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Pozzi E, Velasquez DA, Varnum AA, Kava BR, Ramasamy R. Artificial Intelligence Modeling and Priapism. Curr Urol Rep 2024; 25:261-265. [PMID: 38886246 DOI: 10.1007/s11934-024-01221-9] [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] [Accepted: 06/12/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE OF REVIEW This narrative review aims to outline the current available evidence, challenges, and future perspectives of Artificial Intelligence (AI) in the diagnosis and management of priapism, a condition marked by prolonged and often painful erections that presents unique diagnostic and therapeutic challenges. RECENT FINDINGS Recent advancements in AI offer promising solutions to face the challenges in diagnosing and treating priapism. AI models have demonstrated the potential to predict the need for surgical intervention and improve diagnostic accuracy. The integration of AI models into medical decision-making for priapism can also predict long-term consequences. AI is currently being implemented in urology to enhance diagnostics and treatment work-up for various conditions, including priapism. Traditional diagnostic approaches rely heavily on assessments based on history, leading to potential delays in treatment with possible long-term sequelae. To date, the role of AI in the management of priapism is understudied, yet to achieve dependable and effective models that can reliably assist physicians in making decisions regarding both diagnostic and treatment strategies.
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Affiliation(s)
- Edoardo Pozzi
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.
- University Vita-Salute San Raffaele, Milan, Italy.
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - David A Velasquez
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alexandra Aponte Varnum
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Bruce R Kava
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
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Unal S, Karakus S, Du Comb W, Burnett AL. Clinical outcomes of the Burnett "snake" maneuver shunt modification for ischemic priapism. J Sex Med 2024; 21:723-728. [PMID: 38971576 DOI: 10.1093/jsxmed/qdae078] [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: 01/28/2024] [Revised: 05/23/2024] [Accepted: 06/17/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Major ischemic priapism (IP) is defined as a persistent penile erection for >4 hours. IP may cause serious complications, especially if prompt resolution is not achieved. Therefore, selecting the most effective and usable shunt technique is crucial in IP cases that are refractory to medical therapy. AIM To compare the effectiveness and complication risks of distal corporoglanular shunt procedures with and without the Burnett "snake" maneuver. METHODS We conducted a retrospective study of patients who presented with IP and underwent surgical treatment at our institution between 2005 and 2021. The patients were categorized into 2 groups: group 1 (n = 26) underwent distal shunt + Burnett snake maneuver, and group 2 (n = 56) underwent distal shunt-only. Clinical history, parameters of IP, details of medical and surgical treatments, and follow-up information were evaluated. OUTCOMES Outcomes included differences in IP resolution and recurrence, functional erections, and complications between corporoglanular shunt procedures with and without the Burnett snake maneuver. RESULTS In group 1, 24 of 26 patients (92.3%) experienced priapism resolution with a single surgical intervention, while this outcome was observed in 30 of 56 patients (53.6%) in group 2 (P < .001). Notably, priapism recurrence was significantly lower in group 1, occurring in 1 of 24 patients (4.2%), as opposed to 8 of 30 patients (26.6%) in group 2 (P < .001). Of the patients with documented sexual function status at follow-up, functional erections (capable of penetration with or without phosphodiesterase 5 inhibitors) were noted in 6 of 14 patients (42.8%) in group 1 and 13 of 26 patients (50%) in group 2 (P = .66). CLINICAL IMPLICATIONS This study provides valuable insights regarding technical aspects of distal shunt procedures with and without the Burnett snake maneuver for treating major IP episodes. These results can help surgeons with clinical decision making for patients who present with IP. STRENGTH AND LIMITATIONS Limitations include the single-site retrospective design with potential selection bias, inaccuracies in medical record data, challenges in controlling confounding variables, and the lack of validated questionnaire scores for erectile function evaluation. CONCLUSION Our study demonstrates that modifying distal shunt procedures using the Burnett snake maneuver significantly improves priapism resolution and effectively prevents further priapism episodes without introducing additional complications or erectile function loss, thereby distinguishing it from distal shunt-only procedures.
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Affiliation(s)
- Selman Unal
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Serkan Karakus
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - William Du Comb
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Arthur L Burnett
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
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Altez-Fernandez C, Lamas L, Bohorquez M, Chantada V, Ralph D. Cocaine-related ischemic priapism. Systematic review and presentation of a single center series. Actas Urol Esp 2024; 48:281-288. [PMID: 38369291 DOI: 10.1016/j.acuroe.2024.02.007] [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: 09/25/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Ischemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing. This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism? METHODS We conducted a systematic review according to PRISMA guidelines and described our case series. RESULTS Eight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6 h, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75 h and 2, respectively. CONCLUSION Cocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.
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Affiliation(s)
- C Altez-Fernandez
- Servicio de Urología, Hospital Universitario de A Coruña, A Coruña, Spain.
| | - L Lamas
- Servicio de Urología, Hospital Universitario de A Coruña, A Coruña, Spain
| | - M Bohorquez
- Servicio de Urología, Hospital Universitario de A Coruña, A Coruña, Spain
| | - V Chantada
- Servicio de Urología, Hospital Universitario de A Coruña, A Coruña, Spain
| | - D Ralph
- Andrology Department, University College London, Londres, United Kingdom
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Milenkovic U, Cocci A, Veeratterapillay R, Dimitropoulos K, Boeri L, Capogrosso P, Cilesiz NC, Gul M, Hatzichristodoulou G, Modgil V, Russo GI, Tharakan T, Omar MI, Bettocchi C, Carvalho J, Yuhong Y, Corona G, Jones H, Kadioglu A, Martinez-Salamanca JI, Verze P, Serefoglu EC, Minhas S, Salonia A. Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism: a systematic review by the EAU Sexual and Reproductive Health Guidelines panel. Int J Impot Res 2024; 36:36-49. [PMID: 36151318 DOI: 10.1038/s41443-022-00604-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/13/2022] [Accepted: 07/28/2022] [Indexed: 11/09/2022]
Abstract
Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an arterial fistula and embolisation may be required. We conducted a systematic review on behalf of the EAU Sexual and Reproductive health Guidelines panel to analyse the available evidence on efficacy and safety of surgical modalities for IP and NIP. Outcomes were priapism resolution, sexual function and adverse events following surgery. Overall, 63 studies (n = 923) met inclusion criteria up to September 2021. For IP (n = 702), surgery comprised distal (n = 274), proximal shunts (n = 209) and penile prostheses (n = 194). Resolution occurred in 18.7-100% for distal, 5.7-100% for proximal shunts and 100% for penile prostheses. Potency rate was 20-100% for distal, 11.1-77.2% for proximal shunts, and 26.3-100% for penile prostheses, respectively. Patient satisfaction was 60-100% following penile prostheses implantation. Complications were 0-42.5% for shunts and 0-13.6% for IPP. For NIP (n = 221), embolisation success was 85.7-100% and potency 80-100%. The majority of studies were retrospective cohort studies. Risk of bias was high. Overall, surgical shunts have acceptable success rates in IP. Proximal/venous shunts should be abandoned due to morbidity/ED rates. In IP > 48 h, best outcomes are seen with penile prostheses implantation. Embolisation is the mainstay technique for NIP with high resolution rates and adequate erectile function.
