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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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Asmundo MG, Russo GI. ManAgement of pRiapiSm and its impact on outcomes: an international register (MARS study) - the first international, multicenter, observational study regarding priapism in perspective. Int J Impot Res 2024:10.1038/s41443-024-00849-y. [PMID: 38418865 DOI: 10.1038/s41443-024-00849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Affiliation(s)
| | - Giorgio Ivan Russo
- Urology section, Department of Surgery, University of Catania, Catania, Italy.
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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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Abstract
Priapism is defined as a persistent penile erection lasting more than 4 hours. Priapism is a rare condition but when present it requires prompt evaluation and definitive diagnosis. Priapism has 2 pathophysiologic subtypes: ischemic and nonischemic. Ischemic priapism accounts for a majority of cases reported. Ischemic priapism is a urologic emergency and requires intervention to alleviate pain and prevent irreversible damage to erectile tissues. This article highlights current guidelines and the contemporary literature on priapism.
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Affiliation(s)
- Christian Ericson
- Department of Urology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Bryce Baird
- Department of Urology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Gregory A Broderick
- Department of Urology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Stuttering Priapism in a Patient with Sickle Cell Trait Treated with Automated Red Cell Exchange Transfusion. Blood Adv 2021; 5:5020-5022. [PMID: 34464970 PMCID: PMC9153021 DOI: 10.1182/bloodadvances.2021004338] [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: 01/24/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Red blood cell exchange should be considered in sickle cell trait with refractory stuttering priapism.
Sickle cell trait (SCT) is typically an asymptomatic carrier state, but sickling complications can occur under extreme conditions. Priapism is known to be associated with sickle cell disease (SCD); The link with SCT is less well established. We report the case of a 19-year-old man with SCT presenting with prolonged priapism and a refractory, stuttering course requiring multiple invasive procedures over a 5-day period with no clear alternative triggers. In light of ongoing, stuttering priapism, he underwent red blood cell (RBC) exchange transfusion with decrease of hemoglobin S from 45.8% to 11.7%. This was followed by immediate and sustained cessation of stuttering priapism, with no further episodes at 5 months. Multiple cases of priapism associated with SCT have been reported in the literature. In most cases invasive interventions were required but RBC exchange was not attempted. RBC exchange has been reported in 2 people with exertional rhabdomyolysis in the context of SCT, with improvement in 1 case. In patients with SCT and priapism, conservative measures are used to treat brief episodes, but invasive management is required for persistent or prolonged episodes. RBC exchange transfusion may be considered for treatment of refractory, stuttering priapism in individuals with SCT.
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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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Liguori G, Rizzo M, Boschian R, Cai T, Palmieri A, Bucci S, Pavan N, Claps F, Boltri M, Bertolotto M, Trombetta C. The management of stuttering priapism. MINERVA UROL NEFROL 2019; 72:173-186. [PMID: 30957473 DOI: 10.23736/s0393-2249.19.03323-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Stuttering priapism is a variation of ischemic priapism, generally transient and self-limiting, occurring during sleep and lasting less than 3-4 hours. It may progress to episodes of complete ischemic priapism in approximately one third of cases, necessitating emergent intervention. EVIDENCE ACQUISITION This review aims to provide an up-to-date picture of the pathophysiology and management of stuttering priapism. A search using Medline and EMBASE for relevant publications using the terms "priapism", "stuttering", "diagnosis", "treatment", "fibrosis", was performed. EVIDENCE SYNTHESIS Stuttering priapism shares its etiologies with ischemic priapism and a large number of diseases or clinical situations have risk association for developing the disorder. The most common causes are sickle cell disease or other hematologic and coagulative dyscrasias especially in children. In the adult population, idiopathic priapism occurring without any discernible cause is considered to be the most common form in adults. The medical management of priapism represents a therapeutic challenge to urologists. Unfortunately, although numerous medical treatment options have been reported, the majority are through small trials or anecdotal reports. Understanding the underlying pathophysiology and understanding the current and emerging future agents and therapeutic options are mandatory in order to provide the best solution for each patient. CONCLUSIONS The goal of management of priapism is to achieve detumescence of the persistent erection in order to preserve erectile function. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.
