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Carnicelli D, Bondil P, Habold D. Priapisme veineux aigu aux urgences : procédure fondée sur une revue systématique de la littérature. ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le priapisme veineux aigu (PVA) est urgent en raison de séquelles érectiles éventuelles. Sa rareté et l’absence de procédure expliquent des traitements encore inégaux, peu normés.
Objectif : Optimiser la prise en charge initiale d’un PVA grâce à une procédure décisionnelle, adaptée aux urgentistes.
Matériel et méthode : Une revue systématique de la littérature recense les algorithmes schématisés ainsi que des articles de revue et mises au point récents. Les critères diagnostiques et thérapeutiques ont été analysés puis comparés pour vérifier s’ils répondaient aux besoins. La validation de cette procédure par des experts a été recherchée. Résultats : L’originalité de notre procédure réside dans sa cible (urgentistes), sa hiérarchisation, « Que faire ? Comment faire ? Quand faire ? Qui fait ? », de façon graduée et séquentielle via une chronologie détaillée, et une priorité donnée à la gazométrie caverneuse, fil conducteur de la prise en charge, facilement disponible. À cela s’ajoutent des tableaux, des check-lists (contexte étiologique et souffrance ischémique), des schémas descriptifs des traitements médicaux indiqués en première ligne (technique, matériel de ponction décompressive et d’injection intracaverneuse d’alpha-stimulant), critères de recours à l’urologue, suivi et hospitalisation. Cette procédure a été validée par le conseil scientifique du réseau nord-alpin des Urgences, le comité d’andrologie et médecine sexuelle de l’Association française d’urologie.
Conclusion : Facile à utiliser, cette procédure inédite répond à un réel besoin. Son appropriation et sa diffusion s’inscrivent dans une démarche qualité adaptée au parcours de soins du PVA en France afin de prévenir les séquelles érectiles de cette urgence affectant majoritairement des sujets jeunes.
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Kumar M, Garg G, Sharma A, Pandey S, Singh M, Sankhwar SN. Comparison of outcomes in malignant vs. non-malignant ischemic priapism: 12-year experience from a tertiary center. Turk J Urol 2019; 45:340-344. [PMID: 30817276 DOI: 10.5152/tud.2019.75044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Data on outcome of patients with ischemic priapism (IP) due to malignant causes are scant. In this study, we compared outcome of patients with malignant vs. non-malignant IP in adult North Indian men. MATERIAL AND METHODS We analyzed medical records of patients with IP who presented to a large tertiary care referral center from August 2005 to July 2017. RESULTS Data of 71 patients were analyzed. The median age was 30 years (range 17-65). The average duration of symptoms was 4.39 days (range 1-10). Most common etiology was idiopathic in 29 (40.84%), chronic myeloid leukemia (CML) in 24 (33.80%), and drug-induced in 15 patients. Thirty-eight patients underwent distal shunts, while nine patients underwent proximal shunt procedure. Men with malignant priapism (CML) had significantly lower success rates with interventions, prolonged hospital stay, and higher complications (p<0.05). Most complications after shunt surgery were minor (Clavein grade 1 and 2). After shunt surgery, bleeding at shunt site was observed in 14 cases, and wound infection developed in five patients. Prevalence of erectile dysfunction in patients at follow-up was high. CONCLUSION Men with malignant priapism (CML) had significantly lower success rates with interventions, prolonged hospital stay, and higher complications than men with non-malignant priapism.
