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Masuda Y, Shikata H, Sawachika H, Kaneko M. Priapism as an initial manifestation in an adult patient with chronic myeloid leukemia in Japan: case report and review of the literature. Int Cancer Conf J 2024; 13:289-295. [PMID: 38962033 PMCID: PMC11217260 DOI: 10.1007/s13691-024-00680-8] [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: 02/08/2024] [Accepted: 04/01/2024] [Indexed: 07/05/2024] Open
Abstract
We report the first documented Japanese case in the English literature of chronic myeloid leukemia (CML) in which priapism was the presenting symptom. Priapism, a rare manifestation in CML patients, is particularly uncommon in Japan. This can be attributed to the high quality of medical services and proactive health strategies implemented by the Japanese government. These strategies include recommending regular blood tests for company employees aged 35 and above, thereby facilitating early detection of CML. Hence, it is crucial to consider CML when examining any patient presenting with priapism, particularly among those who have not undergone regular medical check-ups.
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Affiliation(s)
- Yuya Masuda
- Department of Hematology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime 798-8510 Japan
| | - Hisaharu Shikata
- Department of Hematology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime 798-8510 Japan
| | - Hiroshi Sawachika
- Department of Hematology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime 798-8510 Japan
| | - Masahiko Kaneko
- Department of Hematology, Uwajima City Hospital, 1-1 Goten-machi, Uwajima, Ehime 798-8510 Japan
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2
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van der Velde MGAM, Tiellemans SMB, de Lil H, Nieuwenhuizen L. The value of leukapheresis for treatment of priapism as presenting feature of chronic myeloid leukemia-Case report and review of literature. EJHAEM 2022; 3:1100-1115. [PMID: 36467799 PMCID: PMC9713041 DOI: 10.1002/jha2.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 06/17/2023]
Abstract
Priapism is a rare presenting feature of chronic myeloid leukemia (CML) in male patients. Treatment aims to relieve symptoms and to prevent erectile dysfunction. Several treatment modalities exist, however no standard treatment is recommended. We evaluated literature concerning different treatment approaches and evaluate the value of leukapheresis in treatment of priapism. The literature search resulted in 57 included articles, consisting of 53 studied patients. Patients had a mean age of 25.3 years, average time from onset to presentation at the hospital was 2 days, and mean white blood cell (WBC) count was 344 × 109/L. Most patients (67.9%) were treated with a combined approach (different modalities were radiological, urological, and oncological treatment). Twelve patients, with a mean WBC count of 365 × 109/L, received leukapheresis. Only two of them reported erectile dysfunction after treatment. Priapism is an urological emergency requiring urgent multidisciplinary treatment. We highlight the importance of local urological therapy combined with systemic therapy for CML. Therapeutic leukapheresis should be applied when available and with no other contraindications.
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Affiliation(s)
- Marleen G. A. M. van der Velde
- Department of Internal MedicineMáxima MCVeldhoven/EindhovenThe Netherlands
- Department of Health Services ResearchCAPHRI School for Public Health and Primary CareAging and Long Term Care, MaastrichtLimburgThe Netherlands
| | | | - Heleen de Lil
- Department of Internal MedicineMáxima MCVeldhoven/EindhovenThe Netherlands
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3
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Bintoro SUY, Romadhon PZ, Suryantoro SD, Aminy RZ, Windradi C, Widiyastuti KN. Case Report: Priapism as The Clinical Presenting Feature of Chronic Myeloid Leukemia: Case Report and 20-Year Literature Review. F1000Res 2022; 10:571. [PMID: 35087660 PMCID: PMC8762679 DOI: 10.12688/f1000research.53365.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/25/2022] Open
Abstract
Priapism in chronic myeloid leukemia (CML) appears to be an infrequent manifestation as well as a crucial emergency. Here, we report an 18-year-old male presenting with a persistent erection of the penis for 20 days. We evaluated and compared the reported cases within 20 years discussing the management of priapism in CML. Cytoreductive therapy followed by leukapheresis, the administration of tyrosine kinase inhibitor, and intra-cavernosal blood aspiration may resolve the symptoms of priapism. Early intervention for cytoreduction and aspiration are the pivotal keys to successfully impeding the complications.
