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Elmarasi M, Alsaeedi A, Elmakaty I, Elsayed B, Khalil IA, Aldeeb M, Khalafalla K, Al Kubaisi K, Arafa M, Majzoub A. Early vs delayed insertion of penile prosthesis in patients with refractory priapism: a systematic review and meta-analysis. Sex Med Rev 2024; 12:528-536. [PMID: 38465856 DOI: 10.1093/sxmrev/qeae007] [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: 12/10/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Refractory priapism, characterized by persistent and prolonged painful erections despite initial treatment maneuvers, can significantly impair erectile function secondary to ischemia-induced corporal tissue fibrosis. These patients will likely require subsequent penile prosthesis (PP) surgery to regain sexual activity, yet consensus regarding the optimal timing of implantation remains lacking. OBJECTIVES To evaluate and compare the clinical outcomes associated with early vs delayed PP implantation in individuals with priapism-induced erectile dysfunction (ED). METHODS We included studies that focused on refractory priapism leading to ED and its management with PP implantation. We assessed cohort study bias with a risk-of-bias tool and case series bias with the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated by a fixed-effect model. RESULTS We included 9 studies, comprising 4 cohort studies and 5 case series, involving a total of 278 patients. Total complications were higher in the delayed group (OR, 4.16; 95% CI, 2.77-6.26). Fibrosis was significantly more pronounced in the delayed group (OR, 118.18; 95% CI, 20.06-696.32). The odds of erosion, infections, and penile injury did not show statistically significant differences between the groups (OR, 2.52 [95% CI, 0.67-9.49], 0.89 [0.38-2.10], 1.83 [0.79-4.26], respectively). Patients' satisfaction resulted in a pooled OR of 0.15 (95% CI, 0.04-0.49) in favor of the early PP insertion group. CONCLUSION The results from this study favor an early approach to ED (within 30 days) following ischemic priapism. However, it is important to consider patients' preferences, values, and psychological factors to make an informed decision.
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Affiliation(s)
| | - Ahmad Alsaeedi
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
| | | | - Basel Elsayed
- College of Medicine, Qatar University, Doha, 2713, Qatar
| | - Ibrahim A Khalil
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
| | - Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, 3050, Qatar
| | | | | | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
| | - Ahmed Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, 3050,Qatar
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VanDyke M. Response to the comment on: "Current opinions on the management of prolonged ischemic priapism: does penoscrotal decompression outperform corporoglanular tunneling?". Int J Impot Res 2024:10.1038/s41443-024-00883-w. [PMID: 38649767 DOI: 10.1038/s41443-024-00883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Maia VanDyke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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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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Yassin M, Chen R, Ager M, Desouky E, Minhas S. Penile implants in low flow priapism. Int J Impot Res 2023; 35:651-663. [PMID: 37898653 DOI: 10.1038/s41443-023-00787-1] [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: 02/14/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
Priapism is a persistent or prolonged erection, in the absence of sexual stimulation, that fails to subside. Prolonged ischaemic or low flow priapism is defined as a full or partial erection persisting for more than 4 h and unrelated to sexual interest or stimulation, characterised by little or no cavernous blood flow. Low flow priapism leads to progressive corporal fibrosis, which could, in turn, lead to long-lasting erectile dysfunction if left untreated. Penile prosthesis implantation is recognised as a management option in refractory and delayed low flow priapism for restoring erectile function with high patient satisfaction rates. However, the ensuing corporal fibrotic scarring poses a surgical challenge to clinicians, given the higher complication rates in this patient subset. Postoperative patient satisfaction has been closely linked to preoperative expectations and perceived loss of penile length. Therefore, thorough patient counselling concerning the risk and benefits of penile implants should be a priority for all clinicians. Moreover, there is a lack of consensus on the ideal prosthesis choice and procedural timing in refractory low flow priapism. In this review, we will examine the existing literature on penile implants in patients with priapism and discuss the options for managing complications associated with penile prosthesis surgery.
