1
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Lumbiganon S, Moukhtar Hammad MA, Azad B, Yafi FA. A narrative review of initial treatment for ischemic priapism. Int J Impot Res 2024:10.1038/s41443-024-00951-1. [PMID: 39068212 DOI: 10.1038/s41443-024-00951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 06/20/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024]
Abstract
Priapism is a rare condition characterized by prolonged and often painful penile erection unrelated to sexual stimulation. Ischemic priapism, the most common subtype, requires immediate attention to prevent irreversible damage to erectile tissue. This narrative review explores the initial management strategies for ischemic priapism. Intracavernosal phenylephrine injection and aspiration with or without irrigation are recommended as first-line treatments, with alternative options available depending on clinical settings and patient factors. While guidelines offer clear recommendations for priapism lasting more than 4 h, management of shorter-duration cases remains challenging due to limited evidence.
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Affiliation(s)
- Supanut Lumbiganon
- Department of Urology, University of California, Irvine, CA, USA
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Babak Azad
- Department of Urology, University of California, Irvine, CA, USA
| | - Faysal A Yafi
- Department of Urology, University of California, Irvine, CA, USA.
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2
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Rosellen J, Hauptmann A, Wagenlehner F, Diemer T. [Priapism]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:566-572. [PMID: 38653788 DOI: 10.1007/s00120-024-02338-y] [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: 03/21/2024] [Indexed: 04/25/2024]
Abstract
Priapism is defined as penile erection lasting more than four hours that is unrelated to sexual arousal. Priapism is classified based on the oxygenation of the penile tissue into ischemic and non-ischemic subtypes. As the most common form, ischemic priapism is usually associated with pain and carries a significant risk of permanent loss of erectile function; thus, rapid intervention is necessary. Initial therapy consists of corporal aspiration and injection of sympathomimetic agents. If detumescence is not achieved, a cavernosal shunt is necessary. Non-ischemic priapism is less common than the ischemic type and is usually the result of perineal trauma. In this subtype, there is usually no pain and treatment is initially conservative. Recurrent (stuttering) priapism is a variant of the ischemic subtype, but is self-limiting and usually occurs during sleep with a duration of less than three to four hours. In the case of prolonged erection, therapy is analogous to that of the ischemic subtype.
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Affiliation(s)
- Jens Rosellen
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland.
| | - Arne Hauptmann
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland
| | - Florian Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland
| | - Thorsten Diemer
- Klinik für Urologie, Kinderurologie und Andrologie, Justus Liebig Universität, Rudolf-Buchheim-Straße 8, 35392, Gießen, Deutschland
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3
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Gül M, Luca B, Dimitropoulos K, Capogrosso P, Milenkovic U, Cocci A, Veeratterapillay R, Hatzichristodoulou G, Modgil V, Russo GI, Tharakan T, Kalkanli A, Omar MI, Bettocchi C, Carvalho J, Corona G, Jones TH, Kadioglu A, Martinez-Salamanca JI, Serefoglu EC, Verze P, Minhas S, Salonia A. What is the effectiveness of surgical and non-surgical therapies in the treatment of ischemic priapism in patients with sickle cell disease? A systematic review by the EAU Sexual and Reproductive Health Guidelines Panel. Int J Impot Res 2024; 36:20-35. [PMID: 35941221 DOI: 10.1038/s41443-022-00590-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/09/2022]
Abstract
Sickle cell disease (SCD) is an inherited hemoglobin disorder characterized by the occlusion of small blood vessels by sickle-shaped red blood cells. SCD is associated with a number of complications, including ischemic priapism. While SCD accounts for at least one-third of all priapism cases, no definitive treatment strategy has been established to specifically treat patients with SC priapism. The aim of this systematic review was to assess the efficacy and safety of contemporary treatment modalities for acute and stuttering ischemic priapism associated with SCD. The primary outcome measures were defined as resolution of acute priapism (detumescence) and complete response of stuttering priapism, while the primary harm outcome was as sexual dysfunction. The protocol for the review has been registered (PROSPERO Nr: CRD42020182001), and a systematic search of Medline, Embase, and Cochrane controlled trials databases was performed. Three trials with 41 observational studies met the criteria for inclusion in this review. None of the trials assessed detumescence, as a primary outcome. All of the trials reported a complete response of stuttering priapism; however, the certainty of the evidence was low. It is clear that assessing the effectiveness of specific interventions for priapism in SCD, well-designed, adequately-powered, multicenter trials are strongly required.
