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Rybár Ľ, Hesko P, Kollárik B, Andrisová J. Partial segmental thrombosis of the corpus cavernosum post prolonged run and MRI changes during follow-up: A case report. Urol Case Rep 2023; 51:102615. [PMID: 38046257 PMCID: PMC10689872 DOI: 10.1016/j.eucr.2023.102615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
Partial segmental thrombosis of the corpus cavernosum (PSTCC) is a rare condition predominantly occurring in young men. We report a case of a 44-year-old man presenting with a spontaneous painful mass in the right proximal cavernous corpus (CC) one day following a prolonged run. An ultrasonography and MRI identified a thrombus in the CC. Anticoagulants and analgesics were prescribed, a non-surgical approach was chosen. Symptoms disappeared in a week as apparent by a reduction of thrombus on the MRI. Three years later, a residual thrombus with fibrosis was detected. Patient continues to be asymptomatic at the time of follow-up.
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Affiliation(s)
- Ľuboš Rybár
- Department of Urology, Bory Hospital, Ivana Kadlečíka 2, Lamač, 841 03, Bratislava, Slovakia
| | - Patrik Hesko
- Department of Urology, Bory Hospital, Ivana Kadlečíka 2, Lamač, 841 03, Bratislava, Slovakia
| | - Boris Kollárik
- Department of Urology, Bory Hospital, Ivana Kadlečíka 2, Lamač, 841 03, Bratislava, Slovakia
| | - Jana Andrisová
- Radiologia s.r.o., St. Cyril and Methodius Hospital, University Hospital in Bratislava, Antolská 11, 851 07, Bratislava, Slovakia
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2
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Senthilkumaran S, Sampath S, Miller SW, Almeida JR, Williams J, Williams HF, Thirumalaikolundusubramanian P, Patel K, Vaiyapuri S. Partial segmental thrombosis of the corpus cavernosum following Russell's viper bite. Toxicon 2023; 234:107284. [PMID: 37683700 DOI: 10.1016/j.toxicon.2023.107284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
Snakebite envenoming (SBE) is common in rural communities living in tropical regions that often have fragile and/or overwhelmed healthcare systems. The complex scenarios around SBE lead to a high number of deaths, disabilities, and long-term consequences in patients. Russell's viper (Daboia russelii) is one of the most medically important snake species in India, which causes devastating pathological conditions characterised by a wide range of clinical manifestations. This broad spectrum of symptoms requires additional therapeutic interventions beyond the classical antivenom administration. Hence, positive outcomes for patients affected by SBE can be achieved with a better understanding of previous experiences describing clinical manifestations and various therapeutic interventions including for rare and underreported conditions. Here, we report an SBE victim who developed partial segmental thrombosis in the corpus cavernosum following Russell's viper envenomation and its diagnostic and treatment approaches. The patients received 180 ml of antivenom to resolve the abnormalities in their haematological parameters. Despite antivenom treatment, they developed severe pain in their genital region, and subsequent ultrasound and magnetic resonance imaging confirmed segmental thrombosis in the corpus cavernosum, which required supportive measures. The treatment using low molecular weight heparin, rivaroxaban and non-steroidal anti-inflammatory drugs resolved segmental thrombosis. In conclusion, this case report exemplifies the development of a rare segmental thrombosis in corpus cavernosum and how the medical, scientific, and general community can benefit from documenting clinical manifestations, medically relevant insights into patient care and the management of underreported complications.
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Affiliation(s)
| | | | - Stephen W Miller
- The Poison Control Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - José R Almeida
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
| | - Jarred Williams
- School of Pharmacy, University of Reading, Reading, RG6 6UB, UK
| | - Harry F Williams
- Toxiven Biotech Private Limited, Coimbatore, 641042, Tamil Nadu, India
| | | | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, RG6 6UB, UK
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3
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Schneider J, Schöttle T, Randecker D, Schwaibold H. [Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) : A rare urological emergency]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:929-935. [PMID: 37142812 DOI: 10.1007/s00120-023-02082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) is a rare, semi-acute disease in young, healthy men. In addition to an anatomical predisposition, perineal microtrauma is stated as the main risk factor. MATERIALS AND METHODS A case report and the results of a literature search with descriptive-statistical processing of 57 peer-reviewed publications are presented. A therapy concept was drawn up for clinical practice. RESULTS Our patient was treated conservatively and was consistent with the 87 cases which have been published since 1976. IPTCC is a disease of young men (33.2 years, range 18-70), which is associated with pain and perineal swelling in 88%. Sonography and contrast-enhanced magnetic resonance imaging (MRI) proved to be the diagnostic modality of choice, demonstrating the thrombus and in 89% a connective tissue membrane inside the corpus cavernosum. Treatment included antithrombotic and analgesic (n = 54, 62.1%), surgical (n = 20, 23%), analgesic (n = 8, 9.2%), via injection (n = 2, 2.3%), as well as radiological interventional (n = 1, 1.1%) options. In 12 cases, erectile dysfunction, mostly temporary, which required phosphodiesterase (PDE)-5 therapy developed. Recurrence and prolonged courses were rare. CONCLUSION IPTCC is a rare disease in young men. Conservative therapy with antithrombotic and analgesic treatment has shown good chances of full recovery. If relapse occurs or the patient refuses antithrombotic treatment, operative/alternative therapy management should be considered.