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Affiliation(s)
| | - Michele Rizzo
- Department of Urology, University of Trieste, Trieste, Italy
| | | | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | | | - Stefano Bucci
- Department of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Urology, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Department of Urology, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Department of Urology, University of Trieste, Trieste, Italy
| | | | - Carlo Trombetta
- Department of Urology, University of Trieste, Trieste, Italy
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Kousournas G, Muneer A, Ralph D, Zacharakis E. Contemporary best practice in the evaluation and management of stuttering priapism. Ther Adv Urol 2017; 9:227-238. [PMID: 28932276 DOI: 10.1177/1756287217717913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/07/2017] [Indexed: 12/22/2022] Open
Abstract
Stuttering priapism is rare and under-investigated clinical entity. Although it shares similarities with ischaemic priapism, by definition, stuttering priapism has distinct characteristics that advocate for a different management in the clinical setting. Therefore, the management of stuttering priapism aims primarily to prevent recurrence rather than the resolution of spontaneous attacks. A multimodal approach and the individualization of each case are essential because of the diversity of the condition and the plethora of proposed therapeutic strategies. Understanding the underlying pathophysiology and familiarity with contemporary, past and emerging future agents and therapeutic options are required in order to provide an optimal solution for each patient. In addition, patient counselling and the option to combine therapeutic strategies and challenge second-line therapies are essential weapons in the armament of the urologist. Although further clinical trials and studies are mandatory in order to obtain solid data and provide recommendations, all therapeutic options are analysed, with specific interest in the potential advantages and disadvantages. A structured evaluation procedure is also described.
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Affiliation(s)
- Georgios Kousournas
- St Peter's Andrology Centre London, University College Hospital of London, UK
| | - Asif Muneer
- St Peter's Andrology Centre London, University College Hospital of London, UK
| | - David Ralph
- St Peter's Andrology Centre London, University College Hospital of London, UK
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AlDallal S, AlDallal N, Alam A. Sickle cell-induced ischemic priapism. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1268357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Salma AlDallal
- Kuwait Ministry of Health, Amiri Hospital, Sharq, Kuwait
| | - Nasser AlDallal
- Kuwait Ministry of Health, Farwaniya Hospital, Kuwait City, Kuwait
| | - Adel Alam
- Kuwait Ministry of Health, Farwaniya Hospital, Kuwait City, Kuwait
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Yücel ÖB, Salabaş E, Ermeç B, Kadıoğlu A. The Case Report of Priapus and a Modern Approach to an Ancient Affliction. Sex Med Rev 2016; 5:120-128. [PMID: 27687736 DOI: 10.1016/j.sxmr.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/11/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Priapism, taking its name from God Priapus, is total or partial erection lasting longer than 4 hours independent of sexual stimulus and can result in erectile dysfunction. There are three subtypes of priapism. AIM To review the three subtypes of priapism, their pathophysiology, current treatment options, and complications. METHODS The literature including priapism guidelines, review articles, and current trial studies was reviewed and the priapism type of God Priapus was investigated according to the mythology. MAIN OUTCOME MEASURES All three types of priapism were reviewed for etiology, diagnosis, and management. Medical and surgical treatment options were reviewed in relation to the current literature. Special emphasis concerned current treatment strategies and controversial surgical topics. RESULTS Ischemic priapism is the most common type, constituting 95% of all cases, and is an emergency. First-line treatments are blood aspiration and intracavernosal sympathomimetic drug injections. If these fail, then surgical shunt operations are recommended. A T-shunt combined with corporal tunneling is the currently popular option. Immediate penile prosthesis implantation is recommended for patients who present 48 to 72 hours after the onset of a priapism episode. High-flow priapism is caused by irregular arterial cavernosal blood flow, which usually occurs after a blunt perineal trauma. Antiandrogens and selective arterial embolization are the treatment options. Stuttering priapism is repetitive, self-limiting ischemic priapism and frequent in patients with sickle cell anemia. Ketoconazole is safe, cheap, and effective and appears to be a logical and suitable current treatment option to prevent further episodes, which is the primary treatment goal of stuttering priapism. CONCLUSION Priapism is a relatively common condition but not well known by clinicians. The lack and delay of treatment result in irreversible complications such as erectile dysfunction. Each type of priapism should be diagnosed and treated correctly with caution.