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Affiliation(s)
- M Gül
- Department of Urology, Selcuk University School of Medicine, Urology, Konya, Turkey
| | - B Luca
- Urological Research Institute, IRCCS Ospedale San Raffaele, Experimental Oncology/Unit of Urology, Milan, Italy
| | | | - P Capogrosso
- ASST-Sette Laghi, Circolo & Fondazione Macchi Hospital, University of Insurbria, Varese, Italy
| | - U Milenkovic
- University of Leuven, Laboratory for Experimental Urology, Leuven, Belgium
| | - A Cocci
- Careggi Hospital, University of Florence, Urology, Florence, Italy
| | - R Veeratterapillay
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Urology, Newcastle, UK
| | - G Hatzichristodoulou
- Julius-Maximilians-University of Würzburg, Urology and Pediatric Urology, Würzburg, Germany
| | - V Modgil
- Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester Andrology Centre, Manchester, UK
| | - G I Russo
- Vittorio Emanuele II, University of Catania, Urology, Catania, Italy
| | - T Tharakan
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, Urology, London, UK
| | - A Kalkanli
- Taksim Education and Research Hospital, Department of Urology, Istanbul, Turkey
| | - M I Omar
- University of Aberdeen, Academic Urology Unit, Aberdeen, UK
| | - C Bettocchi
- University of Foggia, Department of Urology, Foggia, Italy
| | - J Carvalho
- Lusófona University of Humanities and Technologies, School of Psychology and Life Sciences, Lisbon, Portugal
| | - G Corona
- Azienda Usl Bologna Maggiore-Bellaria Hospital, Endocrinology Unit, Bologna, Italy
| | - T H Jones
- University of Sheffield Medical School, Oncology and Metabolism, Sheffield, UK
| | - A Kadioglu
- Istanbul University, Urology, Istanbul, Turkey
| | | | | | - P Verze
- University of Naples Federico II, Urology, Naples, Italy
| | - S Minhas
- Imperial Healthcare NHS Trust, Charing Cross Hospital, Urology, London, UK
| | - A Salonia
- URI-Urological Research Institute, Experimental Oncology/Unit of Urology, Milan, Italy.
- University Vita-salute San Raffaele, Milan, Italy.
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4
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Suttorp M, Sembill S, Kalwak K, Metzler M, Millot F. Priapism at Diagnosis of Pediatric Chronic Myeloid Leukemia: Data Derived from a Large Cohort of Children and Teenagers and a Narrative Review on Priapism Management. J Clin Med 2023; 12:4776. [PMID: 37510891 PMCID: PMC10380995 DOI: 10.3390/jcm12144776] [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: 06/01/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Pediatric chronic myeloid leukemia (CML) is a very rare malignancy (age-related incidence 0.1/100,000) typically presenting with leucocyte counts >100,000/µL. However, clinical signs of leukostasis are observed at diagnosis in only approximately 10% of all cases and among these, priapism is infrequent. Here, we analyze data from pediatric CML registries on the occurrence of priapism heralding diagnosis of CML in 16/491 (3.2%) boys (median age 13.5 years, range 4-18) with pediatric CML. In the cohort investigated, duration of priapism resulting in a diagnosis of CML was not reported in 5 patients, and in the remaining 11 patients, occurred as stuttering priapism over 3 months (n = 1), over 6 weeks (n = 1), over 1-2 weeks (n = 2), over several days (n = 2), or 24 h (n = 1), while the remaining 4 boys reported continuous erection lasting over 11-12 h. All patients exhibited splenomegaly and massive leukocytosis (median WBC 470,000/µL, range 236,700-899,000). Interventions to treat priapism were unknown in 5 patients, and in the remaining cohort, comprised intravenous fluids ± heparin (n = 2), penile puncture (n = 5) ± injection of sympathomimetics (n = 4) ± intracavernous shunt operation (n = 1) paralleled by leukocyte-reductive measures. Management without penile puncture by leukapheresis or exchange transfusion was performed in 3 boys. In total, 7 out 15 (47%) long-term survivors (median age 20 years, range 19-25) responded to a questionnaire. All had maintained full erectile function; however, 5/7 had presented with stuttering priapism while in the remaining 2 patients priapism had lasted <12 h until intervention. At its extreme, low-flow priapism lasting for longer than 24 h may result in partial or total impotence by erectile dysfunction. This physical disability can exert a large psychological impact on patients' lives. In a narrative review fashion, we analyzed the literature on priapism in boys with CML which is by categorization stuttering or persisting as mostly painful, ischemic (low-flow) priapism. Details on the pathophysiology are discussed on the background of the different blood rheology of hyperleukocytosis in acute and chronic leukemias. In addition to the data collected, instructive case vignettes demonstrate the diagnostic and treatment approaches and the outcome of boys presenting with priapism. An algorithm for management of priapism in a stepwise fashion is presented. All approaches must be performed in parallel with cytoreductive treatment of leukostasis in CML which comprises leukapheresis and exchange transfusions ± cytotoxic chemotherapy.