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Affiliation(s)
- U Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - A Cocci
- Department of Urology, University of Florence, Florence, Italy
| | | | - K Dimitropoulos
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - L Boeri
- Department of Urology, IRCCCS Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Capogrosso
- ASST-Sette Laghi, Circolo & Fondazione Macchi Hospital, University of Insurbria, Varese, Italy
| | - N C Cilesiz
- Department. of Urology, Istanbul Taksim GOP Training and Research Hospital, Istanbul, Turkey
| | - M Gul
- Department of Reproductive Biology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - V Modgil
- Department of Urology, Manchester Royal Infirmary, Manchester, UK
| | - G I Russo
- Department of Urology, University of Catania, Catania, Italy
| | - T Tharakan
- Department of Urology, Charing Cross Hospital, London, UK
| | - M I Omar
- Department of Urology, University of Aberdeen, Abderdeen, UK
| | - C Bettocchi
- Department of Urology, University of Foggia, Foggia, Italy
| | - J Carvalho
- Department of Psychology and Health Sciences, Universidade Lusofona de Humanidades e Tecnologias, Lisbon, Portugal
| | - Y Yuhong
- Department of Medicine, McMaster University, Hamilton, Canada
| | - G Corona
- Department of Endocrinology, Maggiore-Bellaria Hospital, Bologna, Italy
| | - H Jones
- Department of Endocrinology, Barnsley Hospital, Barnsley, UK
| | - A Kadioglu
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - J I Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - P Verze
- Department of Urology, University Federico II of Naples, Naples, Italy
| | - E C Serefoglu
- Department of Urology, Bahceci Health Group, Istanbul, Turkey
| | - S Minhas
- Department of Urology, Imperial College, London, UK
| | - A Salonia
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.
- University Vita-Salute San Raffaele, Milan, Italy.
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Muneer A. Insertion of Penile Implants in Patients with Priapism: When Is the Right Time? Eur Urol Focus 2023; 9:49-50. [PMID: 36396558 DOI: 10.1016/j.euf.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/15/2022] [Accepted: 11/02/2022] [Indexed: 11/17/2022]
Abstract
Acute ischaemic priapism is a urological emergency that requires prompt intervention. Refractory cases result in the development of fibrosis in the corpus cavernosum, which results in erectile dysfunction. Early insertion of a penile prosthesis in refractory cases allows easier dilatation and maintains the penile length and girth.
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Affiliation(s)
- Asif Muneer
- Institute of Andrology and NIHR Biomedical Research Centre, University College London Hospital, London, UK.
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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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Abstract
PURPOSE OF REVIEW Priapism is a rare condition that has different presentations, etiologies, pathophysiology, and treatment algorithms. It can be associated with significant patient distress and sexual dysfunction. We aim to examine the most up-to-date literature and guidelines in the management of this condition. RECENT FINDINGS Priapism is a challenging condition to manage for urologists, since the etiology is often multi-factorial and the suggested treatment algorithms are based on small studies and expert anecdotal experience, perhaps due to the rarity of the disorder. Ischemic priapism of less than 24 h can be managed non-surgically in most cases with excellent results. Ischemic priapism of more than 36 h is frequently associated with permanent erectile dysfunction. Management of prolonged priapism with penile shunting still may result in poor erectile function, so penile prosthesis can be discussed in these scenarios.
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Voepel H. [56/m-Continuous erection lasting 5 h : Preparation for the medical specialist examination: part 26]. Urologe A 2021; 61:90-96. [PMID: 34739568 DOI: 10.1007/s00120-021-01686-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Harald Voepel
- St.-Clemens-Hospital, Geldern, Clemensstraße 6, 47608, Geldern, Deutschland.
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Clavell-Hernández J. Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation. Sex Med 2021; 9:100379. [PMID: 34082302 PMCID: PMC8240336 DOI: 10.1016/j.esxm.2021.100379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Impending cylinder erosion and floppy glans secondary to an undersized penile prosthesis are rare complications that can cause cosmetic deformity and patient discomfort. Aim To demonstrate a technique for the management of impending cylinder erosion and floppy glans secondary to cylinder under-sizing. Methods We retrospectively reviewed 6 patients who required the proximal extracapsular tunneling technique during penile prosthesis revision surgery. Main Outcome Measure Main outcome was successful placement of a penile prosthesis with proper cylinder placement. Results Mean patient age for these 6 patients was 71.2 years (64–86 y). After a mean follow-up of 6.6 months, all 6 patients who underwent this procedure had a functional penile prosthesis without evidence of recurrence. Conclusion The proximal extracapsular tunneling technique is a simple approach performed through a single incision that can be used for proper cylinder replacement during penile prosthesis revision surgeries. It may be utilized for the management of impending cylinder erosion and other cases with coporal dilation-related complications in which the surgical pseudo-capsule has already formed around the implant. This technique can be safely performed without the need of a distal counter-incision on the penis. Clavell-Hernández J. Proximal Extracapsular Tunneling: A Simple Technique for the Management of Impending Cylinder Erosion and Complications Related to Corporal Dilation. Sex Med 2021;9:100379.
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Affiliation(s)
- Jonathan Clavell-Hernández
- University of Texas Health Science Center - McGovern Medical School at Houston, Texas, USA; St Joseph Medical Center, Houston, Texas, USA.
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Factors Associated With Corporoglandular Shunting for Patients With First-time Ischemic Priapism. Urology 2021; 154:191-195. [PMID: 33823171 DOI: 10.1016/j.urology.2021.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To establish predictive factors of patients who failed intra-cavernosal injection therapy and ultimately required corporoglandular shunting during first-time ischemic priapism episodes. METHODS A retrospective review was performed of all patients over the age of 18 who presented to our institution with first-time episode of ischemic priapism from 2009 to 2019. Variables assessed included: body mass index, diabetes, hypertension, race, insurance-type, hypertension, etiology, age, duration of erection prior to evaluation, total amount of phenylephrine injected, and use of corporal irrigation. A receiver operating characteristic (ROC) curve was performed utilizing duration of erection and amount of phenylephrine. RESULTS One-hundred and forty-seven patients met inclusion criteria of which 24 patients required surgical intervention. There were differences associated with mean total phenylephrine used, duration of erection between shunted patients and non-shunted patients with regards to age (P = .38) or etiology (P = .81). Multivariable analysis revealed differences between duration of erection and BMI greater than 25 kg/m2. ROC curve analyses revealed total amount of phenylephrine injected and duration of erection were acceptable and excellent predictors of need for shunt procedures with area under the curves of 0.72 and 0.90, respectively. Optimal cut-off values for each were found to be 950 mcg and 15.5 hours. CONCLUSION Our study suggests that patients who require greater than 950 mcg of total phenylephrine or present with erections lasting greater than 15.5 hours are significantly more likely to require corporoglandular shunting and should be counseled appropriately as such.