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Affiliation(s)
- Ömer Barış Yücel
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emre Salabaş
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahadır Ermeç
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ateş Kadıoğlu
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Migliorini F, Porcaro AB, Baldassarre R, Artibani W. Idiopathic stuttering priapism treated with salbutamol orally: a case report. Andrologia 2016; 48:238-40. [DOI: 10.1111/and.12438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- F. Migliorini
- Department of Urology; University Hospital; Azienda Ospedaliera Universitaria Integrata di Verona; Verona Italy
| | - A. B. Porcaro
- Department of Urology; University Hospital; Azienda Ospedaliera Universitaria Integrata di Verona; Verona Italy
| | - R. Baldassarre
- Department of Urology; University Hospital; Azienda Ospedaliera Universitaria Integrata di Verona; Verona Italy
| | - W. Artibani
- Department of Urology; University Hospital; Azienda Ospedaliera Universitaria Integrata di Verona; Verona Italy
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Manjunatha N, Benegal V. Stuttering priapism associated with topiramate. Gen Hosp Psychiatry 2015; 37:620.e1-2. [PMID: 26116965 DOI: 10.1016/j.genhosppsych.2015.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Priapism, or prolonged penile erection in the absence of sexual stimulation, may be a medical emergency. Many medications including antianxiety, antidepressants and antipsychotics have been implicated. This paper presents a case of priapism associated with topiramate use. METHODS This is a description of case report where topiramate was prescribed as anticraving medication in a patient with alcohol dependence. Episodic priapism developed soon after topiramate was prescribed. The severity of priapism reduced with reduction of dosage and disappeared with its discontinuation. RESULTS Reversible priapism (stuttering subtype) is associated with topiramate. CONCLUSIONS This is the first report of priapism associated with topiramate in the scientific literature.
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Affiliation(s)
- Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India.
| | - Vivek Benegal
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
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Hoeh MP, Levine LA. Management of Recurrent Ischemic Priapism 2014: A Complex Condition with Devastating Consequences. Sex Med Rev 2015; 3:24-35. [PMID: 27784569 DOI: 10.1002/smrj.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The management of recurrent ischemic priapism (RIP) is not clearly defined. Given the rarity of this condition, most treatment options are supported at best by level 3 or 4 evidence. AIM In this article, we review the current literature regarding the pathophysiology and management of RIP and discuss the risks and benefits associated with each option, which includes ketoconazole (KTZ), 5-α-reductase inhibitors and other hormonal therapies, phosphodiesterase type 5 (PDE5) inhibitors, intracavernosal sympathomimetic injection, oral sympathomimetic agents, and other investigational therapies. METHODS A comprehensive literature review was performed regarding the management options for RIP. MAIN OUTCOME MEASURE To examine the pathophysiology of RIP and evaluate the treatment options. RESULTS Multiple agents have been investigated to manage RIP. KTZ, finasteride, anti-androgens, gonadotropin-releasing hormone agonists, and estrogen have been shown to be effective in several reports, though some of these agents may have significant hormonal side effects. PDE5 inhibitors currently appear to be well tolerated in this patient population, though evidence of its efficacy is limited. Intracavernosal α-agonist therapy may be used to treat episodes of priapism after they occur. Very limited data suggest terbutaline, oral α-agonists, digoxin, hydroxyurea, and gabapentin may have a role in RIP management. CONCLUSIONS An ideal management strategy for RIP should focus on prevention of priapic episodes using an effective, well-tolerated, cost-effective medication. We currently have several proposed options, with varying efficacy rates and side effect profiles. While significant advancements in our understanding and management of stuttering priapism have been made within the past few years, clearly continuing research and clinical studies are needed to guide our management of this disease process. Hoeh MP and Levine LA. Management of recurrent ischemic priapism 2014: A complex condition with devastating consequences. Sex Med Rev 2015;3:24-35.
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Affiliation(s)
- Michael P Hoeh
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
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Anele UA, Burnett AL. Nitrergic Mechanisms for Management of Recurrent Priapism. Sex Med Rev 2015; 3:160-168. [PMID: 26478814 DOI: 10.1002/smrj.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Priapism is a condition involving prolonged penile erection unrelated to sexual interest or desire. The ischemic type, including its recurrent variant, is often associated with both physical and psychological complications. As such, management is of critical importance. Ideal therapies for recurrent priapism should address its underlying pathophysiology. AIM To review the available literature on priapism management approaches particularly related to nitrergic mechanisms. METHODS A literature review of the pathophysiology and management of priapism was performed using PubMed. MAIN OUTCOME MEASURE Publications pertaining to mechanisms of the molecular pathophysiology of priapism. RESULTS Nitrergic mechanisms are characterized as major players in the molecular pathophysiology of priapism. PDE5 inhibitors represent an available therapeutic option with demonstrated ability in attenuating these underlying nitrergic derangements. Several additional signaling pathways have been found to play a role in the molecular pathophysiology of priapism and have also been associated with these nitrergic mechanisms. CONCLUSION An increasing understanding of the molecular pathophysiology of priapism has led to the discovery of new potential targets. Several mechanism-based therapeutic approaches may become available in the future.