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Affiliation(s)
- Meinolf Suttorp
- Pediatric Hematology and Oncology, Medical Faculty, TU Dresden, 01307 Dresden, Germany
| | - Stephanie Sembill
- Pediatric Oncology and Hematology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany; (S.S.); (M.M.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Krzysztof Kalwak
- Supraregional Center of Pediatric Oncology “Cape of Hope”, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Markus Metzler
- Pediatric Oncology and Hematology, Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany; (S.S.); (M.M.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - Frederic Millot
- Inserm CIC 1402, University Hospital of Poitiers, 86000 Poitiers, France;
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Nellesen D, Lucas S, Liu CR, Bhor M, Paulose J, Burnett AL. A systematic review to assess the burden of ischemic priapism in patients with sickle cell disease. Sex Med Rev 2023. [DOI: 10.1093/sxmrev/qeac001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abstract
Introduction
Ischemic priapism is a serious condition characterized by a persistent and painful involuntary erection. Patients with sickle cell disease (SCD) are at an elevated risk of experiencing priapism, with approximately 40% experiencing priapism during their lifetime.
Objectives
This systematic literature review (SLR) sought to identify studies reporting the clinical, humanistic, and economic burden of SCD-related priapism.
Methods
MEDLINE, Embase, Cochrane CENTRAL/CDSR, and 14 congresses were searched. Results were screened against predefined criteria and studies assessing relevant aspects of burden for human patients with SCD-related priapism were included. Outcomes of interest included rates of erectile dysfunction (ED), other disease-related complications, health-related quality of life (HRQoL), and economic burden.
Results
Of 1,236 publications identified, 34 were included. Most studies were retrospective observational (21). Sample size varied widely (range, 15–10,788). Study publication dates ranged from November 1980 through April 2018. Twenty-one studies reported clinical burden, with findings falling into 4 categories-priapism duration, recurrence frequency, incidence/severity of ED, and other complications. Nineteen studies reported humanistic burden, finding limited use of validated HRQoL measures such as the International Index of Erectile Function and the Priapism Impact Profile. Other patient-reported humanistic outcomes included worse scores on sleep-related indices and low rates of satisfactory intercourse. Eight studies reported economic burden. Direct treatment costs ranged from $4,996 for patients without penile operations to $22,906 (2019 USD) for patients receiving transfusions and urologic procedures.
Conclusions
This SLR identified 34 studies providing evidence of the burden of priapism for patients with SCD, including painful complications and diminished physical, mental and sexual function.
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Affiliation(s)
- Dave Nellesen
- Analysis Group, Inc. , Menlo Park, CA, United States
| | - Sedge Lucas
- Analysis Group, Inc. , Menlo Park, CA, United States
| | - Che-Rung Liu
- Analysis Group, Inc. , Menlo Park, CA, United States
| | - Menaka Bhor
- Novartis Pharmaceuticals Corporation , East Hanover, NJ, United States
| | - Jincy Paulose
- Novartis Pharmaceuticals Corporation , East Hanover, NJ, United States
| | - Arthur L Burnett
- The Johns Hopkins University School of Medicine , Baltimore, MD, United States
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Guedenon KM, Fiawoo M, Akolly DAE, Akpako E, Esso B, Dossou FC, Gbadoe AD. Management of acute sickle cell priapism in an African (Togo) pediatric department includes conservative measures and intracavernous epinephrine which is safe and efficacious. EJHAEM 2022; 3:628-635. [PMID: 36051024 PMCID: PMC9422026 DOI: 10.1002/jha2.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/02/2022]
Abstract
Priapism is a well-known urologic complication of sickle cell anemia. This study describes the results of a protocol for the treatment of acute priapism by intracavernous injection of epinephrine due to unavailability of etilefrine. A descriptive cross-sectional study of 18 cases of acute priapism in sickle cell patients treated in the pediatric department of the Sylvanus Olympio CHU from January 1 to December 31, 2020. The average age was 21.7 ± 7.7 years, the youngest patient was 8 and the oldest was 32 years old. Students represented 61.1% of the patients. The hemoglobin profiles were homozygous SS (n = 14) and double heterozygous SC (n = 4). Most of the crisis (83.3%) occurred at night. Most of the patients (66.7%) came to the hospital before the sixth hour of crisis, one patient came by the 48th hour. Walking was the most self-relief method tried by patients (67%). It was followed by a cold penile bath, attempted urination, body bath, and lastly lukewarm bath. Fourteen patients had a history of chronic intermittent priapism. The average pain intensity was 9.5 ± 0.9 with restlessness (33.3%) and crying (33.3%). Fifteen patients were treated upon admission with an intracavernosal injection of epinephrine, and three patients were first drained. Thirteen patients achieved remission immediately, while five patients required a second injection and only one had to be drained before remission. Tolerance was good. One patient had a borderline systolic blood pressure. One erectile weakness case was noticed and no cases of sexual impotence. Epinephrine by intracavernosal injection is an efficient treatment for acute priapism in sickle cell patients. Epinephrine, which has a good tolerance in pediatric and young adult patients, should be used in lieu of etilefrine due to its unavailability in areas where it is unavailable.