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Micoogullari U, Unal S, Alijla A, Okulu E, Micoogullari LD, Kayigil O. Effectiveness of the caverno-dorsal vein shunt (Barry shunt) on prolonged ischaemic priapism and its effect on the post-operative long-term erectile function. Andrologia 2020; 53:e13945. [PMID: 33368421 DOI: 10.1111/and.13945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/14/2020] [Accepted: 11/29/2020] [Indexed: 11/27/2022] Open
Abstract
Ischaemic priapism is the most common form of priapism and requires urgent treatment. In this study, we evaluated the effectiveness of the caverno-dorsal vein shunt on resolution of ischaemic priapism and on the post-operative long-term erectile function in patients presenting with priapism. The study included 10 patients admitted to our hospital for priapism between 2010 and 2018. The median age of the patients was 31 (24-66) years. The median priapism time was 13.5 (7-38) hours. The blood gas measurements were taken from the corpus cavernosum, and the drainage of the corpus cavernosum was performed as an emergency intervention. Then, the corpus cavernosum was irrigated with 0.01% adrenaline 5 times in 20-min intervals. The caverno-dorsal vein shunt procedure was performed in cases without regression of priapism. Two months after, the operation shunt was closed. Detumescence occurred in all patients. Eight of 10 patients maintained their erectile function. In 2 patients, severe erectile dysfunction occurred at post-operative 2 months following a priapism attack and penile prosthesis implantation was performed in these 2 patients. Our study showed that caverno-dorsal vein shunt procedure is effective in providing detumescence and maintaining potency in cases with ischaemic priapism. In our opinion, caverno-dorsal vein shunt can be considered as the first treatment of choice for refractory low-flow priapism.
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Affiliation(s)
- Uygar Micoogullari
- Department of Urology, Tepecik Education and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Selman Unal
- Department of Urology, School of Medicine, Ankara City Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | - Amjad Alijla
- Department of Urology, Medisun Hospital, Ankara, Turkey
| | - Emrah Okulu
- Department of Urology, School of Medicine, Ankara City Hospital, Yıldırım Beyazıt University, Ankara, Turkey
| | | | - Onder Kayigil
- Department of Urology, School of Medicine, Ankara City Hospital, Yıldırım Beyazıt University, Ankara, Turkey
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Ralph D. Managing prolonged ischaemic priapism. BJU Int 2020; 126:407. [DOI: 10.1111/bju.15232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Baumgarten AS, VanDyke ME, Yi YA, Keith CG, Fuchs JS, Ortiz NM, Cordon BH, Pagliara TJ, Ward EE, Jaderlund JW, Teeple CS, Christine BS, Yafi FA, Hudak SJ, Morey AF. Favourable multi‐institutional experience with penoscrotal decompression for prolonged ischaemic priapism. BJU Int 2020; 126:441-446. [DOI: 10.1111/bju.15127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Adam S. Baumgarten
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Maia E. VanDyke
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Yooni A. Yi
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Christopher G. Keith
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Joceline S. Fuchs
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Nicolas M. Ortiz
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Billy H. Cordon
- Division of Urology Mount Sinai Medical Center Miami Beach FLUSA
| | | | - Ellen E. Ward
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | | | | | | | - Faysal A. Yafi
- Department of Urology University of California Irvine Orange CA USA
| | - Steven J. Hudak
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Allen F. Morey
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
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The surgical management of ischaemic priapism. Int J Impot Res 2019; 32:81-88. [DOI: 10.1038/s41443-019-0197-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/22/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022]
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15
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Muneer A, Ralph DJ. Immediate Placement of a Penile Prosthesis as First-line Treatment for the Management of Ischaemic Priapism. Eur Urol Focus 2019; 5:529-530. [DOI: 10.1016/j.euf.2019.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/09/2019] [Indexed: 11/16/2022]
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Vreugdenhil S, de Jong IJ, van Driel MF. Priapism Throughout the Ages. Urology 2018; 118:21-24. [DOI: 10.1016/j.urology.2018.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 11/17/2022]
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17
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Ortac M, Pazır Y, Kadıoğlu A. A new cause of ischaemic priapism: Synthetic cannabinoids. Andrologia 2018; 50:e13013. [PMID: 29607523 DOI: 10.1111/and.13013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2018] [Indexed: 12/26/2022] Open
Abstract
Priapism is a urological emergency that needs early intervention and may lead to irreversible cavernosal damage. Ischaemic priapism is the most common type, which is frequently idiopathic and commonly associated with haematological diseases, medications or recreational drugs. Synthetic cannabinoids (SCs) have been increasingly used all over the world, particularly among young-adult population. SCs can cause severe adverse effects on several organ systems. However, there are no studies in the literature which have stated the possible relationship between using of SCs and priapism. We present a case of 28-year-old man who was diagnosed with a 58-hr lasting priapism after regular administrations of SCs. The priapism did not resolve neither after applying aspiration with irrigation nor shunt surgery. Finally, penile prosthesis implantation was performed as last treatment option. The SCs have been increasingly used among young population in recent years; therefore, new SC-related ischaemic priapism cases might be encountered in the emergency departments.
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Affiliation(s)
- M Ortac
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Y Pazır
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Kadıoğlu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Abstract
Priapism is an uncommon urological emergency that can lead to permanent impotence if prompt presentation and medical intervention is not performed. It is a breakdown of the usual physiological mechanisms controlling penile tumescence and detumescence, leading to a prolonged penile erection (>4 hours) that is unrelated to sexual stimulation. Currently, there are three accepted subtypes: ischaemic, non-ischaemic, and stuttering priapism, which is also known as recurrent ischemic priapism. The aim of treatment is the immediate resolution of the painful erection and the preservation of cavernosal smooth muscle function in order to prevent cavernosal fibrosis, which can lead to penile shortening and permanent erectile dysfunction.