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Affiliation(s)
- Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, India
| | - Gaurav Garg
- Department of Urology, King George's Medical University, Lucknow, India
| | - Ashish Sharma
- Department of Urology, King George's Medical University, Lucknow, India
| | - Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, India
| | - Manmeet Singh
- Department of Urology, King George's Medical University, Lucknow, India
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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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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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Mean velocity and peak systolic velocity can help determine ischaemic and non-ischaemic priapism. Clin Radiol 2017; 72:611.e9-611.e16. [DOI: 10.1016/j.crad.2017.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/01/2017] [Accepted: 02/28/2017] [Indexed: 11/18/2022]
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Ridgley J, Raison N, Sheikh MI, Dasgupta P, Khan MS, Ahmed K. Ischaemic priapism: A clinical review. Turk J Urol 2017; 43:1-8. [PMID: 28270944 PMCID: PMC5330261 DOI: 10.5152/tud.2017.59458] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/06/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Ischaemic priapism is a rare condition characterised by little or no cavernosal blood flow, pain and rigidity of the penis. Immediate intervention is required to restore blood flow, prevent necrosis and erectile dysfunction. This review was conducted to determine the best course of treatment and identify areas in current guidelines to which improvements could be made. MATERIAL AND METHODS PubMed, Ovid, MEDLINE (1946-December 2016) and the Cochrane Library were searched as sources for literature. Key studies in each of the areas of management were identified and analysed. RESULTS A total of 45 articles were reviewed. The first step in treatment should be aspiration of corporeal blood. Further studies are needed to make firm recommendations as to whether irrigation should follow, as currently literature is inconclusive. If this fails to cause detumescence, sympathomimetics should be injected. The sympathomimetic of choice is phenylephrine as it is effective, specific and causes minimal cardiovascular side effects. It should be injected at a concentration of 100-500 μg/mL, with 1 mL being injected every 3-5 minutes for up to an hour (maximum 1mg in an hour). Surgical shunting is the next step, except in the cases of delayed priapism (48-72 hours duration) where immediate penile prosthesis insertion may be considered more appropriate. Distal shunts should be performed first, followed by proximal ones to minimise damage leading to erectile dysfunction. There exists little evidence recommending one shunting procedure over another. The final intervention is insertion of a penile prosthesis. Literature suggests that an inflatable prosthesis inserted immediately will yield the greatest patient satisfaction. CONCLUSION A review of the literature has highlighted areas in which further research needs to be done to make conclusive recommendations, including whether irrigation should accompany aspiration and efficacy of shunting procedures. Further studies are required to ensure that patients receive the treatment most likely to cause detumescence and maintain erectile function.
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Affiliation(s)
- Joanne Ridgley
- GKT School of Medicine, King’s College London, London, UK
| | - Nicholas Raison
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
| | | | - Prokar Dasgupta
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
| | - M. Shamim Khan
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
| | - Kamran Ahmed
- Urology Department, Guy’s Hospital, Guy’s and St Thomas Trust, London, UK
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Sekerci CA, Akbal C, Sener TE, Sahan A, Sahin B, Baltacioglu F, Simsek F. Resistant pediatric priapism: A real challenge for the urologist. Can Urol Assoc J 2015; 9:E562-4. [PMID: 26609335 DOI: 10.5489/cuaj.2952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Priapism in pediatric patients is a rare entity. We present an 8-year-old boy with known cerebral palsy. He came to the emergency department with sustained painful erection for 12 hours. Physical examination showed rigid penis. Blood count and biochemical analysis were normal. Although penile Doppler ultrasound revealed normal arterial and venous flow, cavernosal blood gas was hypoxic. A total of 50 mL of dark blood was aspirated, and 2 mL of 0.001% adrenalin solution was applied to both corpus cavernosum, twice within 20 minutes, which eventually did not achieve detumescence. A distal Winter shunt was performed at the end of which the penis was semi-flaccid. By the 18th hour of surgery, the penis re-gained painful erection status, so an Al-Ghorab shunt was performed. After the Al-Ghorab shunt, the penis was still in the semi-flaccid state. The next day, an angiography was performed and an arteriovenous fistula was discovered and treated by embolization. The flaccid state was achieved and the patient was discharged the day after the embolization.