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Affiliation(s)
- Uzoma A Anele
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 20817
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, MD 20817
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Burnett AL, Anele UA, Derogatis LR. Priapism Impact Profile Questionnaire: Development and Initial Validation. Urology 2015; 85:1376-81. [PMID: 25863831 DOI: 10.1016/j.urology.2015.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/29/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To create and evaluate a psychometric instrument that measures the impact of experiencing priapism from the patient perspective. METHODS The research protocol consisted of several phases as follows: (1) generating items, (2) composing a patient questionnaire, (3) administering the questionnaire to patients with both active and remitted (≥1 year without priapism episodes) histories of priapism, (4) performing internal consistency and criterion-oriented validity analyses in correlation with clinical histories and erectile function assessment tools, and (5) ascertaining psychometric properties of the instrument. RESULTS The final instrument comprised a 12-item Priapism Impact Profile (PIP) questionnaire, representing the following 3 domains adversely impacted by priapism: quality of life (QoL), sexual function (SF), and physical wellness (PW), with higher scores indicating inferior experience in respective domains. Internal consistency reliability coefficients for the total PIP score and the 3 domain scores were >0.75. Fifty-four patients (mean age, 31.7 ± 11.4 years) completed the questionnaire. Patients with active priapism (n = 42) had higher total, QoL, SF, and PW scores than those with priapism remission (n = 8; P <.05, P <.05, P = .09, and P <.01, respectively). Patients with a history of recurrent priapism episodes >2 hours in duration had higher total, QoL, SF, and PW scores than those with "very minor" priapism recurrences (≤2 hours in duration; P <.01, P <.01, P <.05, and P <.001, respectively). Patients with "mild-to-moderate" to "severe" erectile dysfunction had higher total, QoL, SF, and PW scores than those with no or "mild" erectile dysfunction (P <.05, P = .14, P <.01, and P = .25, respectively). CONCLUSION The PIP questionnaire is a novel psychometric instrument that offers a means to quantify the adverse health impact of the patient's experience with priapism.
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Affiliation(s)
- Arthur L Burnett
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Uzoma A Anele
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leonard R Derogatis
- Maryland Center for Sexual Health, Lutherville, MD; Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
Priapism is a disorder of persistent penile erection unrelated to sexual interest or desire. This pathologic condition, specifically the ischemic variant, is often associated with devastating complications, notably erectile dysfunction. Because priapism demonstrates high prevalence in patients with hematologic disorders, most commonly sickle cell disease (SCD), there is significant concern for its sequelae in this affected population. Thus, timely diagnosis and management are critical for the prevention or at least reduction of cavernosal tissue ischemia and potential damage consequent to each episode. Current guidelines and management strategies focus primarily on reactive treatments. However, an increasing understanding of the molecular pathophysiology of SCD-associated priapism has led to the identification of new potential therapeutic targets. Future agents are being developed and explored for use in the prevention of priapism.
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Patel U, Sujenthiran A, Watkin N. Penile Doppler Ultrasound in Men with Stuttering Priapism and Sickle Cell Disease—A Labile Baseline Diastolic Velocity Is a Characteristic Finding. J Sex Med 2015; 12:549-56. [DOI: 10.1111/jsm.12756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Jones SD, Tan RBW, Hellstrom WJG. Phosphodiesterase type 5 inhibitors for stuttering priapism: recent advances. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.937703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Paladino JR, Nascimento FJ, Gromatsky C, Pompeo ACL. Corpus cavernosum abscess after Winter procedure performance. BMJ Case Rep 2014; 2014:bcr-2013-202089. [PMID: 24515231 DOI: 10.1136/bcr-2013-202089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 23-year-old male patient with sickle-cell disease reported his third episode of priapism complicated by the presence of a corpus cavernosum abscess after the performance of a Winter procedure 20 days prior to his presentation. While in hospital for 11 days, two penile needle aspirations and three surgical drainages were performed with associated antibiotic therapy. He evolved with erectile dysfunction refractory to drug therapy and his infectious condition improved. An early penile prosthesis implantation followed after the use of a vacuum pump in an attempt to decrease the fibrotic process of the corpora cavernosa. Final results were positive.
