Partial priapism

Partial thrombosis of the corpus cavernosum – a malignancy mimicker

Partial thrombosis of the corpus cavernosum is a rare condition, typically seen in young patients. Etiology, physiopathology and treatment are still not entirely understood.

The authors report a case of a 49-year-old male with gastric cancer, who successfully treated a thrombosis of the corpus cavernosum conservatively. Diagnostic considerations and treatment options are discussed.

Idiopathic Partial Thrombosis (IPT) of the Corpus Cavernosum: A Hypothesis-Generating Case Series and Review of the Literature

INTRODUCTION

Idiopathic partial thrombosis (IPT) of the corpus cavernosum is a rare condition. The etiology is not fully understood; however, the presence of an either or not congenital web in these patients may contribute to the development of IPT.

AIM

The aim of this study was to describe 18 new IPT cases and compare these with 38 cases found in the literature.

METHODS

A multicenter retrospective analysis was performed. Descriptive statistics are given.

MAIN OUTCOME MEASURES

The main outcome measures used were clinical presentation, clinical and radiographical diagnostics, treatment and resolution of symptoms.

RESULTS

Patients most frequently presented with perineal swelling (10/18; 56%) and pain (13/18; 72%), unilateral (12/18; 67%) or bilateral (4/18; 22%), and pain during erection (10/18; 72%). Penile curvature, dysuria or fever (each 1/18; 6%) were uncommon presenting symptoms. In our series, magnetic resonance imaging demonstrated a fibrous web in the corpus cavernosum in 100% of cases and was more bilaterally (11/18; 61%) than unilaterally (7/18; 39%) diagnosed. Cycling was found to be a provocative factor for IPT occurrence in patients at risk as 61% (11/18) of patients reported being a frequent cyclist with the episode of IPT occurring immediately after or during cycling activity in 8 out of 18 patients (8/18; 44%). In five centers, 15 patients were treated conservatively, the majority being treated with therapeutic doses of low molecular weight heparin and simultaneous anti-aggregant therapy. In one center, all three patients were treated with a surgical approach. Complete resolution of symptoms was noted in only 50% of cases.

CONCLUSION

IPT is a condition that presents typically with perineal pain and swelling. Cycling is often seen as a provocative factor, while the presence of a fibrous web at the level of the crurocavernosal junction is the underlying disorder allowing for entrapment of blood in the crura. Conservative treatment provides a reasonably good outcome in most cases. For therapy resistant cases, surgery can be considered.

Partial priapism

With only 34 prior cases in world literature, partial priapism (PP), also called partial segmental thrombosis of the corpus cavernosum, is a rare urological condition. The aetiology and treatment of PP is still unclear, but bicycle riding, trauma, drug usage, sexual intercourse, haematological diseases and α-blockers have been associated with PP. In this case report and world literature review, we describe the case of a 50-year-old man suffering from PP after ingesting 100 mg of sildenafil. The patient was treated with a surgical incision for corpus cavernosum and clot evacuation, as a conservative treatment of PP was not feasible due to severe pain and unresponsiveness to analgesics.

Idiopathic partial thrombosis of the corpus cavernosum: aetiology, diagnosis and treatment

Idiopathic partial thrombosis of the corpus cavernosum (IPT) is a rare cause of perineal pain involving thrombosis within the proximal corpora cavernosa. This article clarifies the aetiology and makes recommendations on diagnosis and treatment. Three cases are described and a systematic review of the literature is presented. Magnetic resonance imaging (MRI) scans of the penis conducted for reasons other than IPT were also reviewed, to compare the normal anatomy of the corpora cavernosa with that of IPT patients.Twenty-nine IPT cases were identified, including the three described here. All patients presented with perineal pain and in all cases the thrombus was located in the proximal part of the corpora cavernosa.IPT has been associated with haematological diseases, drugs, prior priapism, sexual activity, bicycle riding and aeroplane flights. A fibrous septum within the corporeal tissue has been identified with advanced imaging modalities. Ultrasound, computed tomography and MRI have proven useful in the diagnosis. Both surgical and medical treatments have been attempted and the results have usually been good. However, two cases of surgical treatment have resulted in erectile dysfunction. It is suggested that ITP is based on the development of penile thrombosis and/or priapism in the presence of a pre-existing fibrous septum in the corpora cavernosa. MRI should be used to confirm the presence of a thrombus and a septum. First choice of treatment is pain medication and systemic anticoagulation; more invasive treatments should only be attempted only if this approach fails.

Partial segmental thrombosis of the corpus cavernosum: a case report and a review of the literature

Partial segmental thrombosis of the corpus cavernosum (PSTCC) is a rare urological condition characterized by a painful, firm mass in the proximal part of the corpus cavernosum. The underlying pathophysiology of this condition is not fully understood. We present a case diagnosed by magnetic resonance imaging with complete clinical recovery after conservative treatment and novel associated findings, such as excessive alcohol intake. We also review the previous cases of PSTCC and propose a two hit model explaining PSTCC's etiology.

Partial segmental thrombosis of the corpus cavernosum

The case of a 32-year-old man with perineal pain and local swelling is presented. Partial segmental thrombosis of the corpus cavernosum was diagnosed and treated conservatively with systemic anticoagulants. Conservative management proved to be a safe and successful therapeutic option in partial thrombosis of the corpus cavernosum.