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Affiliation(s)
- Siprianus Ugroseno Yudho Bintoro
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia.,General Teaching Hospital Dr. Soetomo, Surabaya, East Java, 60286, Indonesia
| | - Pradana Zaky Romadhon
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia.,General Teaching Hospital Dr. Soetomo, Surabaya, East Java, 60286, Indonesia
| | - Satriyo Dwi Suryantoro
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia.,Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
| | - Rusdi Zakki Aminy
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia
| | - Choirina Windradi
- Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia
| | - Krisnina Nurul Widiyastuti
- Department of Internal Medicine, Airlangga University, Faculty of Medicine, Surabaya, East Java, 60131, Indonesia
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4
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Sossa Melo CL, Orozco Orozco CA, Peña Castellanos AM, Rueda Perea MA, Porras Bueno CO, Romero Diaz CI, Rojas Rodríguez HN. Priapism as the first manifestation in chronic myeloid leukemia: A case report and focused review of literature. Clin Case Rep 2021; 9:e04901. [PMID: 34824846 PMCID: PMC8603417 DOI: 10.1002/ccr3.4901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022] Open
Abstract
We report the case of a patient who was initially presented with ischemic priapism to the emergency department. He was treated with adrenaline intracavernous injections and aspiration with irrigation of the corpora cavernosa and distal shunt. In the postoperative period, anemia, basophilia, eosinophilia, thrombocytosis and hyperleukocytosis were detected. The patient was subsequently diagnosed with chronic myeloid leukemia. Priapism is a rare manifestation of chronic myeloid leukemia (≤ 3%) and occurs mostly due to hyperleukocytosis, resulting in thrombus formation and corporal venous outflow obstruction. Priapism occurring in any setting is considered as a medical emergency that requires immediate local therapy because of resulting irreversible cell damage and fibrosis if not treated within the first 24-48 h.
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Affiliation(s)
- Claudia Lucia Sossa Melo
- Servicio de Hemato‐oncologíaFundación Oftalmológica de SantanderFacultad Ciencias de la SaludUniversidad Autónoma de BucaramangaBucaramangaColombia
| | - Carlos Alberto Orozco Orozco
- Servicio de Hemato‐oncologíaFundación Oftalmológica de SantanderPrograma para el Tratamiento y Estudio de Enfermedades Hematológicas y Oncológicas de Santander – PROTEHOSBucaramangaColombia
| | - Angela Maria Peña Castellanos
- Servicio de Hemato‐oncologíaFundación Oftalmológica de SantanderPrograma para el Tratamiento y Estudio de Enfermedades Hematológicas y Oncológicas de Santander – PROTEHOSBucaramangaColombia
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5
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Ali E, Soliman A, De Sanctis V, Nussbaumer D, Yassin M. Priapism in Patients with Chronic Myeloid Leukemia (CML): A Systematic Review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021193. [PMID: 34212918 PMCID: PMC8343736 DOI: 10.23750/abm.v92i3.10796] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Abstract
Background: Priapism is defined as a penile erection that persists four or more hours and is unrelated to sexual stimulation. Priapism resulting from hematologic malignancy is most likely caused by venous obstruction from microemboli/thrombi and hyperviscosity caused by the increased number of circulating leukocytes in mature and immature forms. In patients with leukemia, 50% of cases of priapism are due to Chronic Myeloid Leukemia (CML). We present a systematic review of priapism in CML. Acquisition of evidence: An extensive literature research was carried out in PubMed, Google Scholar, SCOPUS, and Science Citation Index databases. The search included cases up to 4th August 2020. Synthesis of evidence: A total of 68 articles were found and included in our review, including 3 reviews from three different centers. We found 68 articles (102 patients; figure 1) and several case reports on priapism in CML. Priapism was noticed in some patients at the first presentation of CML. However, it was infrequently reported during the start of treatment, following the stop of medication and post-splenectomy. The mean age at presentation was 27.4 years, and the mean time from onset of priapism to the time to get medical attention (presentation) was 78.2 hours. The mean white blood cell count associated with priapism was 321.29x109/L, and the mean platelet count was 569 x10 9/L. The chronic phase of CML was the most common phase where priapism occurred. Most patients were Asian (>50%). Nearly a quarter of patients (27.4%) developed permanent erectile dysfunction. Conclusions: Priapism is a urological emergency requiring urgent multidisciplinary management to prevent erectile dysfunction. Because of the relatively rare occurrence of priapism in CML patients, there is no standard treatment protocol. (www.actabiomedica.it)
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Affiliation(s)
| | | | - Vincenzo De Sanctis
- Coordinator of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A), Ferrara, Italy.