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Affiliation(s)
| | - Cem Akbal
- Marmara University, School of Medicine, Department of Urology, Turkey
| | - Tarik Emre Sener
- Marmara University, School of Medicine, Department of Urology, Turkey
| | - Ahmet Sahan
- Marmara University, School of Medicine, Department of Urology, Turkey
| | - Bahadir Sahin
- Marmara University, School of Medicine, Department of Urology, Turkey
| | | | - Ferruh Simsek
- Marmara University, School of Medicine, Department of Urology, Turkey
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Trost L, Hellstrom WJG. History, Contemporary Outcomes, and Future of Penile Prostheses: A Review of the Literature. Sex Med Rev 2015; 1:150-163. [PMID: 27784554 DOI: 10.1002/smrj.8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Since their introduction, penile prostheses have consistently remained a superior treatment option for men with erectile dysfunction (ED) refractory to conservative measures. Ongoing enhancements to prosthetic design, materials, and surgical techniques have resulted in improved outcomes. AIM To review available literature on notable historical advancements and improvements of the penile prosthesis, summarize contemporary outcomes of recent devices, and discuss possible future directions of the penile prosthesis. METHODS A PubMed search was performed of all articles published from 1960 to present relating to penile prosthesis. Priority was given to series with 12 months of follow-up or greater, larger series, and studies reporting on outcomes of more recent prosthetic models. MAIN OUTCOME MEASURES Main outcomes included historical review of improvements leading to, and contemporary series reporting on rates of mechanical failures, infections, and satisfaction with penile prostheses. RESULTS Penile prostheses have undergone numerous enhancements since initial reports of synthetic materials utilized in the 1950s. Among others, recent notable device enhancements include Parylene coating, Bioflex® material, InhibizoneTM antibacterial impregnation, hydrophilic coating, lockout valves, and easy release pump mechanisms, all of which have improved mechanical reliability, reduced infection rates, and/or improved patient satisfaction with penile prostheses. Contemporary series of 3-piece penile prostheses report mechanical survival of 81-94%, 68-89%, and 57-76% at 5, 10, and 15 years, respectively. Infection rates of current devices are 1-2% in first-time, low-risk populations, and 2-3% for higher risk groups, with patient and partner satisfaction at 92-100% and 91-95%, respectively. Two-piece and malleable devices are associated with slightly higher mechanical reliability and decreased patient satisfaction. Minimal data currently exist on the outcomes of selected patient populations, including Peyronie's disease and corporal fibrosis. CONCLUSIONS Penile prostheses are associated with excellent, long-term outcomes and remain the gold-standard treatment for men with refractory ED. Additional research with prospective studies utilizing objective measures and standardized questionnaires is required. Trost L and Hellstrom WJG. History, contemporary outcomes, and future of penile prostheses: A review of the literature. Sex Med Rev 2013;1:150-163.
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Affiliation(s)
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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Zacharakis E, De Luca F, Raheem AA, Garaffa G, Christopher N, Muneer A, Ralph DJ. Early insertion of a malleable penile prosthesis in ischaemic priapism allows later upsizing of the cylinders. Scand J Urol 2015; 49:468-471. [PMID: 26116193 DOI: 10.3109/21681805.2015.1059359] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Early insertion of a penile prosthesis in prolonged ischaemic priapism is easier to perform than late prosthesis placement, and preserves the penile length. The aim of this study was to assess whether a delayed exchange to an inflatable implant allows upsizing of the cylinders in patients who have undergone early insertion for refractory ischaemic priapism. MATERIALS AND METHODS Over a 30 month period, 10 patients with ischaemic priapism underwent an early insertion of a malleable penile prosthesis. The mean age was 41.3 years and the mean duration of priapism was 188 h. Following a median period of 130.5 days, all of these patients underwent exchange of the malleable to an inflatable prosthesis. RESULTS At the time of penile implant exchange, a median upsize in the length of the cylinders of 1 cm in either one or both corporal bodies (range 0-3 cm) was recorded. Five patients had deliberate downsizing at the initial operation owing to a previous shunt. The mean score on the five-item International Index of Erectile Function (IIEF-5) before insertion of the malleable prosthesis was 24 (range 20-25). Three months after the initial insertion of a malleable penile implant the satisfaction rate according to the IIEF-5 score was 80%. Three months after the exchange, the patient satisfaction rate increased to 90%. CONCLUSION Insertion of a malleable penile prosthesis is an acceptable option for patients with refractory ischaemic priapism. Although some patients deliberately have a shorter implant inserted initially owing to a previous distal shunt procedure, following a period of resolution the cylinders can be upsized at a later operation.