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Affiliation(s)
- Musaab Yassin
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Runzhi Chen
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Michael Ager
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elsayed Desouky
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
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Salman B, Elsherif E, Elgharabawy M, Badawy A. Early versus delayed penile prosthesis insertion for refractory ischemic priapism. Arab J Urol 2022; 21:76-81. [PMID: 37234682 PMCID: PMC10208160 DOI: 10.1080/2090598x.2022.2135290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/21/2022] [Accepted: 10/09/2022] [Indexed: 11/02/2022] Open
Abstract
Objectives Penile prosthesis insertion is a well-established therapeutic option in refractory ischemic priapism but there is a lack of standardization regarding the timing of surgery, the type of prosthesis (malleable or inflatable), as well as the possible complications. In this study, we retrospectively compared early versus delayed penile prosthesis insertion in patients with refractory ischemic priapism. Methods 42 male patients who presented with refractory ischemic priapism during the period between January 2019 and January 2022 were included in this study. All patients had malleable penile prosthesis insertion by four highly experienced consultants. Patients were divided into two groups based on the time of the prosthesis insertion. 23 patients had immediate insertion of the prosthesis within the first week of the onset of priapism while the remaining 19 patients had delayed prosthesis insertion three months or later after the onset of priapism. The outcome as well as the intra- and the postoperative complications were recorded. Results Postoperative complications such as prosthesis erosion and infection were higher among the early insertion group while the delayed insertion group had higher incidence of intraoperative complications such as corporal perforation and urethral injury. The insertion of the prosthesis was much more difficult among the delayed insertion group due to fibrosis which made dilatation of the corpora very difficult. The length and the width of the penile implant were significantly higher among the early insertion group as compared to the delayed insertion group. Conclusions Early penile prosthesis insertion for refractory ischemic priapism is a safe and effective treatment option as delayed prosthesis insertion is more difficult and challenging due to corporal fibrosis and is associated with higher complication.
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Affiliation(s)
- Baher Salman
- Urology Department, Faculty of Medicine, Menofia University, Shibin Elkoom, Egypt
| | - Eid Elsherif
- Urology Department, Faculty of Medicine, Menofia University, Shibin Elkoom, Egypt
| | - Mohamed Elgharabawy
- Urology Department, Faculty of Medicine, Menofia University, Shibin Elkoom, Egypt
| | - Atef Badawy
- Urology Department, Faculty of Medicine, Menofia University, Shibin Elkoom, Egypt
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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
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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Capece M, Falcone M, Cai T, Palmieri A, Cocci A, La Rocca R. Penile Prosthesis Implantation in Refractory Ischaemic Priapism: Patient Selection and Special Considerations. Res Rep Urol 2022; 14:1-6. [PMID: 35059330 PMCID: PMC8765601 DOI: 10.2147/rru.s278807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Marco Capece
- Department of Urology, AOU Federico II, University Hospital, Naples, Italy
| | - Marco Falcone
- Department of Neurourology, A.O.U. Città della Salute e della Scienza di Torino - Unità Spinale Unipolare, Turin, Italy
| | | | - Alessandro Palmieri
- Department of Urology, AOU Federico II, University Hospital, Naples, Italy
- Correspondence: Alessandro Palmieri Department of Neuroscience, Reproductive Science and Odontostomatology, University Federico II of Naples, via S.Pansini 5, Naples, 80131, ItalyTel +39 081 746 2611Fax +39 081 746 4311 Email
| | - Andrea Cocci
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Roberto La Rocca
- Department of Urology, AOU Federico II, University Hospital, Naples, Italy
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Palmisano F, Vagnoni V, Franceschelli A, Gentile G, Colombo F. Immediate insertion of a soft penile prosthesis as a new option for a safe and cost-effective treatment of refractory ischemic priapism. Arch Ital Urol Androl 2021; 93:356-360. [PMID: 34839644 DOI: 10.4081/aiua.2021.3.356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the management of refractory ischemic priapism (IP) by the immediate insertion of a soft penile prosthesis (sPP). PATIENTS AND METHODS We identified men affected by IP who underwent early sPP placement from May 2017 to October 2019. All patients underwent a detailed medical history review; intraoperative, postoperative features and adverse events were recorded. We evaluated the penile lengthening and bending, presence of complementary erection, ability to have sexual intercourse, postoperative sexual life satisfaction (International Index of Erectile Function [IIEF] questionnaire - question number 5). A cost-analysis was included. RESULTS A total of six patients were identified. Median time (range) since onset was 78 (48-108) hours with a mean age (SD) of 33 (6.9) years. Median operative time (range) was 82 minutes (62-180). No complications were recorded. Median follow- up was 9 months (range 3-17). No significant loss of penile length, neither penile angulation was recorded. Despite a transient reduction of penile sensitivity, all patients reported satisfactory sexual intercourse (mean score question number 5 from IIEF-5 of 4). The cost of sPP was € 1769,00 with a surgeryrelated reimbursement fee from the National Health System of € 3856,75. CONCLUSIONS The insertion of a sPP for patients with refractory IP results in immediate pain relief, preservation of sexual function and penile size, with a higher surgery reproducibility in an emergency. In addition to this, financial and resource burdens of IP on the health-care system can be potentially reduced.