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Affiliation(s)
- Asif Muneer
- Department of Urology, University College London Hospitals NHS Trust, London, UK.,NIHR Biomedical Research Centre, University College London Hospitals NHS Trust, London, UK
| | - Hussain M Alnajjar
- Department of Urology, University College London Hospitals NHS Trust, London, UK
| | - David Ralph
- Department of Urology, University College London Hospitals NHS Trust, London, UK
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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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Abstract
Ischemic, or low-flow, priapism is among the most common and challenging urologic emergencies. Management of recurrent or refractory ischemic priapism is even more challenging, with increasing levels of risk for both the patient and the urologist. The goal of this commentary is to condense a career of experience (TF Lue) in the management of ischemic priapism into a concise, practical clinical tool for the reader. We will describe our current algorithm for the treatment of ischemic priapism in addition to detailing how we arrived at these recommendations. We will also describe why we believe that the presented approach is the best available approach and why we have turned away from alternative procedures.
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Affiliation(s)
- Amanda B Reed-Maldonado
- Department of Urology, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Janet S Kim
- Urology Care Center, 400 Newport Center Drive Ste. 409, Newport Beach, CA 92660, USA
| | - Tom F Lue
- Department of Urology, University of California at San Francisco, San Francisco, CA 94143, USA
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21
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Abstract
Priapism, a persistent penile erection lasting longer than 4 hours and unrelated to sexual activity, is one of the most common emergencies treated by urologists. Priapism can be categorized as ischemic, recurrent ischemic (stuttering), and non-ischemic. Advances in understanding the pathophysiology of various types of priapism have led to targeted management strategies. This review aims to provide an up-to-date picture of the pathophysiology and management of priapism. A search of Medline and PubMed for relevant publications using the term "priapism" was performed. In addition to the "classical" articles, emphasis was placed on publications from January 2013 to September 2016 to evaluate the most recent literature available. Though advances in both basic and clinical research continue and effective treatment options are available, methods for the prevention of priapism continue to be elusive.
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Affiliation(s)
- Matthew Hudnall
- Department of Urology, University of California, San Francisco, San Francisco, CA 94143-0738, USA
| | - Amanda B Reed-Maldonado
- Department of Urology, University of California, San Francisco, San Francisco, CA 94143-0738, USA
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, San Francisco, CA 94143-0738, USA
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22
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Afriansyah A, Yuri P, Hutasoit YI. Intracorporeal Dilatation Plus Al-Ghorab Corporoglandular Shunt for Salvage Management of Prolonged Ischemic Priapism. Urol Case Rep 2017; 12:11-13. [PMID: 28271049 PMCID: PMC5337527 DOI: 10.1016/j.eucr.2017.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 01/10/2017] [Indexed: 11/24/2022] Open
Abstract
Ischemic priapism (IP) is a urological emergency that requires early intervention in order to prevent irreversible structural and functional changes. The purpose of penile shunt surgery is to passage out ischemic blood in the corpus cavernosum (CC), restoring the normal circulation within these structures. Here, we present our first experience using modification of Al-Ghorab shunt procedure to treat severe and prolonged IP. The Al-Ghorab shunt procedure was modified by the retrograde insertion of a 7/8 Hegar dilator into the opening of the distal cavernous tissue via the original Al-Ghorab incision. Priapism was successfully relieved, and no recurrent IP was reported.
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Affiliation(s)
- Andika Afriansyah
- Department of Urology, Cipto Mangunkusumo Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Prahara Yuri
- Department of Urology, Sarjito Hospital - Universitas Gadjah Mada, Yogyakarta, Indonesia
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23
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Ridgley J, Raison N, Sheikh MI, Dasgupta P, Khan MS, Ahmed K. Ischaemic priapism: A clinical review. Turk J Urol 2017; 43:1-8. [PMID: 28270944 PMCID: PMC5330261 DOI: 10.5152/tud.2017.59458] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/06/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Ischaemic priapism is a rare condition characterised by little or no cavernosal blood flow, pain and rigidity of the penis. Immediate intervention is required to restore blood flow, prevent necrosis and erectile dysfunction. This review was conducted to determine the best course of treatment and identify areas in current guidelines to which improvements could be made. MATERIAL AND METHODS PubMed, Ovid, MEDLINE (1946-December 2016) and the Cochrane Library were searched as sources for literature. Key studies in each of the areas of management were identified and analysed. RESULTS A total of 45 articles were reviewed. The first step in treatment should be aspiration of corporeal blood. Further studies are needed to make firm recommendations as to whether irrigation should follow, as currently literature is inconclusive. If this fails to cause detumescence, sympathomimetics should be injected. The sympathomimetic of choice is phenylephrine as it is effective, specific and causes minimal cardiovascular side effects. It should be injected at a concentration of 100-500 μg/mL, with 1 mL being injected every 3-5 minutes for up to an hour (maximum 1mg in an hour). Surgical shunting is the next step, except in the cases of delayed priapism (48-72 hours duration) where immediate penile prosthesis insertion may be considered more appropriate. Distal shunts should be performed first, followed by proximal ones to minimise damage leading to erectile dysfunction. There exists little evidence recommending one shunting procedure over another. The final intervention is insertion of a penile prosthesis. Literature suggests that an inflatable prosthesis inserted immediately will yield the greatest patient satisfaction. CONCLUSION A review of the literature has highlighted areas in which further research needs to be done to make conclusive recommendations, including whether irrigation should accompany aspiration and efficacy of shunting procedures. Further studies are required to ensure that patients receive the treatment most likely to cause detumescence and maintain erectile function.
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Affiliation(s)
- Joanne Ridgley
- GKT School of Medicine, King’s College London, London, UK
| | - Nicholas Raison
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
| | | | - Prokar Dasgupta
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
| | - M. Shamim Khan
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
| | - Kamran Ahmed
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
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Mistry NA, Tadros NN, Hedges JC. Conversion of Low-Flow Priapism to High-Flow State Using T-Shunt with Tunneling. Case Rep Urol 2017; 2017:7394185. [PMID: 28331646 PMCID: PMC5346373 DOI: 10.1155/2017/7394185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/24/2017] [Accepted: 02/06/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. The three types of priapism are stuttering, arterial (high-flow, nonischemic), and venoocclusive (low-flow, ischemic). These are usually distinct entities and rarely occur in the same patient. T-shunts and other distal shunts are frequently combined with tunneling, but a seldom recognized potential complication is conversion to a high-flow state. Case Presentation. We describe 2 cases of men who presented with low-flow priapism episodes that were treated using T-shunts with tunneling that resulted with both men having recurrent erections shortly after surgery that were found to be consistent with high-flow states. Case 1 was a 33-year-old male with sickle cell anemia and case 2 was a 24-year-old male with idiopathic thrombocytopenic purpura. In both cases the men were observed over several weeks and both men returned to normal erectile function. Conclusions. Historically, proximal shunts were performed only in cases when distal shunts failed and carry a higher risk of serious complications. T-shunts and other distal shunts combined with tunneling are being used more frequently in place of proximal shunts. These cases illustrate how postoperative erections after T-shunts with tunneling can signify a conversion from low-flow to high-flow states and could potentially be misdiagnosed as an operative failure.