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Affiliation(s)
- J Schneider
- Klinikum am Steinenberg Reutlingen, Steinenbergstr. 31, 72764, Reutlingen, Deutschland.
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4
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Ocampo Flórez GM, Obando AC, García-Perdomo HA. Association between partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome: A scoping review. Andrology 2022; 10:844-851. [PMID: 35460544 DOI: 10.1111/andr.13190] [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: 09/09/2021] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
AIM To describe the association between partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome. METHODS An scoping review was performed according to the recommendations of the Joanna Briggs Institute. Moreover, we performed a search strategy using the MEDLINE, EMBASE, and CENTRAL databases. We included the available information, evaluating the conditions of partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome, and their molecular and physiological mechanisms and clinical presentation. RESULTS We identified 207 manuscripts and chose eight studies published between 2001 and 2021. The total number of patients was 34, and their mean age was 28.2 years. Moreover, in 84% of the studies, the pathophysiology of the events was related to microtrauma or prolonged perineal compression. Also, 94.2% of the patients had some degree of erectile dysfunction. In addition, out of all patients, 94% underwent magnetic resonance imaging (MRI). However, patients with hard flaccid syndrome did not show relevant findings in these studies. Conversely, MRIs showed asymmetry in the proximal corpora cavernosa, thrombosed corpus cavernosum segments, and mainly cavernous fibrous septum in patients with partial cavernous thrombosis and partial priapism. CONCLUSION Partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome occurred more frequently in young patients, possibly related to microtraumas that generate cavernous fibrosis and trigger alterations in the erection of the distal portion of the penis. Also, they cause proximal hardening pelvic, perineal pain, painful ejaculations, and cavernous asymmetry. Moreover, the imaging characteristics are similar in patients with partial priapism and partial cavernous thrombosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ginna Marcela Ocampo Flórez
- UROGIV Research Group, School of Medicine, University of Valle, Cali, Colombia.,Department of Urology, CES University, Medellín, Colombia
| | | | - Herney Andrés García-Perdomo
- UROGIV Research Group, School of Medicine, University of Valle, Cali, Colombia.,Division of Urology/Uro-oncology, Department of Surgery, School of Medicine, University of Valle, Cali, Colombia
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5
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Terkmane N, Van Glabeke E, Olicki JM, Andre MH, Benkhelifa AM, Mouheb M. [Partial thrombosis of the corpus cavernosum: A new case with good outcomes under non-steroidal anti-inflammatory drugs]. Prog Urol 2021; 31:503-505. [PMID: 33941456 DOI: 10.1016/j.purol.2021.03.007] [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: 05/06/2020] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
Partial priapism is a rare pathology with less than 60 cases published in the literature; the etiology remains unknown, although certain favorable factors are identified as having in relation a prolonged perineal compression or a thrombopathy. The symptomatology is characterized by the appearance of pain, perineal edema and an induration of the root of the penis, which do not concern the distal part of the penis or the glans. MRI is the best complementary examination. The first-line surgical treatment is abandoned. Medical treatment with non-steroidal anti-inflammatory drugs or low molecular weight heparins combined with platelet aggregation inhibitors give good results with complete resolution of symptoms in 82% of cases; first-line medical treatment should be favored. We report a case of idiopathic partial priapism, successfully treated with non-steroidal anti-inflammatory without recurrence after 10 years.