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Affiliation(s)
- Franco Palmisano
- ASST Fatebenefretalli-Sacco, Luigi Sacco University Hospital, Department of Urology, Milan.
| | - Valerio Vagnoni
- Andrology Unit, Department of Urology and Gynecology, Sant'Orsola University Hospital, Bologna.
| | | | - Giorgio Gentile
- Andrology Unit, Department of Urology and Gynecology, Sant'Orsola University Hospital, Bologna.
| | - Fulvio Colombo
- Andrology Unit, Department of Urology and Gynecology, Sant'Orsola University Hospital, Bologna.
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Fernandez-Crespo RE, Buscaino K, Parker J, Carrion R. Current Status for Semirigid Penile Prosthetic Devices. Curr Urol Rep 2021; 22:7. [PMID: 33420928 DOI: 10.1007/s11934-020-01028-4] [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] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to evaluate the current use of semirigid penile prosthesis (SRPP), surgical techniques for insertion of SRPP, and how to prevent and approach surgical complications. RECENT FINDINGS SRPP is a valid option for those who are refractory to medical therapy for erectile dysfunction (ED) and even more appropriate for specific subsets of patient populations. It is important for urologists to know which patient population SRPP is preferred for. Several studies have shown good patient outcomes and patient satisfaction with those who underwent SRPP.
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Affiliation(s)
- Raul E Fernandez-Crespo
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA. .,University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Kristina Buscaino
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA.,University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Justin Parker
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA.,University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Rafael Carrion
- Tampa General Hospital, 1 Tampa General Circle, Tampa, FL, 33606, USA.,University of South Florida, Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA
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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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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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13
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Current practice in the management of ischemic priapism: an anonymous survey of ISSM members. Int J Impot Res 2019; 31:404-409. [PMID: 30718828 PMCID: PMC6679808 DOI: 10.1038/s41443-019-0120-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 02/06/2023]
Abstract
Penile shunting is the standard of care in management of ischemic priapism refractory (IPR) to non-surgical interventions. Due to high rates of impotence, corporal fibrosis, and loss of penile length, recent literature suggests these patients benefit from immediate penile prosthesis (PP) placement. An IRB-exempt anonymous electronic survey of the 2168 members of the International Society for Sexual Medicine (ISSM) was conducted. The survey included demographic information, confidence, and experience-related management of IPR. The aim was to evaluate current practice patterns in management of IPR and to investigate the role of immediate PP implantation in the management of prolonged (>36 h) IPR. The survey response rate was 11.6% (n = 251). Most respondents were urologists (173), from the USA (49.1%), and had completed a fellowship in male sexual medicine, men's health, reconstruction, or andrology (71.1%). The majority (91.3%) see at least one case of prolonged priapism (>36 h) that requires surgical management yearly. When looking at volume in training and after, our respondents had a significantly higher experience with penile prostheses (over 70%, > = 10) as compared with shunts (less than 40%, > = 10). Overall, 70.9% of respondents felt more comfortable with a malleable PP than a shunt. However, penile shunts are still preferred as the first line of surgical management by ~80% of respondents as compared with 12.7% who instead prefer a PP. We also found that under 40% of respondents currently use penile MRI or corporal biopsies in their management of prolonged assessment. This is the first study to assess current clinical practices in management of IPR globally. As in any anonymous self-reported survey-based research, recall and sampling bias are an inherent limitation. Penile shunting for IPR continues to be the preferred treatment despite emerging data. Respondents performed PP surgery routinely and feel more confident placing PP than performing penile shunting procedures.