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Affiliation(s)
- Evangelos Zacharakis
- a 1 Department of Urology, Guy's Hospital, King's College London , London, UK.,b 2 Department of Urology, University College London Hospitals , London, UK
| | - Francesco De Luca
- a 1 Department of Urology, Guy's Hospital, King's College London , London, UK.,b 2 Department of Urology, University College London Hospitals , London, UK
| | - Amr Abdul Raheem
- b 2 Department of Urology, University College London Hospitals , London, UK
| | - Giulio Garaffa
- b 2 Department of Urology, University College London Hospitals , London, UK
| | - Nim Christopher
- b 2 Department of Urology, University College London Hospitals , London, UK
| | - Asif Muneer
- b 2 Department of Urology, University College London Hospitals , London, UK
| | - David J Ralph
- b 2 Department of Urology, University College London Hospitals , London, UK
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Burnett AL, Anele UA, Derogatis LR. Priapism Impact Profile Questionnaire: Development and Initial Validation. Urology 2015; 85:1376-81. [PMID: 25863831 DOI: 10.1016/j.urology.2015.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/29/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To create and evaluate a psychometric instrument that measures the impact of experiencing priapism from the patient perspective. METHODS The research protocol consisted of several phases as follows: (1) generating items, (2) composing a patient questionnaire, (3) administering the questionnaire to patients with both active and remitted (≥1 year without priapism episodes) histories of priapism, (4) performing internal consistency and criterion-oriented validity analyses in correlation with clinical histories and erectile function assessment tools, and (5) ascertaining psychometric properties of the instrument. RESULTS The final instrument comprised a 12-item Priapism Impact Profile (PIP) questionnaire, representing the following 3 domains adversely impacted by priapism: quality of life (QoL), sexual function (SF), and physical wellness (PW), with higher scores indicating inferior experience in respective domains. Internal consistency reliability coefficients for the total PIP score and the 3 domain scores were >0.75. Fifty-four patients (mean age, 31.7 ± 11.4 years) completed the questionnaire. Patients with active priapism (n = 42) had higher total, QoL, SF, and PW scores than those with priapism remission (n = 8; P <.05, P <.05, P = .09, and P <.01, respectively). Patients with a history of recurrent priapism episodes >2 hours in duration had higher total, QoL, SF, and PW scores than those with "very minor" priapism recurrences (≤2 hours in duration; P <.01, P <.01, P <.05, and P <.001, respectively). Patients with "mild-to-moderate" to "severe" erectile dysfunction had higher total, QoL, SF, and PW scores than those with no or "mild" erectile dysfunction (P <.05, P = .14, P <.01, and P = .25, respectively). CONCLUSION The PIP questionnaire is a novel psychometric instrument that offers a means to quantify the adverse health impact of the patient's experience with priapism.
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Affiliation(s)
- Arthur L Burnett
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Uzoma A Anele
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leonard R Derogatis
- Maryland Center for Sexual Health, Lutherville, MD; Department of Psychiatry, The Johns Hopkins University School of Medicine, Baltimore, MD
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Abstract
Priapism is a disorder of persistent penile erection unrelated to sexual interest or desire. This pathologic condition, specifically the ischemic variant, is often associated with devastating complications, notably erectile dysfunction. Because priapism demonstrates high prevalence in patients with hematologic disorders, most commonly sickle cell disease (SCD), there is significant concern for its sequelae in this affected population. Thus, timely diagnosis and management are critical for the prevention or at least reduction of cavernosal tissue ischemia and potential damage consequent to each episode. Current guidelines and management strategies focus primarily on reactive treatments. However, an increasing understanding of the molecular pathophysiology of SCD-associated priapism has led to the identification of new potential therapeutic targets. Future agents are being developed and explored for use in the prevention of priapism.
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Chen W, Sun SB, Sun LA, Guo JM, Wang GM. Modified technique in treating recurrent priapism: a technique report. Asian J Androl 2015; 17:329-31. [PMID: 25578936 PMCID: PMC4650462 DOI: 10.4103/1008-682x.144944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recurrent ischemic priapism is a problem in clinical treatment. Most of the cases require more invasive surgery to shunt the blood stasis. We introduce a modified technique in treating recurrent ischemic priapism. The technique described is applied to acute ischaemic priapic episodes in patients with a history of stuttering priapism. It was carried out by a Winter's shunt combined with a continuous cavernosal irrigation system. Priapism was effectively resolved on the patients without recurrence. The four patients who received this treatment recovered most sexual function after 6 months follow-up.