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Affiliation(s)
- N Terkmane
- Service d'urologie, Centre hospitalier intercommunal André-Grégoire, Montreuil, France; Fédération interhospitalière d'urologie de Seine Saint-Denis, Paris, France.
| | - E Van Glabeke
- Service d'urologie, Centre hospitalier intercommunal André-Grégoire, Montreuil, France; Fédération interhospitalière d'urologie de Seine Saint-Denis, Paris, France
| | - J-M Olicki
- Service de radiologie, Centre hospitalier intercommunal André-Grégoire, Montreuil, France
| | - M-H Andre
- Service de médecine interne, Centre hospitalier intercommunal André-Grégoire, Montreuil, France
| | - A M Benkhelifa
- Fédération interhospitalière d'urologie de Seine Saint-Denis, Paris, France
| | - M Mouheb
- Service d'urologie, Centre hospitalier intercommunal André-Grégoire, Montreuil, France; Fédération interhospitalière d'urologie de Seine Saint-Denis, Paris, France
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6
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Singh D, Larson T, Campbell K, Dennis M, Yeung L. Surgical Management of Idiopathic Partial Thrombosis of the Corpus Cavernosum. Sex Med 2021; 9:100273. [PMID: 33307340 PMCID: PMC7930853 DOI: 10.1016/j.esxm.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/12/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022] Open
Abstract
A 36-year-old African American man presented to the emergency department with 2 days of left-sided perineal pain after sexual activity. He was found to have induration in the left perineum overlying the proximal left corporal body. Clinical picture was suspicious for traumatic corporal rupture; however, advanced imaging showed a proximal segmental thrombosis of the left corpus cavernosum. The patient underwent perineal exploration with evacuation of an intracorporal penile hematoma. In spite of disrupting a fibrous membrane in the proximal corpora and drainage of the corpora, we observed repeat tumescence during the procedure because of an observed arterial high-flow state in the corpora cavernosum. This was resolved with administration of phenylephrine into the cavernosum. The patient had return of normal erectile function 2 days after the procedure with resolution of pain at the site. Singh D, Larson T, Campbell K, et al. Surgical Management of Idiopathic Partial Thrombosis of the Corpus Cavernosum. Sex Med 2021;9:100273.
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Affiliation(s)
- Danish Singh
- University of Florida College of Medicine, Gainesville, FL, USA.
| | - Troy Larson
- Department of Urology, University of Florida College of Medicine Gainesville, FL, USA
| | - Kevin Campbell
- Department of Urology, University of Florida College of Medicine Gainesville, FL, USA
| | - Michael Dennis
- Department of Urology, University of Florida College of Medicine Gainesville, FL, USA
| | - Lawrence Yeung
- Department of Urology, University of Florida College of Medicine Gainesville, FL, USA
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7
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Ali EA, Nashwan AJ, Yassin MA. Essential thrombocythemia with (type2) calreticulin presented as stuttering priapism case report and review of literature. Clin Case Rep 2021; 9:399-404. [PMID: 33489189 PMCID: PMC7813073 DOI: 10.1002/ccr3.3541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/16/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
Priapism is a rare presentation and complication of ET that might be underreported. In ET, priapism can present as an ischemic or stuttering type. These patients are more likely to be anemic and have a high platelet count.
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Affiliation(s)
| | | | - Mohamed A Yassin
- Hematology and Oncology DepartmentHamad Medical CorporationDohaQatar
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8
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Gomez Gomez E, Campos Hernandez JP, Cazalilla M, Triviño F, Barbudo J, Prieto R, Requena Tapia MJ. Partial thrombosis of the corpus cavernosum: should we dig deeper into coagulopathy disorders? Andrologia 2016; 48:1313-1316. [DOI: 10.1111/and.12572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- E. Gomez Gomez
- Department of Urology (IMIBIC); Reina Sofia University Hospital; University of Córdoba; Córdoba Spain
| | - J. P. Campos Hernandez
- Department of Urology (IMIBIC); Reina Sofia University Hospital; University of Córdoba; Córdoba Spain
| | - M. Cazalilla
- Department of Internal Medicine; Reina Sofia University Hospital; University of Córdoba; Córdoba Spain
| | - F. Triviño
- Department of Radiology; Reina Sofia University Hospital; University of Córdoba; Córdoba Spain
| | - J. Barbudo
- Department of Emergency; Reina Sofia University Hospital; University of Córdoba; Córdoba Spain
| | - R. Prieto
- Department of Urology (IMIBIC); Reina Sofia University Hospital; University of Córdoba; Córdoba Spain
| | - M. J. Requena Tapia
- Department of Urology (IMIBIC); Reina Sofia University Hospital; University of Córdoba; Córdoba Spain