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Affiliation(s)
- Neil A. Mistry
- School of Medicine, Oregon Health & Science University, 3303 SW Bond Ave. CH10U, Portland, OR 97239, USA
| | - Nicholas N. Tadros
- Department of Urology, Oregon Health & Science University, Portland, OR, USA
| | - Jason C. Hedges
- Department of Urology, Oregon Health & Science University, Portland, OR, USA
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25
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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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26
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Seideman CA, Gitlin JS. T-shaped Shunt With Intracavernosal Tunneling for a Pediatric Case of Refractory Ischemic Priapism. Urology 2016; 110:220-222. [PMID: 27693479 DOI: 10.1016/j.urology.2016.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
We present the first reported case of refractory pediatric priapism treated by intracavernosal tunneling T shunt. A 12-year-old male, with sickle cell disease, presented with 72 hours of painful erection. The patient failed conservative measures including aspiration, injection of phenylephrine, as well as distal shunt procedure. A T-T shunt was performed, as previously described in the adult literature. There was immediate resolution of the erection with no complications. At 1-year follow-up, he reports no subsequent episodes of priapism and normal erections. T shunt with tunneling can be performed in select cases of severe pediatric refractory ischemic priapism.
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27
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Shigehara K, Namiki M. Clinical Management of Priapism: A Review. World J Mens Health 2016; 34:1-8. [PMID: 27169123 PMCID: PMC4853765 DOI: 10.5534/wjmh.2016.34.1.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/31/2016] [Accepted: 04/02/2016] [Indexed: 01/30/2023] Open
Abstract
Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. Based on episode history and pathophysiology, priapism is classified into three subtypes: ischemic (low-flow), non-ischemic (high-flow), and stuttering priapism. Ischemic priapism is characterized by a persistent, painful erection with remarkable rigidity of the corpora cavernosa caused by a disorder of venous blood outflow from this tissue mass, and is similar to penile compartment syndrome. Stuttering priapism is characterized by a self-limited, recurrent, and intermittent erection, frequently occurring in patients with sickle cell disease. Non-ischemic priapism is characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. Because ischemic and non-ischemic priapism differ based on emergency status and treatment options, appropriate discrimination of each type of priapism is required to initiate adequate clinical management. The goal of management of priapism is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism. 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)
- Kazuyoshi Shigehara
- Departments of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
| | - Mikio Namiki
- Departments of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
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28
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Kalathia J, Agrawal S, Chipde SS, Agrawal R. Homocysteinemia: A rare cause of priapism. Urol Ann 2016; 8:118-21. [PMID: 26834419 PMCID: PMC4719504 DOI: 10.4103/0974-7796.171497] [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] [Indexed: 11/24/2022] Open
Abstract
Priaprism is a persistent painful erection that continuous beyond or is unrelated to sexual stimulation. Majority of cases are idiopathic (46%), alcohol and drug related (21%), perineal trauma (12%), sickle cell anemia and hypercoagualable state related (11%). We report case of priapism caused by hyperhomocysteinemia with favorable outcome with only few cases so far reported in the literature to the best of our knowledge. A 31 year-old male referred to our institution with non resolving priaprism for the last 6 days. Immediate distal shunt (Al-ghorab) was created but it could not achieve the detumescence. The penile Doppler showed no flow into the corpora, so a proximal shunt (Quackels) was made which achieved satisfactory detumescence. On thorough evaluation for the cause of priaprism, only homocysteine level was found to be significantly raised (40.46 µmol/L), being the unusual and rare cause for priaprism. The patient was discharged on homocheck. In the follow-up the patient is on vacuum assisted device for the erectile dysfunction and has been advised for the penile implant. Priaprism being a urological emergency should be thoroughly evaluated even for the rare causes and should be timely intervened to avoid the unavoidable consequences of permanent erectile dysfunction.
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Affiliation(s)
- Jaisukh Kalathia
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Santosh Agrawal
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Saurabh Sudhir Chipde
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Rajeev Agrawal
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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29
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Affiliation(s)
- Maurice Garcia
- Department of Urology, University of California, San Francisco, USA
| | - Sima Porten
- Department of Urology, University of California, San Francisco, USA
| | - Tom F Lue
- Department of Urology, University of California, San Francisco, USA
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30
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Faddan AA, Aksenov AV, Naumann CM, Jünemann KP, Osmonov DK. Semi-rigid penile prosthesis as a salvage management of idiopathic ischemic stuttering priapism. Res Rep Urol 2015; 7:137-41. [PMID: 26380229 PMCID: PMC4567212 DOI: 10.2147/rru.s83361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Priapism is the persistent erection resulting from dysfunction of the mechanisms that regulate penile swelling, stiffness, and sagging. It is a full or partial erection that persists for a period more than 4 hours beyond sexual stimulation and/or orgasm or is unrelated to sexual stimulation. Ischemic priapism should be managed in a step-by-step fashion. Objective To demonstrate step-by-step management of stuttering refractory ischemic priapism. We report a case of stuttering refractory ischemic priapism. Moreover, we reviewed different approaches to priapism management in the literature. Case presentation A 53-year-old male presented with a painful erection of 29 hours’ duration, probably caused by consumption of alcohol. The penile blood gas showed a pH of 7.08, PCO2 of 75 mmHg and PO2 of 39 mmHg. Aspiration was followed by irrigation of an α-adrenergic, Winter and T-shunt operations were preformed, and finally a semi-rigid penile prosthesis was implanted to overcome the refractory stuttering ischemic priapism. Conclusion In case of stuttering refractory ischemic priapism, immediate implantation of a penile prosthesis is a simple and effective procedure that manages both the acute episode and the inevitable erectile dysfunction that would otherwise occur, while preserving penile length.