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Affiliation(s)
| | | | | | - Jian-Ming Guo
- Department of Urology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Guo-Min Wang
- Department of Urology, Zhongshan Hospital of Fudan University, Shanghai, China
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Martinez DR, Manimala NJ, Rafiei A, Hakky TS, Yang C, Carrion R. The reduction corporoplasty: the answer to the improbable urologic question "can you make my penis smaller?". J Sex Med 2014; 12:835-9. [PMID: 25402607 DOI: 10.1111/jsm.12767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Aneurysmal dilatation of the corpora cavernosa can occur because of recurrent priapism in the setting of sickle cell disease. AIM We present the first case of a successful implementation of the reduction corporoplasty technique for treatment of a phallus that was "too large for intercourse." METHODS We describe the presentation of a 17-year-old male with a history of sickle cell disease with a phallus "too large for intercourse." Patient reported normal erectile function and response with masturbation but also reported inability to penetrate his partner due to the enlarged and disfigured morphology. He had three priapismic episodes since the age of 10 that progressively led to an aneurysmal morphologic deformity of his phallus. Evaluation included a magnetic resonance imaging, which revealed true aneurysmal dilatation of bilateral corpora cavernosa in the middle and distal portions, and diffusely hyperplastic tunica. MAIN OUTCOME MEASURE The main outcome measure is the successful management of phallic disfiguration. RESULTS Reduction corporoplasty was performed, and the patient reported intact erectile function without aneurysmal recurrence. CONCLUSIONS Patients with significant corporal aneurysmal defects secondary to recurrent priapism can be successfully managed with reduction corporoplasty.
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Affiliation(s)
- Daniel R Martinez
- Department of Urology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Paladino JR, Wroclawski M, Den Julio A, Teixeira GK, Glina S, Lima Pompeo AC. Urethrocutaneous fistula post-Al-Ghorab shunt. Can Urol Assoc J 2014; 8:E570-1. [PMID: 25210568 DOI: 10.5489/cuaj.1774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Priapism is a rare event that may be induced by clinical conditions and medications. Ischemic priapism (IP) is a compartment syndrome of the penis, and it constitutes a medical emergency that may cause significant morbidity on the erectile function in particular. We report a case of a 30-year-old male in his fourth episode of priapism. The aspiration and washing of the corpora cavernosa with saline solution were performed, followed by washing with adrenaline solution without resolution of the condition. Treatment was followed by the performance of the Al-Ghorab shunt procedure with dorsal incision of the glans. During follow-up, an area of necrosis distal to the incision was detected, and after the catheter removal on postoperative day 14, the patient developed a glandular dorsal urethrocutaneous fistula and meatal stenosis. The meatal stenosis was corrected by Johanson urethroplasty with a neo-meatus at the coronal sulcus, along with resection and debridement of the fistula tract and a three-layer closure.
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Affiliation(s)
| | | | | | | | - Sidney Glina
- Department of Urology, ABC Medical School, Santo André, Brazil
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15
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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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16
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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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17
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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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Incidence of Priapism in Emergency Departments in the United States. J Urol 2013; 190:1275-80. [DOI: 10.1016/j.juro.2013.03.118] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 11/18/2022]
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Droupy S, Giuliano F. [Priapisms]. Prog Urol 2013; 23:638-46. [PMID: 23830258 DOI: 10.1016/j.purol.2013.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Priapism is a rare condition for which urgent diagnosis and treatment is required. This paper reviews the literature regarding ischaemic, non-ischaemic and stuttering priapism in order to provide management recommendations. METHODS A Medline search was carried out to identify all relevant papers with management guidelines for priapism and combined with expert opinion of the authors. RESULTS Ischaemic priapism represents a compartment syndrome of the penis and urgent intervention is required to decrease the risk of erectile dysfunction. First line treatment is medical and associate cavernosal blood aspiration and sympathomimetic intracavernosal injection. Second line treatment is surgical by creating a cavernospongious shunt. Non-ischaemic priapism is not a medical emergency; however, it may need embolization of the arteriocavernosal fistula and result in erectile dysfunction. The treatment objective for stuttering priapism is to decrease episodes of prolonged erections with systemic treatments, while treating each acute episode as an emergency. CONCLUSIONS Priapism is a potentially severe condition that requires urgent diagnosis and well-defined sequential management to prevent treatment delay, complications and irreversible erectile dysfunction.