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9
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Trombosis parcial segmentaria de cuerpo cavernoso: reporte de un caso, imágenes y factores de riesgo. Rev Int Androl 2016. [DOI: 10.1016/j.androl.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Weyne E, Schillebeeckx C, Jamaer C, D'Hulst P, Bozzini G, Grunert R, d'Hondt F, Hoebeke P, Müller A, Van Renterghem K, Joniau S, Albersen M. Idiopathic Partial Thrombosis (IPT) of the Corpus Cavernosum: A Hypothesis-Generating Case Series and Review of the Literature. J Sex Med 2015; 12:2118-25. [PMID: 26553854 DOI: 10.1111/jsm.13036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Emmanuel Weyne
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Caroline Jamaer
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Pieter D'Hulst
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Giorgio Bozzini
- Department of Urology, Humanitas Mater Domini, Humanitas University, Castellanza, Italy
| | - Richard Grunert
- Division of Urology, Department of Surgery, University of Vermont College of Medicine, Burlington, VT, USA
| | | | - Piet Hoebeke
- Department of Urology, Gent University Hospital, Ghent, Belgium
| | - Alexander Müller
- Clinic of Urology, Universitats Spital Zürich, Zürich, Zwitserland
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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11
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Cooper MA, Carrion RE, Yang C. Partial Priapism Treated with Pentoxifylline. Int Braz J Urol 2015; 41:804-7. [PMID: 26401875 PMCID: PMC4757011 DOI: 10.1590/s1677-5538.ibju.2014.0363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/18/2014] [Indexed: 11/22/2022] Open
Abstract
MAIN FINDINGS A 26-year-old man suffering from partial priapism was successfully treated with a regimen including pentoxifylline, a nonspecific phosphodiesterase inhibitor that is often used to conservatively treat Peyronie's disease. CASE HYPOTHESIS: Partial priapism is an extremely rare urological condition that is characterized by thrombosis within the proximal segment of a single corpus cavernosum. There have only been 36 reported cases to date. Although several factors have been associated with this unusual disorder, such as trauma or bicycle riding, the etiology is still not completely understood. Treatment is usually conservative and consists of a non-steroidal anti-inflammatory and anti-thrombotic. Promising future implications: This case report supports the utilization of pentoxifylline in patients with partial priapism due to its anti-fibrogenic and anti-thrombotic properties.
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Affiliation(s)
- Meghan A. Cooper
- Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Rafael E. Carrion
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Christopher Yang
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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12
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Sauer S, Goltz JP, Gassenmaier T, Kunz AS, Bley TA, Klein D, Petritsch B. Partial segmental thrombosis of the corpus cavernosum (PSTCC) diagnosed by contrast-enhanced ultrasound: a case report. BMC Urol 2014; 14:100. [PMID: 25515840 PMCID: PMC4289566 DOI: 10.1186/1471-2490-14-100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/11/2014] [Indexed: 11/23/2022] Open
Abstract
Background Partial segmental thrombosis of the corpus cavernosum (PSTCC) is a rare disease predominantly occurring in young men. Cardinal symptoms are pain and perineal swelling. Although several risk factors are described in the literature, the exact etiology of penile thrombosis remains unclear in most cases. MRI or ultrasound (US) is usually used for diagnosing this condition. Case presentation We report a case of penile thrombosis after left-sided varicocele ligature in a young patient. The diagnosis was established using contrast-enhanced ultrasound (CEUS) and was confirmed by contrast-enhanced magnetic resonance imaging (ceMRI). Successful conservative treatment consisted of systemic anticoagulation using low molecular weight heparin and acetylsalicylic acid. Conclusion PSTCC is a rare condition in young men and appears with massive pain and perineal swelling. In case of suspected PSTCC utilization of CEUS may be of diagnostic benefit.
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Affiliation(s)
| | | | | | | | | | | | - Bernhard Petritsch
- University Hospital Würzburg, Institute of Diagnostic and Interventional Radiology, Oberdürrbacher Str, 6, 97080 Würzburg, Germany.
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13
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Kropman RF, Schipper J. Hematoma or “Partial Priapism” in the Proximal Part of the Corpus Cavernosum. J Sex Med 2014; 11:2618-22. [DOI: 10.1111/jsm.12388] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Pediatric penile pain secondary to idiopathic arterial thrombosis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Abstract
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.