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Yafi FA, Hellstrom WJG. Immediate Placement of Penile Prosthesis for the Management of Ischemic Priapism as First-line Treatment. Eur Urol Focus 2019; 5:531-532. [PMID: 30639251 DOI: 10.1016/j.euf.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
In patients presenting with early ischemic priapism, proceeding with the conventional paradigm is recommended. In those presenting late (>48 h), penile prosthesis placement can easily be performed 2-6 wk later, with no increase in surgical difficulty or morbidity. Immediate penile prosthesis implantation should be reserved for motivated patients who understand the increased associated risks, have evidence of corporal fibrosis on imaging, and are being treated in a center of excellence.
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Affiliation(s)
- Faysal A Yafi
- Department of Urology, University of California Irvine, Newport Beach, CA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University Health Sciences Center, New Orleans, LA, USA.
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Garcia-Perdomo H, Gómez-Puerto D, Zapata-Copete J, Manzano-Núñez R. Interventional management of low-flow priapism: A protocol proposal. UROLOGICAL SCIENCE 2018. [DOI: 10.4103/uros.uros_4_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Reddy AG, Alzweri LM, Gabrielson AT, Leinwand G, Hellstrom WJG. Role of Penile Prosthesis in Priapism: A Review. World J Mens Health 2018; 36:4-14. [PMID: 29299902 PMCID: PMC5756805 DOI: 10.5534/wjmh.17040] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 12/23/2022] Open
Abstract
Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.
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Affiliation(s)
- Amit G Reddy
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Laith M Alzweri
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew T Gabrielson
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Gabriel Leinwand
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Falcone M, Gillo A, Capece M, Raheem A, Ralph D, Garaffa G. The management of the acute ischemic priapism: A state of the art review. Actas Urol Esp 2017; 41:607-613. [PMID: 28528136 DOI: 10.1016/j.acuro.2017.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review the current literature on early penile prosthesis implantation in patients with refractory ischemic priapism (IP). ACQUISITION OF EVIDENCE A systematic search for the terms "penile prosthesis", "priapism", "impotence", "fibrosis", "downsized prosthesis cylinders", and "patient satisfaction" has been carried out in PubMed, EMBASE, Cochrane, SCOPUS and Science Citation Index databases. SYNTHESIS OF EVIDENCE Cavernosal tissue damage in IP is time related. Conservative measures and aspiration with or without intracorporeal instillation of α-adrenergic agonists are usually successful in the early stages. Shunt surgery in patients remains debatable, as the lack of response to aspiration and instillation of α-adrenergic agonists indicates that irreversible changes in the cavernosal smooth muscle are likely to have already occurred. Immediate penile prosthesis implantation in patients with refractory IP settles the priapic episode, maintains the long term rigidity necessary to engage in penetrative sexual intercourse and prevents the otherwise inevitable penile shortening. Although complication rates after penile prosthesis implantation in acute priapism are higher than in virgin cases, they are still lower than after implantation in patients with severe corporal fibrosis due to chronic priapism. Regardless of the complication rates, penile prosthesis implantation in refractory IP should be preferred as it allows the preservation of penile length, which is one of the main factors influencing postoperative patient's satisfaction following surgery.