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Affiliation(s)
- S Droupy
- Service d'urologie andrologie, université Montpellier 1, CHU Carémeau, place du Pr-Robert-Debré, 30029 Nîmes cedex 9, France. Ele
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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
Priapism due to sickle cell disease is a common but less well characterized complication of the disorder. It represents a "medical emergency" with the key determinant of outcome being the duration of penile ischaemia and time to detumescence of <4 h associated with a successful treatment outcome. Management can be outpatient-based and consists of pre-emptive strategies for early stuttering attacks based on prior health education of the association between the 2 disorders, non pharmacological management, outpatient penile aspiration and irrigation with or without instillation of alpha and beta adrenergic agonists for acute episodes and secondary prophylaxis to prevent the high rates of recurrences. The evidence to recommend medical prophylaxis is sparse but based on a consensus of experts and small phase 2 or III clinical trials. A clearer understanding of the molecular mechanism(s) involving normal and dysregulated erectile physiology, scavenger haemolysis and nitric oxide pathway paves way for the use of phosphodiesterase type 5 inhibitors in medical prophylaxis of stuttering attacks. These agents will need to be studied in multi-centre randomized phase III trials before they become standard of care. A multidisciplinary team approach is required to enhance "sexual wellness" and prevent erectile dysfunction in this sexually vulnerable group.
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Affiliation(s)
- Ade Olujohungbe
- Department of Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.
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Segal RL, Readal N, Pierorazio PM, Burnett AL, Bivalacqua TJ. Corporal Burnett "Snake" surgical maneuver for the treatment of ischemic priapism: long-term followup. J Urol 2012; 189:1025-9. [PMID: 23017524 DOI: 10.1016/j.juro.2012.08.245] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/25/2005] [Accepted: 08/02/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE We provide long-term followup on a modification of the Al-Ghorab distal penile corporoglanular shunt surgery for the treatment of ischemic priapism. MATERIALS AND METHODS We conducted a retrospective review of patients surgically treated for ischemic priapism at The Johns Hopkins Hospital from January 2008 to April 2012 with the Burnett "Snake" maneuver of the Al-Ghorab shunt. Electronic medical records were reviewed to collect demographic information and telephone followup was performed to verify treatment outcomes. Patients completed the SHIM (Sexual Health Inventory for Men) to assess current erectile function. RESULTS A total of 10 patients were analyzed (age range 31 to 59 years). Mean followup was 6.7 months (range 0.5 to 17). Priapism etiologies were idiopathic (3), trazodone (2), trazodone and cocaine (3), intracavernous injection of trimix (1) and spinal cord injury (1). There were 6 patients who had previously undergone unsuccessful surgical attempts at priapism decompression and mean priapism duration was 75 hours (range 24 to 288). Of the 10 men 8 achieved successful resolution of priapism with no recurrence. There were 2 men with recurrent priapism refractory to all management who were definitively treated with insertion of an inflatable penile prosthesis. Of 9 men 6 had normal erectile function preoperatively, of whom 2 achieved at least partial erectile function postoperatively. Complications were sustained by 2 men, including wound infection with skin necrosis in 1, and an intraoperative urethral injury in the other with subsequent urethrocutaneous fistula formation and wound infection with skin necrosis. CONCLUSIONS The modified Al-Ghorab corporoglanular shunt using the Burnett snake maneuver is successful in resolving ischemic priapism, particularly in cases refractory to first line management, and in preventing further episodes of priapism.
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Affiliation(s)
- Robert L Segal
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-2162, USA.