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European Association of Urology Guidelines on Priapism. Eur Urol 2014; 65:480-9. [DOI: 10.1016/j.eururo.2013.11.008] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/05/2013] [Indexed: 01/04/2023]
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Hoeh MP, Levine LA. Prevention of Recurrent Ischemic Priapism with Ketoconazole: Evolution of a Treatment Protocol and Patient Outcomes. J Sex Med 2014; 11:197-204. [DOI: 10.1111/jsm.12359] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Prostate cancer risk after anti-androgen treatment for priapism. Int Urol Nephrol 2013; 46:757-60. [PMID: 24136185 DOI: 10.1007/s11255-013-0583-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/03/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with recurrent ischemic priapism have historically been treated with anti-androgen therapy due to the limited available evidence for more targeted therapies to treat the underlying pathophysiologic mechanisms of this condition. We report a case in which anti-androgen therapy caused significant adverse side effects and likely masked this patient's elevated prostate-specific antigen (PSA) levels, which adversely impacted the timely diagnosis and treatment of his prostate cancer. CASE REPORT A 69-year-old man treated with anti-androgens for priapism initially developed unwanted anti-androgenic side effects such as gynecomastia, erectile dysfunction, and decreased libido. After decreasing his anti-androgen dosage and starting a specified regimen of phosphodiesterase type 5 inhibitor therapy, his serum PSA levels were found to be elevated. He was subsequently diagnosed with adenocarcinoma of the prostate and underwent a radical prostatectomy with the pathologic finding of high-grade, locally progressive disease. CONCLUSION Anti-androgen therapy carries significant complication risks, including the potential to alter the diagnosis and treatment of prostate cancer. Clinicians administering this therapy for priapism management should be aware of these possible risks.
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Pradhan T, Hardan A. Priapism associated with risperidone in a 21-year-old male with autism. J Child Adolesc Psychopharmacol 2013; 23:367-8. [PMID: 23738870 DOI: 10.1089/cap.2013.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Taniya Pradhan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA.
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Kim JW, Chae JY, Kim JW, Yoon CY, Oh MM, Kim JJ, Moon DG. Stuttering priapism in a patient with neurosyphilis. World J Mens Health 2013; 31:76-8. [PMID: 23658870 PMCID: PMC3640157 DOI: 10.5534/wjmh.2013.31.1.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/21/2012] [Accepted: 09/03/2012] [Indexed: 11/15/2022] Open
Abstract
We recently encountered a case of stuttering priapism in a 41-year-old patient with neurosyphilis. Priapism very rarely has a neurogenic cause, and to our knowledge, priapism caused by neurosyphilis has not been reported previously in the literature. Our aim was to report this case and systematically review the related literature.
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Affiliation(s)
- Jong Wook Kim
- Department of Urology, Korea University Medical Center, Seoul, Korea
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Morrison BF, Reid M, Madden W, Burnett AL. Testosterone replacement therapy does not promote priapism in hypogonadal men with sickle cell disease: 12-month safety report. Andrology 2013; 1:576-82. [PMID: 23606509 DOI: 10.1111/j.2047-2927.2013.00084.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/24/2013] [Accepted: 02/27/2013] [Indexed: 11/29/2022]
Abstract
Hypogonadism, which is highly prevalent in men with sickle cell disease (SCD), affects quality of life and causes great morbidity. The safety of testosterone replacement therapy (TRT) in SCD in relation to priapism episodes is relatively unknown. Our aim was to monitor the safety of TRT in a cohort of seven hypogonadal men with SCD. Testosterone undecanoate (Nebido) 1 g was administered intramuscularly to adult men with homozygous SCD (Hb SS) having hypogonadism [serum total testosterone ≤12.0 nmol/L (346 ng/dL), reference range 12.5-38.1 nmol/L (360-1098 ng/dL)] for 12 months. Serum total testosterone, haemoglobin, haematocrit, renal and liver function tests, glucose and PSA measurements were done at baseline and 12-month follow-up. Trough serum total testosterone, haemoglobin and haematocrit were measured three monthly. Priapism events and adverse drug events were assessed every 3 months. International Index of Erectile Function (IIEF), Androgen Deficiency in the Ageing Male (ADAM) and World Health Organization Quality of Life (WHOQOL) questionnaires were administered at baseline, 6 and 12 months. Seven men with a mean age of 34.4 years were treated. Median total testosterone increased from 10.6 to 11.2 nmol/L (p = 0.46). Median serum lactate dehydrogenase levels decreased from 1445 to 1143.5 IU/L (p < 0.05), while all other laboratory indices remained stable. Injection site pain was the most frequently reported adverse event, with no increases in painful crises, hypersensitivity or oedema. After TRT, there was no significant increase in priapism frequency. Median questionnaire scores were increased for the IIEF (46-68, p = 0.018), reduced for ADAM (5.0-2.0, p = 0.016) and unchanged for WHOQOL (98-103, p = 0.086). TRT using testosterone undecanoate with eugonadal intent for hypogonadism appears to be safe in men with SCD. This treatment does not appear to promote priapism occurrences and rather it possibly improves sexual function. Future prospective evaluations in larger groups of hypogonadal men with SCD are necessary to confirm these findings.
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Affiliation(s)
- B F Morrison
- Department of Surgery, University of the West Indies, Mona, Jamaica.
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