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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: 8] [Impact Index Per Article: 1.1] [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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Capece M, Gillo A, Cocci A, Garaffa G, Timpano M, Falcone M. Management of refractory ischemic priapism: current perspectives. Res Rep Urol 2017; 9:175-179. [PMID: 28920056 PMCID: PMC5587151 DOI: 10.2147/rru.s128003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of the present manuscript is to review the current literature on priapism, focusing on the state-of-the-art knowledge of both the diagnosis and the treatment of the refractory ischemic priapism (IP). METHODS Pubmed and EMBASE search engines were used to search for words "priapism", "refractory priapism", "penile prosthesis", "diagnosis priapism", "priapism treatment", "penile fibrosis", "priapism therapy". All the studies were carefully examined by the authors and then included in the review. RESULTS First-line treatment involves ejaculation, physical exercise and cold shower followed by corporal blood aspiration and injection of α-adrenoceptor agonists. Subsequently, a distal or proximal shunt may be considered. If none of the treatment is effective or the priapism episode lasts >48 hours penile prosthesis implantation could be the only option to solve the priapism and treat the ongoing erectile dysfunction. CONCLUSION The management of IP is to achieve detumescence of persistent penile erection and to preserve erectile function after resolution of the priapic episode. On the other hand, penile fibrosis and following shortening should be prevented. Early penile prosthesis implantation in patients with refractory IP is able to solve both the priapic episode and prevent the otherwise certain penile shortening. Penile prosthesis implantation is the actual gold standard of care in cases of refractory IP.
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Affiliation(s)
- Marco Capece
- The Institute of Urology, University College of London Hospital (UCLH), London, UK
| | - Arianna Gillo
- Department of Urology, "Umberto Parini" Hospital, Aosta
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, Firenze
| | - Giulio Garaffa
- The Institute of Urology, University College of London Hospital (UCLH), London, UK
| | - Massimiliano Timpano
- Department of Urology, University of Turin, Città della Salute e della Scienza, Turin, Italy
| | - Marco Falcone
- Department of Urology, University of Turin, Città della Salute e della Scienza, Turin, Italy
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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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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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Zacharakis E, Garaffa G, Raheem AA, Christopher AN, Muneer A, Ralph DJ. Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation. BJU Int 2014; 114:576-81. [DOI: 10.1111/bju.12686] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Evangelos Zacharakis
- The Institute of Urology; University College Hospital London; London UK
- Department of Urology; Guy's Hospital; King's College London; London UK
| | - Gulio Garaffa
- The Institute of Urology; University College Hospital London; London UK
| | - Amr A. Raheem
- The Institute of Urology; University College Hospital London; London UK
| | | | - Asif Muneer
- The Institute of Urology; University College Hospital London; London UK
| | - David J. Ralph
- The Institute of Urology; University College Hospital London; London UK
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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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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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Trost LW, McCaslin R, Linder B, Hellstrom WJG. Long-term outcomes of penile prostheses for the treatment of erectile dysfunction. Expert Rev Med Devices 2014; 10:353-66. [DOI: 10.1586/erd.12.92] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Alhalbouni S, Deem S, Abu-Halimah S, Sadek BT, Mousa A. Atypical Presentation of Priapism in a Patient With Acute Iliocaval Deep Venous Thrombosis Secondary to May-Thurner Syndrome. Vasc Endovascular Surg 2013; 47:488-92. [PMID: 23843289 DOI: 10.1177/1538574413493680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report on a 42-year-old male who presented with priapism, severe scrotal swelling, and left lower extremity pain and swelling. Initial management of priapism failed, and he was noted to have both cavernosal and glandular venous obstruction. Computed tomography (CT) was performed and identified extensive acute thrombosis involving the distal inferior vena cava and the left iliac veins. Pharmacomechanical thrombolysis (PMT) was started over the course of two days. At completion of thrombolysis, the culprit lesion in the left common iliac vein was treated with angioplasty and stenting. His postoperative course was uneventful, and his priapism as well as the scrotal and leg swelling improved. He was discharged home on full anticoagulation. To our knowledge, this is the first available description of this rare presentation along with a literature review of the underlying vascular etiology for priapism.