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Zheng DC, Yao HJ, Zhang K, Xu MX, Chen Q, Chen YB, Cai ZK, Lu MJ, Wang Z. Unsatisfactory outcomes of prolonged ischemic priapism without early surgical shunts: our clinical experience and a review of the literature. Asian J Androl 2012; 15:75-8. [PMID: 22922321 DOI: 10.1038/aja.2012.63] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Ischemic priapism is a rare occurrence which can cause severe erectile dysfunction (ED) without timely treatment. This retrospective study reports our experience in treating prolonged ischemic priapism and proposes our further considerations. In this paper, a total of nine patients with prolonged ischemic priapism underwent one to three types of surgical shunts, including nine Winter shunts, two Al-Ghorab shunts and one Grayhack shunt. During the follow-up visit (after a mean of 21.11 months), all patients' postoperative characters were recorded, except one patient lost for death. Six postoperative patients accepted a 25-mg oral administration of sildenafil citrate. The erectile function of the patients was evaluated by their postoperative 5-item version of International Index of Erectile Function Questionnaire (IIEF-5), which were later compared with their premorbid scores. All patients had complete resolutions, and none relapsed. The resolution rate was 100%. Seven patients were resolved with Winter shunts, one with an Al-Ghorab shunt and one with a Grayhack shunt. The mean hospital stay was 8.22 days. There was only one urethral fistula, and the incidence of postoperative ED was 66.67%. Four patients with more than a 72-h duration of priapism had no response to the long-term phosphodiesterase type 5 (PDE-5) inhibitor treatment. These results suggest that surgical shunts are an efficient approach to make the penis flaccid after prolonged priapism. However, the severe ED caused by prolonged duration is irreversible, and long-term PDE-5 inhibitor treatments are ineffective. Thus, we recommend early penile prosthesis surgeries for these patients.
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Affiliation(s)
- Da-Chao Zheng
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
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Abstract
UNLABELLED What's known on the subject? and What does the study add? Priapism is a rare event. However, various medications and medical conditions may increase the risk. Priapism can be ischaemic, non-ischaemic or stuttering. It is paramount to distinguish the type of priapism, as misdiagnosis may lead to significant morbidity. Ischaemic priapism represents a compartment syndrome of the penis and is therefore a medical emergency. A delay in management may significantly affect future erectile function. Stuttering priapism represents recurrent subacute episodes of ischaemic priapism, which may lead to erectile dysfunction. Thus episodes must be minimised. Non-ischaemic priapism is not a medical emergency. However, misdiagnosis and injection with sympathomimetic agents can result in system absorption and toxicity. This review article provides a summary of the evaluation and management of priapism. Furthermore, a step by step flow chart is provided to guide the clinician through the assessment and management of this complex issue. OBJECTIVES To review the literature regarding ischaemic, non-ischaemic and stuttering priapism. To provide management recommendations. PATIENTS AND METHODS A Medline search was carried out to identify all relevant papers with management guidelines for priapism. RESULTS Ischaemic priapism represents a compartment syndrome of the penis and urgent intervention is required to decrease the risk of erectile dysfunction. Non-ischaemic priapism is not a medical emergency; however, it can result in erectile dysfunction. The treatment objective for stuttering priapism is to reduce future episodes with systemic treatments, whilst treating each ischaemic episode as an emergency. CONCLUSIONS Priapism is a complex condition that requires expert care to prevent complications and irreversible erectile dysfunction.
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Affiliation(s)
- Yeng K Tay
- Department of Urology, Monash Medical Centre, Melbourne, Victoria, Australia
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Abstract
AIM To provide standard operating procedures for the diagnosis and management of priapism. METHODS Review of the literature. MAIN OUTCOME MEASURES Reduction of priapism and preservation of erectile function. RESULTS Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation. Priapism requires prompt evaluation and usually requires emergency management. There are two types of priapism: (i) ischemic (veno-occlusive or low flow), which is found in 95% of cases, and (ii) nonischemic (arterial or high flow). Stuttering (intermittent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must determine whether the priapism is ischemic or nonischemic. Necessary diagnostic steps are an accurate history, physical examination, and cavernous blood gas analysis and/or color duplex ultrasonography of the corpora cavernosa. Management of ischemic priapism should achieve resolution as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic drugs is the next step. Surgical shunts should be performed if nonsurgical treatment has failed. The initial management of nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in patients who request treatment. The goal of management for a patient with recurrent (stuttering) priapism is prevention of future episodes. CONCLUSION Management of priapism has become increasingly successful as scientific understanding of the pathophysiology and molecular biology of priapism improves. The key to further success in the treatment of priapism is basic research of this uncommon but potentially devastating condition.
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