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Affiliation(s)
- Amr A Faddan
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Alexey V Aksenov
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Carsten M Naumann
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Klaus P Jünemann
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Daniar K Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Kiel, Germany
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31
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Kucukdurmaz F, Kucukgergin C, Akman T, Salabas E, Armagan A, Seckin S, Kadıoglu A. Duration of priapism is associated with increased corporal oxidative stress and antioxidant enzymes in a rat model. Andrologia 2015. [DOI: 10.1111/and.12455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- F. Kucukdurmaz
- Istanbul University; Istanbul Medical Faculty; Department of Urology; Istanbul Turkey
| | - C. Kucukgergin
- Istanbul University Istanbul Medical Faculty; Department of Biochemistry; Istanbul Turkey
| | - T. Akman
- Bezmialem Vakif University; Faculty of Medicine; Department of Urology; Istanbul Turkey
| | - E. Salabas
- Istanbul University; Istanbul Medical Faculty; Department of Urology; Istanbul Turkey
| | - A. Armagan
- Bezmialem Vakif University; Faculty of Medicine; Department of Urology; Istanbul Turkey
| | - S. Seckin
- Istanbul University Istanbul Medical Faculty; Department of Biochemistry; Istanbul Turkey
| | - A. Kadıoglu
- Istanbul University; Istanbul Medical Faculty; Department of Urology; Istanbul Turkey
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32
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Yafi FA, April D, Powers MK, Sangkum P, Hellstrom WJ. Penile Priapism, Clitoral Priapism, and Persistent Genital Arousal Disorder: A Contemporary Review. Sex Med Rev 2015; 3:145-159. [DOI: 10.1002/smrj.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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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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34
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Abstract
Priapism is a prolonged erection that persists beyond or is unrelated to sexual stimulation. It is associated with significant morbidity: psychological, socioeconomic, and physical, including pain and potentially irreversible compromise of erectile function. There are three major types of priapism: ischemic, nonischemic, and stuttering. Establishing the type of priapism is paramount to safely and effectively treating these episodes. Ischemic priapism represents a urological emergency. Its treatment may involve aspiration/irrigation with sympathomimetic injections, surgical shunts, and as a last resort, penile prosthesis implantation. Nonischemic priapism results from continuous flow of arterial blood into the penis, most commonly related to penile trauma. This is not an emergency and may be managed conservatively initially, as most of these episodes are self-limiting. Stuttering priapism involves recurrent self-limiting episodes of ischemic priapism. The primary goal of therapy is prevention, but acute episodes should be managed in accordance with guidelines for ischemic priapism. In this paper we review the diagnosis and treatment of the three priapism variants, as well as discuss future targets of therapy and novel targets on the horizon.
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Affiliation(s)
- Helen R Levey
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert L Segal
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, 600 North Wolfe Avenue, Marburg 405, Baltimore, MD 21287, USA
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35
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Matta A, Tandra PK, Berim L. Priapism in a patient with sickle cell trait using marijuana. BMJ Case Rep 2014; 2014:bcr-2014-204199. [PMID: 24798364 DOI: 10.1136/bcr-2014-204199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 22-year-old man with a history of multiple episodes of priapism presented to the emergency room with an erection lasting more than 48 h after conservative management failed at home. He had no known family history of sickle cell disease or trait. He was haemodynamically stable. Physical examination revealed an enlarged, tender penis. Laboratory data revealed a positive sickle solubility test. Haemoglobin electrophoresis revealed sickle cell trait and urine drug screen was positive for cannabinoids. Initial management was attempted with intracavernosal phenylephrine without any success. The patient underwent a limited El-Ghorab procedure on the right corpora cavernosa but the priapism did not resolve adequately. Two days later, the patient had to undergo a bilateral El-Ghorab procedure and achieved complete resolution of the priapism.
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Affiliation(s)
- Abhishek Matta
- Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA
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36
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Priapism: an Update on Principles and Practices. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-013-0004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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37
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Role of Penile Prosthesis Insertion in the Treatment of Acute Priapism. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-013-0009-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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38
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Song PH, Moon KH. Priapism: current updates in clinical management. Korean J Urol 2013; 54:816-23. [PMID: 24363861 PMCID: PMC3866283 DOI: 10.4111/kju.2013.54.12.816] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/04/2013] [Indexed: 12/04/2022] Open
Abstract
Priapism is a persistent penile erection that continues for hours beyond, or is unrelated to, sexual stimulation. Priapism requires a prompt evaluation and usually requires an emergency management. There are two types of priapism: 1) ischemic (veno-occlusive or low-flow), which is found in 95% of cases, and 2) nonischemic (arterial or high-flow). Stuttering (intermittent or recurrent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must decide whether the priapism is ischemic or nonischemic. In the management of an ischemic priapism, resolution should be achieved as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic agents is the next step. Surgical shunts should be performed in cases involving failure of nonsurgical treatment. The first management of a nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in cases that request treatment. The goal of management for stuttering priapism is prevention of future episodes. This article provides a review of recent clinical developments in the medical and surgical management of priapism and an investigation of scientific research activity in this rapidly developing field of study.
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Affiliation(s)
- Phil Hyun Song
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ki Hak Moon
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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39
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Lue TF, Garcia M. Should perioperative anticoagulation be an integral part of the priapism shunting procedure? Transl Androl Urol 2013; 2:316-20. [PMID: 26816745 PMCID: PMC4708115 DOI: 10.3978/j.issn.2223-4683.2013.10.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tom F Lue
- Department of Urology, University of California, San Francisco, USA
| | - Maurice Garcia
- Department of Urology, University of California, San Francisco, USA
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40
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Zacharakis E, Raheem AA, Freeman A, Skolarikos A, Garaffa G, Christopher AN, Muneer A, Ralph DJ. The efficacy of the T-shunt procedure and intracavernous tunneling (snake maneuver) for refractory ischemic priapism. J Urol 2013; 191:164-8. [PMID: 23892191 DOI: 10.1016/j.juro.2013.07.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE The current management of ischemic priapism that is refractory to conventional medical therapy is a form of shunt procedure that diverts blood away from the corpus cavernosum. We assessed the outcome of the T-shunt and intracavernous tunneling for the management of ischemic priapism. MATERIALS AND METHODS During a 36-month period 45 patients presented with prolonged ischemic priapism. Patients were divided into subgroups according to the duration of priapism. All patients had an unsuccessful primary treatment, and underwent a T-shunt and intracavernous tunneling with cavernous muscle biopsies. All patients completed an IIEF-5 (International Index of Erectile Function-5) questionnaire preoperatively and 6 months postoperatively. RESULTS Resolution of the priapism using a T-shunt and snake maneuver occurred in all patients with a priapism duration of less than 24 hours and in only 30% of those with priapism lasting more than 48 hours. After a 6-month median followup the IIEF-5 score was significantly reduced from a mean of 24 (range 23 to 25) preoperatively to 7.7 (range 5 to 24), which was related to the duration of the priapism (p <0.0005). All patients with priapism for more than 48 hours had necrotic cavernous smooth muscle on biopsy and had severe erectile dysfunction requiring the insertion of a penile prosthesis. Those patients with moderate and mild erectile dysfunction were treated with phosphodiesterase type 5 inhibitors. CONCLUSIONS The success of the T-shunt with snake tunneling is dependent on the duration of priapism. When it is less than 24 hours the results are favorable, although erectile dysfunction is still present in 50% of patients. In those with a priapism duration greater than 48 hours the technique usually fails to resolve the priapism and all patients end up with erectile dysfunction due to smooth muscle necrosis.