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Affiliation(s)
- Saadi Alhalbouni
- Department of Vascular Surgery, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
| | - Samuel Deem
- Department of Urology, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
| | - Shadi Abu-Halimah
- Department of Urology, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
| | - Betro T. Sadek
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Albeir Mousa
- Department of Vascular Surgery, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA
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Garaffa G, Ralph DJ. Penile Prosthesis Implantation in Acute and Chronic Priapism. Sex Med Rev 2013; 1:76-82. [DOI: 10.1002/smrj.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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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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Mains E, Aboumarzouk O, Ahmad S, El-Mokadem I, Nabi G. A minimally invasive temporary cavernoso-saphenous shunt in the management of priapism after failed conservative treatment. MINIM INVASIV THER 2011; 21:366-8. [PMID: 22142185 DOI: 10.3109/13645706.2011.636821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Priapism is an urological emergency with detrimental consequences, if not managed expeditiously. Though a rare condition with an incidence between 0.3 and 1.5 per 100,000 population, its management options are limited and decision making could be challenging. We present a case of late presenting priapism for which the initial routine clinical care (aspiration, intracavernosal injection, and distal shunt) failed to relieve erection. Subsequently, the patient was successfully treated by a temporary cavernoso-saphenous shunt using carotid shunt and repeated heparin flushes. This novel surgical treatment offers an alternate method of relieving priapism, avoiding the long-term undesired effects associated with permanent proximal shunts such as cavernoso-venous grafts. Moreover, interval flushes (and/or repeated aspirations) with heparin ensures patency of this new shunt during the perioperative period. The patient recovered without any complications and the shunt was removed after one week. He has regained partial erection, however refused to have further treatment. Temporary cavernoso-saphenous shunt using carotid shunt offers an alternate option of management of priapism in patients with failed initial conservative treatment and distal shunts.
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Affiliation(s)
- Edward Mains
- Department of Urology, Ninewells Hospital and Dundee Medical School, Dundee, Scotland, UK
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Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature. Int J Impot Res 2011; 23:158-64. [PMID: 21654814 DOI: 10.1038/ijir.2011.23] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A cohort of 20 patients with delayed priapism who underwent treatment at the Emergency Department of our academic referral centers between January 2002 and April 2010 was studied. Of these, 16 cases suffered from a low-flow priapism. A total of 6 cases were managed non-surgically, 10 required shunt surgery, and of these 5 were treated by early penile prosthesis surgery. Prostheses were easily implanted in all patients with a mean operative time of 94 min. No intraoperative complications and no infection were registered. All patients with an inflatable prosthesis complained a reduction in penile sensibility that lasted 3 months. All patients were satisfied with the results of surgery (International Index of Erectile Function Questionnaire-5, Q5 mean value 4), and all were successfully engaging in satisfactory sexual intercourses. No significant loss of penile length, neither apical erosion nor extrusion was recorded. Early insertion of a penile prosthesis is a simple and safe procedure in patients with ischemic priapism, which failed to respond to conservative management. Early insertion of a prosthesis helps to maintain adequate penile length, resolve priapism and, in the long term, it results in high satisfaction rates.
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Priapism in sickle cell anemia: emerging mechanistic understanding and better preventative strategies. Anemia 2010; 2011:297364. [PMID: 21490762 PMCID: PMC3066554 DOI: 10.1155/2011/297364] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/11/2010] [Accepted: 10/29/2010] [Indexed: 11/17/2022] Open
Abstract
Sickle cell anemia is a common and disabling disorder profoundly affecting mortality as well as quality of life. Up to 35% of men with sickle cell disease are affected by painful, prolonged erections termed ischemic priapism. A priapic episode may result in fibrosis and permanent erectile dysfunction. The severity of sickle cell disease manifestations is variable dependent on a number of contributing genetic factors; however, priapism tends to cluster with other severe vascular complications including pulmonary hypertension, leg ulceration, and overall risk of death. The mechanisms underlying priapism in sickle cell disease have begun to be elucidated including hemolysis-mediated dysregulation of the nitric oxide signaling pathway and dysregulation of adenosine-mediated vasodilation. A better understanding of these mechanisms is leading toward novel preventative strategies. This paper will focus on the mechanisms underlying development of ischemic priapism in sickle cell disease, current acute and preventative treatment strategies, and future directions for improved management of this disorder.
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