were pilot tested by faculty and then tested for realism and usefulness in a sample of 49 residents after a brief training session. Secondary end points included resident comfort with cavernosa aspiration before and after the session of the model on a visual analog scale. RESULTS Eight faculty pilot tested the procedure model and evaluated it based on a 5-point scale. They unanimously felt that the model was realistic [mean = 4.4, 95% confidence interval (CI) = 3.8-5.0] and useful for resident education (mean = 4.8, 95% CI = 4.4-5.0). The model was then evaluated for realism and usefulness in 49 residents. The model was felt to be realistic (mean = 4.3, 95% CI = 4.0-4.5) and useful for resident education (mean = 4.6, 95% CI = 4.4-4.8). Residents also noted an improvement in comfort performing the procedure before and after simulation session with the mean visual analog scale rating increasing from 34.3 to 83.8 (P < 0.001). CONCLUSIONS An easily constructed priapism task trainer was felt to be realistic and useful for resident education. Secondarily, use of the model in a simulation session can improve resident comfort in an important and infrequent procedure.
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Gandhi J, Seyam O, Smith NL, Joshi G, Vatsia S, Khan SA. Clinical utility of hyperbaric oxygen therapy in genitourinary medicine. Med Gas Res 2018; 8:29-33. [PMID: 29770194 PMCID: PMC5937301 DOI: 10.4103/2045-9912.229601] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Hyperbaric oxygen therapy (HBOT) is a medical technique which delivers oxygen at ambient pressures to increase the amount of dissolved oxygen in the blood and oxygen distribution to tissues. There are several beneficial properties of HBOT concomitant with elevated oxygen distribution in tissue including anti-inflammation, angiogenesis through vascular endothelial growth factor proliferation, augmented fibroblast activity through fibroblast growth factor proliferation, tissue and wound repair, enhancement of lymphocyte and macrophage activity, increased male testosterone secretion, and bactericidal activity. Given its renown in treating conditions such as decompression sickness and carbon monoxide poisoning, HBOT is making gradual strides for use in genitourinary medicine due to its low risk and likeliness to achieve favorable results. Early success has been observed in the treatment of Fournier's gangrene, radiation cystitis, and interstitial cystitis via the elimination of clinical symptoms such as pain. Further indications that have exhibited positive outcomes despite HBOT's ambiguous mechanism of action include cyclophosphamide hemorrhagic cystitis, emphysematous cystitis, pelvic radiation disease, radiation-induced proctopathy, dystrophic calcification of the prostate, erectile dysfunction secondary to urethroplasty, priapism, abnormal renal morphology, blood testosterone, calcific uremic arteriolopathy, and hidradenitis suppurativa. For other indications, multicenter studies must be conducted to determine HBOT's true efficacy, mechanism of action, risks, and advantages over conventional treatments.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Medical Student Research Institute, St. George's University School of Medicine, Grenada, West Indies
| | - Omar Seyam
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA
| | - Sohrab Vatsia
- Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Moore J, Whelan TF, Langille GM. The use of penile prostheses in the management of priapism. Transl Androl Urol 2017; 6:S797-S803. [PMID: 29238659 PMCID: PMC5715174 DOI: 10.21037/tau.2017.04.26] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Priapism is a relatively uncommon condition that can result in erectile dysfunction (ED) and corporal fibrosis. Cases of prolonged priapism are particularly prone to ED, which arises when priapism is treatment refractory or had a delayed presentation. Due to the emergent nature of priapism, it behooves urologists to be familiar with all potential treatment modalities to minimize adverse outcomes. In this review paper, we aim to summarize the literature regarding the use of penile prosthesis (PP) implantation in the setting of ischemic priapism (IP). In some patients who present later or have prolonged initial treatment, early insertion of PP may be indicated.
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Affiliation(s)
- Jonathan Moore
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Thomas F Whelan
- Department of Urology, Dalhousie University, Saint John, NB, Canada
| | - Gavin M Langille
- Department of Urology, Dalhousie University, Saint John, NB, Canada
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Barone I, Giordano C, Bonofiglio D, Andò S, Catalano S. Phosphodiesterase type 5 and cancers: progress and challenges. Oncotarget 2017; 8:99179-99202. [PMID: 29228762 PMCID: PMC5716802 DOI: 10.18632/oncotarget.21837] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/23/2017] [Indexed: 01/05/2023] Open
Abstract
Cancers are an extraordinarily heterogeneous collection of diseases with distinct genetic profiles and biological features that directly influence response patterns to various treatment strategies as well as clinical outcomes. Nevertheless, our growing understanding of cancer cell biology and tumor progression is gradually leading towards rational, tailored medical treatments designed to destroy cancer cells by exploiting the unique cellular pathways that distinguish them from normal healthy counterparts. Recently, inhibition of the activity of phosphodiesterase type 5 (PDE5) is emerging as a promising approach to restore normal intracellular cyclic guanosine monophosphate (cGMP) signalling, and thereby resulting into the activation of various downstream molecules to inhibit proliferation, motility and invasion of certain cancer cells. In this review, we present an overview of the experimental and clinical evidences highlighting the role of PDE5 in the pathogenesis and prevention of various malignancies. Current data are still not sufficient to draw conclusive statements for cancer patient management, but could provide further rational for testing PDE5-targeting drugs as anticancer agents in clinical settings.
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Affiliation(s)
- Ines Barone
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Italy
| | - Cinzia Giordano
- Centro Sanitario, University of Calabria, Arcavacata di Rende, CS, Italy
| | - Daniela Bonofiglio
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Italy
| | - Sebastiano Andò
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Italy
| | - Stefania Catalano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Italy
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