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Affiliation(s)
- Peter Hoyerup
- Department of Urology, Roskilde Hospital, Roskilde, Denmark
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16
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Hulth M, Albersen M, Fode M, Peeters K, Ramskov KL, Joniau S, Bisbjerg R, Sønksen J. Idiopathic partial thrombosis of the corpus cavernosum: aetiology, diagnosis and treatment. Scand J Urol 2012; 47:163-8. [PMID: 22762201 DOI: 10.3109/00365599.2012.698305] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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17
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Ilicki J, Krauss W, Andersson SO. Partial segmental thrombosis of the corpus cavernosum: a case report and a review of the literature. Urology 2012; 79:708-12. [PMID: 22386425 DOI: 10.1016/j.urology.2011.11.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 11/15/2011] [Accepted: 11/19/2011] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Jonathan Ilicki
- Department of Urology, Örebro University Hospital and Örebro University, Örebro, Sweden.
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18
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Patel RP, Mucksavage P, Ramchandani P, Hanno PM, Malkowicz SB. Idiopathic Partial Thrombosis of the Corpus Cavernosum. Urology 2010; 76:1373-4. [DOI: 10.1016/j.urology.2009.12.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 11/25/2009] [Accepted: 12/29/2009] [Indexed: 11/27/2022]
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Kilinc M, Piskin M, Guven S, Gurbuz R, Odev K, Kaynar M. Partial priapism secondary to tamsulosin: a case report and review of the literature. Andrologia 2009; 41:199-201. [DOI: 10.1111/j.1439-0272.2008.00908.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Asbach P, Oelrich B, Haase O, Lenk SV, Loening SA. Acute partial segmental thrombosis of the corpus cavernosum: imaging findings on ultrasound, computed tomography, and magnetic resonance imaging. Clin Imaging 2008; 32:400-2. [DOI: 10.1016/j.clinimag.2008.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 02/04/2008] [Indexed: 10/21/2022]
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Blaut S, Schneider M, Zschuppe E, Günl U, Steinbach F. Partielle einseitige Schwellkörperthrombose bei Homozysteinämie. Urologe A 2008; 47:748-52. [DOI: 10.1007/s00120-008-1650-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dubois F, Lesur G, Azzouzi AR, Beurrier P, Chautard D. Thrombose partielle du corps caverneux. Faut-il rechercher systématiquement une anomalie de la coagulation ? Prog Urol 2007; 17:866-8. [PMID: 17634004 DOI: 10.1016/s1166-7087(07)92310-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The authors report a case of partial thrombosis of a corpus cavernosum, confirmed by MRI imaging. In this patient, a neuroleptic had been prescribed several days before the thrombosis and the clotting assessment demonstrated protein C resistance. Conservative management comprising low molecular weight heparin and aspirin was instituted. Three months later, pain had resolved and signs of a thrombotic scar persisted on MRI. The aetiology of thrombosis of the corpus cavernosum, a rare disease, remains unknown. Neuroleptic therapy has been incriminated. In the light of this case, the authors emphasize the value of systematic clotting assessment.
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Al-Mufarrej F, Kamel MH, Mohan P, Hickey D. Tricorporal priapism postradical cystoprostatectomy: First sign of recurrent urogenital malignancy. Int J Urol 2006; 13:460-2. [PMID: 16734875 DOI: 10.1111/j.1442-2042.2006.01333.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Priapism usually involves the whole length of a corpus or two corpora. Rarely is priapism segmental, especially proximally, and seldomly does it involve all three corpora. The causes of priapism are varied, but priapism due to solid malignancy is an extremely uncommon entity. The usual malignancy is urogenital. The disorder is frequently a manifestation of extensive pelvic extension of the primary disease; less commonly, it is associated with pelvic recurrence after seemingly curative surgery. In cases of malignant recurrence, priapism is rarely the first sign of such recurrence. We report a case of proximal tricorporal priapism, secondary to penile metastasis of a bladder malignancy postradical cystoprostatectomy. In this case, priapism was the first sign of disease recurrence and occurred in the absence of pelvic recurrence. This is the first such report of which we are aware.
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Affiliation(s)
- Faisal Al-Mufarrej
- Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland
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Horger DC, Wingo MS, Keane TE. Partial segmental thrombosis of corpus cavernosum: Case report and review of world literature. Urology 2005; 66:194. [PMID: 15921728 DOI: 10.1016/j.urology.2005.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Revised: 12/20/2004] [Accepted: 01/07/2005] [Indexed: 11/21/2022]
Abstract
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.
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Affiliation(s)
- David C Horger
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
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Goeman L, Joniau S, Oyen R, Claes H, Van Poppel H. Idiopathic partial thrombosis of the corpus cavernosum: conservative management is effective and possible. Eur Urol 2003; 44:119-23. [PMID: 12814686 DOI: 10.1016/s0302-2838(03)00217-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Lieven Goeman
- UZ Gasthuisberg Leuven, Department of Urology, Herestraat 49, 3000 Leuven, Belgium
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