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Affiliation(s)
- Evangelos Zacharakis
- Institute of Urology, University College Hospital London, London, United Kingdom; 2nd Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Amr Abdel Raheem
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - Alex Freeman
- Histopathology Department, University College Hospital London, London, United Kingdom
| | - Andreas Skolarikos
- 2nd Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Giulio Garaffa
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - Andrew N Christopher
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - Asif Muneer
- Institute of Urology, University College Hospital London, London, United Kingdom
| | - David J Ralph
- Institute of Urology, University College Hospital London, London, United Kingdom.
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Droupy S, Giuliano F. [Priapisms]. Prog Urol 2013; 23:638-46. [PMID: 23830258 DOI: 10.1016/j.purol.2013.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Priapism is a rare condition for which urgent diagnosis and treatment is required. This paper reviews the literature regarding ischaemic, non-ischaemic and stuttering priapism in order to provide management recommendations. METHODS A Medline search was carried out to identify all relevant papers with management guidelines for priapism and combined with expert opinion of the authors. RESULTS Ischaemic priapism represents a compartment syndrome of the penis and urgent intervention is required to decrease the risk of erectile dysfunction. First line treatment is medical and associate cavernosal blood aspiration and sympathomimetic intracavernosal injection. Second line treatment is surgical by creating a cavernospongious shunt. Non-ischaemic priapism is not a medical emergency; however, it may need embolization of the arteriocavernosal fistula and result in erectile dysfunction. The treatment objective for stuttering priapism is to decrease episodes of prolonged erections with systemic treatments, while treating each acute episode as an emergency. CONCLUSIONS Priapism is a potentially severe condition that requires urgent diagnosis and well-defined sequential management to prevent treatment delay, complications and irreversible erectile dysfunction.
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Affiliation(s)
- S Droupy
- Service d'urologie andrologie, université Montpellier 1, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France. Ele
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Shiraishi K, Matsuyama H. Salvage Management of Prolonged Ischemic Priapism: Al‐Ghorab Shunt Plus Cavernous Tunneling with Blunt Cavernosotomy. J Sex Med 2013; 10:599-602. [DOI: 10.1111/j.1743-6109.2012.02973.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kovac JR, Mak SK, Garcia MM, Lue TF. A pathophysiology-based approach to the management of early priapism. Asian J Androl 2012. [PMID: 23202699 DOI: 10.1038/aja.2012.83] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Priapism is a rare condition that involves persistent penile erection for greater than 4 h. Distinct variants exist, each with unique characteristics. Ischemic priapism is a painful medical emergency that may occur as a result of veno-occlusion leading to hypoxia and tissue death. Recurrent bouts of ischemic priapism, or stuttering priapism, require treatment for individual attacks as well as long-term prevention. Non-ischemic priapism is associated with trauma and may be managed conservatively. Recent advances into the pathophysiology of priapism have allowed the development of treatment algorithms that specifically target the mechanisms involved. In this review, we outline the basics of smooth muscle contraction and describe how derangement of these pathways results in priapism. A pathophysiological approach to the treatment of priapism is proposed with duration-based algorithms presented to assist in management.
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Affiliation(s)
- Jason R Kovac
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
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Zahran AR, Abdel Daiem H, Youssif M. Does pentoxifylline enhance the recovery of erectile function after a T-shunt procedure for prolonged ischaemic priapism? A prospective randomised controlled trial. Arab J Urol 2012; 10:425-8. [PMID: 26558062 PMCID: PMC4442918 DOI: 10.1016/j.aju.2012.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/02/2012] [Accepted: 05/05/2012] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the role of oral pentoxifylline for enhancing the recovery of erectile function (EF) in patients who had a T-shunt, a technically simple procedure for treating prolonged ischaemic priapism, as the recovery of EF has been reported in many patients treated by this procedure. Patients and methods This prospective randomised study was conducted on 40 patients with prolonged ischaemic priapism treated with a T-shunt. Patients were randomly divided into two groups; group A received oral pentoxifylline from the second day after surgery for 3 months, and group B received placebo. Patients were followed for 18 months. Results The pain resolved in all patients, and EF recovered in 15 patients in group A and 10 in group B within 3 months. All patients but three had recovery of EF within the 18-month follow-up. Six patients had recovery of EF by using on-demand 50 mg sildenafil. The three patients who did not recover EF had a penile prosthesis implanted after the end of the study. Conclusion Pentoxifylline had no significant effect on the recovery of EF after a T-shunt procedure, but a larger study (double-blinded) is required for a more accurate assessment of any beneficial effect of pentoxifylline after a T-shunt procedure.
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Affiliation(s)
| | | | - Mohamed Youssif
- Department of Urology, Alexandria University, Alexandria, Egypt
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Segal RL, Readal N, Pierorazio PM, Burnett AL, Bivalacqua TJ. Corporal Burnett "Snake" surgical maneuver for the treatment of ischemic priapism: long-term followup. J Urol 2012; 189:1025-9. [PMID: 23017524 DOI: 10.1016/j.juro.2012.08.245] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/25/2005] [Accepted: 08/02/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE We provide long-term followup on a modification of the Al-Ghorab distal penile corporoglanular shunt surgery for the treatment of ischemic priapism. MATERIALS AND METHODS We conducted a retrospective review of patients surgically treated for ischemic priapism at The Johns Hopkins Hospital from January 2008 to April 2012 with the Burnett "Snake" maneuver of the Al-Ghorab shunt. Electronic medical records were reviewed to collect demographic information and telephone followup was performed to verify treatment outcomes. Patients completed the SHIM (Sexual Health Inventory for Men) to assess current erectile function. RESULTS A total of 10 patients were analyzed (age range 31 to 59 years). Mean followup was 6.7 months (range 0.5 to 17). Priapism etiologies were idiopathic (3), trazodone (2), trazodone and cocaine (3), intracavernous injection of trimix (1) and spinal cord injury (1). There were 6 patients who had previously undergone unsuccessful surgical attempts at priapism decompression and mean priapism duration was 75 hours (range 24 to 288). Of the 10 men 8 achieved successful resolution of priapism with no recurrence. There were 2 men with recurrent priapism refractory to all management who were definitively treated with insertion of an inflatable penile prosthesis. Of 9 men 6 had normal erectile function preoperatively, of whom 2 achieved at least partial erectile function postoperatively. Complications were sustained by 2 men, including wound infection with skin necrosis in 1, and an intraoperative urethral injury in the other with subsequent urethrocutaneous fistula formation and wound infection with skin necrosis. CONCLUSIONS The modified Al-Ghorab corporoglanular shunt using the Burnett snake maneuver is successful in resolving ischemic priapism, particularly in cases refractory to first line management, and in preventing further episodes of priapism.