| | | | - Mohamed Yassin
- Medical Oncology, Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
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6
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Marcu D, Iorga L, Mischianu D, Bacalbasa N, Balescu I, Bratu O. Malignant Priapism - What Do We Know About It? In Vivo 2020; 34:2225-2232. [PMID: 32871745 DOI: 10.21873/invivo.12033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022]
Abstract
Malignancy as an etiological factor involved in priapism pathogenesis is rare. Malignant priapism (MP) can arise as a result of penile tumor invasion, either from primary penile tumors or from metastatic penile tumors, or due to hematological malignancies. Non-urological penile metastases are associated with significant worse prognosis compared to urological penile metastases, the appearance of priapism in such cases affecting even more the prognosis and the survival of these patients. Patients diagnosed with hematological malignancies and priapism present significant higher survival rates compared to those who develop MP in the context of a non-hematological malignancy, this being related to the fact that hematological malignancies are more sensitive to chemo- and radiotherapy. Most malignant priapism cases are ischemic; therefore the management should be based on the initial steps of the IP therapeutic protocol. Considering the trigger factor that has led to the priapic event specific oncologic treatment can be added as well.
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Affiliation(s)
- Dragos Marcu
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Lucian Iorga
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania
| | - Dan Mischianu
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Academy of Romanian Scientists, Bucharest, Romania
| | - Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania .,Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | | | - Ovidiu Bratu
- Clinic of Urology, University Emergency Central Military Hospital "Dr. Carol Davila", Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Academy of Romanian Scientists, Bucharest, Romania
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7
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Qu M, Lu X, Wang L, Liu Z, Sun Y, Gao X. Priapism secondary to chronic myeloid leukemia treated by a surgical cavernosa-corpus spongiosum shunt: Case report. Asian J Urol 2018; 6:373-376. [PMID: 31768325 PMCID: PMC6872760 DOI: 10.1016/j.ajur.2018.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/30/2018] [Accepted: 09/26/2018] [Indexed: 11/26/2022] Open
Abstract
Priapism secondary to chronic myeloid leukemia (CML) is rarely observed in the clinic. Here, we present an 18-year-old patient with priapism for over 72 h due to hyperleukocytosis. Emergent interventions such as therapeutic aspiration and intracorporal injection of phenylephrine failed before a surgical corpora cavernosa-corpus spongiosum shunt was inserted to relieve symptoms. During hospitalization, bone marrow aspiration confirmed the diagnosis of CML.
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Affiliation(s)
- Min Qu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xin Lu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lei Wang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiyong Liu
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, China
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8
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Sun HH, Zhang JH, DeWitt-Foy M, Waldron M, Mukherjee S, Montague DK. Urologic Management of Priapism Secondary to Chronic Myeloid Leukemia. Urology 2018; 125:24-28. [PMID: 30471371 DOI: 10.1016/j.urology.2018.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Helen H Sun
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jj Haijing Zhang
- Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, OH.
| | - Molly DeWitt-Foy
- Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, OH
| | - Madeline Waldron
- Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, OH
| | - Sudipto Mukherjee
- Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, OH
| | - Drogo K Montague
- Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, OH
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9
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Becerra-Pedraza LC, Jiménez-Martínez LE, Peña-Morfin I, Nava-Esquivel R, Villegas-Martínez JA. Priapism as the initial sign in hematologic disease: Case report and literature review. Int J Surg Case Rep 2018; 43:13-17. [PMID: 29414500 PMCID: PMC5907689 DOI: 10.1016/j.ijscr.2017.12.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Priapism is an uncommon sign and sometimes considered a diagnosis challenge into systemic disease; this is defined as ≥4 h continuous penile erection, without sexual stimulation. We state that this work has been reported in line with the SCARE criteria PRESENTATION OF CASE: A Mexican 52-year-old man was brought to the emergency room with priapism of six days of evolution. His medical history reported fatigue and waxy pallor had begun a month ago, the rest of interrogation was unremarked. Hyperleukocitosis (>250,000 cells/ml) was documented on his preoperative evaluation, the initial step was hematology consultation due to malignance suspicion, followed by corpora cavernosa drainage-irrigation and surgery penis shunts. After of procedure, we realized bone marrow aspiration, kariotype and cytogenetic analysis, histopathological and moleculars assay reported myeloid hyperplasia compatible with acute phase CML and Philadelphia translocation t(9:22) (q34;q11.2) with P210 BCR-ABL1 fusion transcriber, patient was discharged with dasatinib for maintenance phase. Actually, he has a satisfactory evolution without relapses. DISCUSSION The majority of reported cases shows the individual importance of hematological diseases in priapism as it is shown in the analysis of the literature of 10 years (2006-2016) that we made. It is imperative to consider the type of priapism, and the genetic and demographic patient aspects due to the early and correct approach improves the short and long term outcome of the hematological patients. CONCLUSION Priapism is an uncommon sign of systemic disease. In the presence of warning signs, malignancy should be considered until proven otherwise.