Partial segmental thrombosis of corpus cavernosum: Case report and review of world literature

Partial segmental priapism is an unusual clinical condition characterized by thrombosis within the proximal corpora cavernosa. Previous management strategies have included open exploration, surgical shunts, corporal injection, irrigation, and oral medication therapy. We report a case of a 37-year-old man treated conservatively with full restoration of erectile function.

Idiopathic partial thrombosis of the corpus cavernosum: conservative management is effective and possible

Three cases of spontaneous, partial, unilateral thrombosis of the corpus cavernosum are described. The patients presented with a painful mass in the perineum without priapism. Diagnosis was made through ultrasound evaluation and magnetic resonance imaging, showing unilateral, partial thrombosis of the corpus cavernosum. Treatment consisted of systemic anticoagulation. In all three cases, the thrombosis resolved spontaneously over several months without complications. The aetiology of partial thrombosis of the corpus cavernosum remains unclear, but conservative management of this rare condition appears to be effective and safe.

Priapism. From Priapus to the present time

Advances in the pharmacotherapeutic options available to treat erectile dysfunction over the past decade have transformed the field of impotence. The initial foray into this field with intracavernous injections of papaverine rapidly expanded the number of men seeking attention for priapism, a previously rare clinical condition. The recent widespread use and acceptance of oral agents for the treatment of erectile dysfunction, with a reduced incidence of priapism has decreased the number of men at risk for injection-related prolonged erections. The use of recreational drugs (cocaine) and perineal trauma leading to presentations of priapism seem to be rising in incidence. The urologist remains the consultant-specialist ultimately responsible for these men and should be cognizant of the array of treatments described for this condition. Early determination of the state of corporal oxygenation is essential and will define the optimal management approach. A wide range of medical conditions and risk factors may be etiologic and should be elicited from the patient at the initial interview. Low-flow ischemic priapism requires a rapid resolution, often achieved through use of alpha-agonists orally or by direct injection into the penile circulation, whereas nonischemic priapism can be treated more conservatively. Research into this condition has only recently been initiated. Through greater understanding of the pathophysiology of priapism, the clinician may become armed with etiology-specific medical alternatives providing timely detumescence for men with prolonged erections.

Management of partial segmental priapism

We report the cases of 2 patients with partial segmental priapism. The patients presented with pain, a perineal mass, and proximal segmental corporal thrombosis. Treatment consisted of a proximal corpus cavernosal-spongiosum shunt. Diagnostic considerations, literature review, and treatment options are discussed.

Priapism in seven cats

Priapism (persistent and painful erection) is an uncommon disorder in cats and dogs. This report describes the clinical and pathological features of seven cases of priapism in cats. Six of the cases were Siamese cats, and in four of them the priapism developed after attempted mating with an oestrus female, despite three of them having been neutered. Five cats were treated by perineal urethrotomy, which was successful in four. In five of the six amputated specimens, thrombosis of the corpus cavenosum was evident.

Idiopathic segmental thrombosis of the corpus cavernosum as a cause of partial priapism

Idiopathic segmental thrombosis of the corpus cavernosum as a cause for partial priapism is an uncommon event. Diagnosis and treatment in the past have principally involved invasive methods. We present a case in which both conventional invasive methods and noninvasive imaging were used.

Priapism: simple method to prevent retumescence following initial decompression

With recent escalation in the use of vasoactive intracorporeal injections to produce erection, the precise treatment of priapism has again achieved much attention. In particular, high inflow priapism must be managed rapidly and definitively to reestablish equilibrium with venous outflow. However, once penile decompression has been achieved tumescence of the penis can recur if appropriate measures are not taken. This may result in additional penile manipulation and operations leading to an increased risk of impotence. A simple method is presented to prevent recurrent tumescence after initial treatment of priapism, irrespective of the etiology.

Drug-induced priapism. Its aetiology, incidence and treatment

Priapism is characterised by a persistent erection that cannot be relieved by sexual intercourse or masturbation. Although priapism subsides spontaneously in a few days, impotence frequently follows. Both vascular and neural mechanisms are implicated in the pathophysiology of priapism, but it is not clear which initiates the process. Idiopathic cases of priapism are the most frequent (near 50%); other medical conditions that can result in priapism are haematological diseases (mainly sickle cell anaemia and leukaemia), traumatism, and neoplastic processes. Drug-induced priapism comprises about 30% of cases. The drugs most frequently implicated are psychotropic drugs (phenothiazines and trazodone), antihypertensives (mainly prazosin) and heparin. Recently, the intracavernosal injection of vasoactive drugs (papaverine and phentolamine) has been described in patients treated for impotence. With the exception of heparin, an alpha-adrenergic blocking mechanism has been suggested in the priapism-inducing action of these drugs. A significant number of anecdotal case reports link priapism and drugs, and it is possible that certain cases of idiopathic priapism could be reclassified if accurate pharmacological anamnesis were to be performed. Priapism must be considered a urological emergency. Surgical procedures are the most preferred treatment for this condition but, in selected cases, drug treatment seems to be an alternative approach.