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Affiliation(s)
- Robert L Segal
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-2162, USA.
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Zheng DC, Yao HJ, Zhang K, Xu MX, Chen Q, Chen YB, Cai ZK, Lu MJ, Wang Z. Unsatisfactory outcomes of prolonged ischemic priapism without early surgical shunts: our clinical experience and a review of the literature. Asian J Androl 2012; 15:75-8. [PMID: 22922321 DOI: 10.1038/aja.2012.63] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Ischemic priapism is a rare occurrence which can cause severe erectile dysfunction (ED) without timely treatment. This retrospective study reports our experience in treating prolonged ischemic priapism and proposes our further considerations. In this paper, a total of nine patients with prolonged ischemic priapism underwent one to three types of surgical shunts, including nine Winter shunts, two Al-Ghorab shunts and one Grayhack shunt. During the follow-up visit (after a mean of 21.11 months), all patients' postoperative characters were recorded, except one patient lost for death. Six postoperative patients accepted a 25-mg oral administration of sildenafil citrate. The erectile function of the patients was evaluated by their postoperative 5-item version of International Index of Erectile Function Questionnaire (IIEF-5), which were later compared with their premorbid scores. All patients had complete resolutions, and none relapsed. The resolution rate was 100%. Seven patients were resolved with Winter shunts, one with an Al-Ghorab shunt and one with a Grayhack shunt. The mean hospital stay was 8.22 days. There was only one urethral fistula, and the incidence of postoperative ED was 66.67%. Four patients with more than a 72-h duration of priapism had no response to the long-term phosphodiesterase type 5 (PDE-5) inhibitor treatment. These results suggest that surgical shunts are an efficient approach to make the penis flaccid after prolonged priapism. However, the severe ED caused by prolonged duration is irreversible, and long-term PDE-5 inhibitor treatments are ineffective. Thus, we recommend early penile prosthesis surgeries for these patients.
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Affiliation(s)
- Da-Chao Zheng
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
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Priapism: comorbid factors and treatment outcomes in a contemporary series. Adv Urol 2012; 2012:672624. [PMID: 22811705 PMCID: PMC3395114 DOI: 10.1155/2012/672624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 05/05/2012] [Accepted: 05/08/2012] [Indexed: 01/22/2023] Open
Abstract
Objective. The goal of this study is to describe comorbid characteristics in patients who have priapism, and their treatment outcomes. Methods. Chart review was undertaken on men who had a diagnosis of priapism from a tertiary medical center, from 2000-2010. Men with priapism due exclusively to the use of prescription erectile aids and medications were not included in the review. Results. We identified 79 patients with the priapism. The most common type of priapism was the low flow variant. High flow priapism was identified in 2 patients. The most common general comorbid condition associated with priapism was mental illness (including substance abuse), which was present in 56% of the patients. Neurogenic priapism accounted for 19% of the total priapism events. Psychopharmaceutical agents and recreational drugs were commonly associated with ischemic priapism. Acute complications of priapism treatment were not common, but long-term complications, especially erectile dysfunction, were frequent. Conclusions. We describe the characteristics and outcomes of a large group of patients with priapism. Our experience at a tertiary care center indicates that mental illness, including substance abuse disorders, is a highly prevalent comorbid condition in men who experience priapism. Consistent with previous reports, erectile dysfunction is the most common complication from priapism and its treatment, occurring in the majority of men.
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Abstract
UNLABELLED What's known on the subject? and What does the study add? Priapism is a rare event. However, various medications and medical conditions may increase the risk. Priapism can be ischaemic, non-ischaemic or stuttering. It is paramount to distinguish the type of priapism, as misdiagnosis may lead to significant morbidity. Ischaemic priapism represents a compartment syndrome of the penis and is therefore a medical emergency. A delay in management may significantly affect future erectile function. Stuttering priapism represents recurrent subacute episodes of ischaemic priapism, which may lead to erectile dysfunction. Thus episodes must be minimised. Non-ischaemic priapism is not a medical emergency. However, misdiagnosis and injection with sympathomimetic agents can result in system absorption and toxicity. This review article provides a summary of the evaluation and management of priapism. Furthermore, a step by step flow chart is provided to guide the clinician through the assessment and management of this complex issue. OBJECTIVES To review the literature regarding ischaemic, non-ischaemic and stuttering priapism. To provide management recommendations. PATIENTS AND METHODS A Medline search was carried out to identify all relevant papers with management guidelines for priapism. RESULTS Ischaemic priapism represents a compartment syndrome of the penis and urgent intervention is required to decrease the risk of erectile dysfunction. Non-ischaemic priapism is not a medical emergency; however, it can result in erectile dysfunction. The treatment objective for stuttering priapism is to reduce future episodes with systemic treatments, whilst treating each ischaemic episode as an emergency. CONCLUSIONS Priapism is a complex condition that requires expert care to prevent complications and irreversible erectile dysfunction.
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Affiliation(s)
- Yeng K Tay
- Department of Urology, Monash Medical Centre, Melbourne, Victoria, Australia
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Abstract
AIM To provide standard operating procedures for the diagnosis and management of priapism. METHODS Review of the literature. MAIN OUTCOME MEASURES Reduction of priapism and preservation of erectile function. RESULTS Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation. Priapism requires prompt evaluation and usually requires emergency management. There are two types of priapism: (i) ischemic (veno-occlusive or low flow), which is found in 95% of cases, and (ii) nonischemic (arterial or high flow). Stuttering (intermittent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must determine whether the priapism is ischemic or nonischemic. Necessary diagnostic steps are an accurate history, physical examination, and cavernous blood gas analysis and/or color duplex ultrasonography of the corpora cavernosa. Management of ischemic priapism should achieve resolution as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic drugs is the next step. Surgical shunts should be performed if nonsurgical treatment has failed. The initial management of nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in patients who request treatment. The goal of management for a patient with recurrent (stuttering) priapism is prevention of future episodes. CONCLUSION Management of priapism has become increasingly successful as scientific understanding of the pathophysiology and molecular biology of priapism improves. The key to further success in the treatment of priapism is basic research of this uncommon but potentially devastating condition.
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