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Affiliation(s)
| | | | - Iran Peña-Morfin
- Department of Surgery, IMSS HGZ/MF 1, La Paz Baja California Sur, México
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Shaeer OKZM, Shaeer KZM, AbdelRahman IFS, El-Haddad MS, Selim OM. Priapism as a result of chronic myeloid leukemia: case report, pathology, and review of the literature. J Sex Med 2015; 12:827-34. [PMID: 25630365 DOI: 10.1111/jsm.12812] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Priapism is rare-presenting feature in male patients with chronic myeloid leukemia (CML). Several hypotheses for pathogenesis have been described. Management has been controversial; some authors described resolution following priapism-specific interventions, and others recommended addition of CML-specific therapy or even CML-specific therapy alone. AIM In this report, we describe presentation and management of a man with refractory priapism that was the first presenting manifestation of CML. We also report, for the first time, the pathology sections of the sinusoidal tissue in such cases. Literature is reviewed for similar cases and their outcome. METHODS A 21-year-old male patient presented with painful priapism that started 6 days earlier and failed aspiration-irrigation. CBC revealed marked leucocytosis. Oncology care diagnosed CML, and treatment with Imatinib was commenced with prior semen cryopreservation. Following remission, a penile prosthesis was implanted, assisted by optical corporotomy. Sinusoidal tissue biopsy was stained by hematoxylin/eosin (H&E) and CD34. MAIN OUTCOME MEASURES Pathology sections of cavernous tissue following CML-induced priapism. RESULTS The penile implant survived without complications. H&E examination of the sinusoidal tissue biopsy revealed leukemic infiltration associated with vascular endothelial damage. CD34 staining showed the mixed picture of leukemic infiltrates, intact vascular endothelium with lumena showing leukemic cells, alternating with destroyed vessels, and no vascular lumena and ruminants of endothelial cells. CONCLUSION Priapism can be the first manifestation of previously undetected CML. The pathological picture of sinusoidal tissue in such cases is presented. In the case at hand, a complete blood picture was helpful in early diagnosis of CML and early initiation of targeted chemotherapy along with the corporal irrigation/aspiration or shunt surgery. It is therefore recommended to have a CBC examined at presentation of any case of ischemic priapism of unknown etiology, early initiation of CML therapy along with aspiration/irrigation, preferably cryopreserving a semen sample before CML therapy.
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Rodgers R, Latif Z, Copland M. How I manage priapism in chronic myeloid leukaemia patients. Br J Haematol 2012; 158:155-164. [PMID: 22571386 DOI: 10.1111/j.1365-2141.2012.09151.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Ryan Rodgers
- Bone Marrow Transplant Unit; Beatson West of Scotland Cancer Centre; Gartnavel General Hospital; Glasgow
| | - Zak Latif
- Department of Urology; Royal Alexandra Hospital; Paisley
| | - Mhairi Copland
- Bone Marrow Transplant Unit; Beatson West of Scotland Cancer Centre; Gartnavel General Hospital; Glasgow
- Paul O'Gorman Leukaemia Research Centre; Institute of Cancer Sciences; College of Medical, Veterinary and Life Sciences; University of Glasgow; Glasgow UK
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12
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Shrewsberry A, Weiss A, Ritenour CWM. Recent advances in the medical and surgical treatment of priapism. Curr Urol Rep 2010; 11:405-13. [PMID: 20878277 DOI: 10.1007/s11934-010-0142-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Priapism often is a urological emergency that requires prompt and aggressive therapy. Over the past several years, research has provided better understanding and new insights into the pathophysiology of this disorder. Subsequently, new treatments have been tried and developed. This report focuses on the latest review of therapy for ischemic and nonischemic priapism.
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Affiliation(s)
- Adam Shrewsberry
- Department of Urology, Emory University School of Medicine, Atlanta, GA 30322, USA
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