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Affiliation(s)
| | - Mawouto Fiawoo
- Department of PediatricsCHU Sylvanus Olympio, University of LoméTogo
| | | | - Etse Akpako
- University of Maryland Medical Systems/Midtown CampusBaltimoreMarylandUSA
| | - Balakibawi Esso
- Department of PediatricsCHU Sylvanus Olympio, University of LoméTogo
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Patel SR, Reddy A, Dai M, Passoni N, Khera M, Koh CJ. Is urgent surgical management necessary for priapism in pediatric patients with hematologic conditions? J Pediatr Urol 2022; 18:528.e1-528.e6. [PMID: 35843787 DOI: 10.1016/j.jpurol.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Acute priapism is usually considered a medical emergency that warrants prompt urologic evaluation and treatment. Efforts have been made to determine the optimal management strategy for pediatric priapism. OBJECTIVE The aim of this study is to assess differences in conservative, minimally-invasive, and operative management of acute priapism in the pediatric population. STUDY DESIGN A retrospective study of pediatric patients with acute priapism from 2015 to 2021 at a single tertiary care children's hospital was conducted. Conservative, minimally-invasive, and operative approaches for the priapism episodes during these hospital encounters were analyzed. RESULTS Thirty-nine patients were identified with a total of 61 cases of acute pediatric priapism were evaluated in the study period. Eight-three percent of patients were African-Americans, and 72% of patients had a history of sickle cell disease. Oxygen therapy (P = 0.001) and hydration with intravenous fluids (P = 0.00318) were more commonly utilized for hematologic-associated cases compared to other etiologies. For priapism episodes of hematologic etiology, 18 (40.0%) and 18 (40.0%) patients received phenylephrine injection and aspiration/irrigation (e.g., minimally-invasive therapy), respectively, while for the other causes of priapism, three (18.8%) and four (25.0%) received phenylephrine injection and aspiration/irrigation (e.g., minimally-invasive), respectively. Conservative and minimally-invasive treatment resulted in complete resolution of priapism in 27 (60%) and 16 (35.5%) patients with hematologic-associated priapism while 12 (75%) and 1 (6.3%) patients with other etiologies had resolution of priapism with conservative and minimally-invasive treatment, respectively. One patient received shunting in the hematologic group while two patients received shunting in the non-hematologic group (P = 0.1031). DISCUSSION Hematologic disorders are the most common causes of priapism in children and adolescents. An overwhelming majority of priapism events in the pediatric population can be managed with conservative therapies including oxygenation and intravenous hydration as well as minimally-invasive procedures such as corporal aspiration, irrigation and/or injections. The utilization of corporal shunting, anesthesia, and hospital resources is infrequently necessary for pediatric priapism episodes. CONCLUSION While urgent surgical management is often performed in the adult population, a minimally-invasive management strategy can be implemented in the pediatric population where an extended period of conservative management that avoids operative management and general anesthesia is effective.
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Affiliation(s)
- Sagar R Patel
- Division of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Amit Reddy
- Division of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Michelle Dai
- Division of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Niccolo Passoni
- Division of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Chester J Koh
- Division of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
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Graham BA, Wael A, Jack C, Rohan MA, Wayne HJG. An overview of emergency pharmacotherapy for priapism. Expert Opin Pharmacother 2022; 23:1371-1380. [PMID: 35815373 DOI: 10.1080/14656566.2022.2099271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Priapism is a compartment syndrome, defined as an unwanted penile erection lasting longer than four hours, unrelated to sexual stimulation, and persistent even after ejaculation/orgasm. Ischemic priapism is considered a urologic emergency requiring time-sensitive management. Studies have documented that untreated priapism is associated with progressive ischemic histological changes in the corpora cavernosa, such as widespread smooth muscle necrosis, blood vessel and nerve attrition, and trabecular fibrosis. Treatment options include conservative management, corporal irrigation, pharmacologic therapy, and surgery. We herein provide an overview of the emergency pharmacology for priapism. AREAS COVERED The American Urological Association (AUA) and the European Association of Urology (EAU) both recommend penile aspiration in conjunction with intracavernosal injection of sympathomimetics as the initial management of ischemic priapism. We have performed a retrospective review of the literature from 1914 to 2022 by using PubMed and a review of the treatment guidelines from the AUA and the EAU to discuss the various therapies for ischemic priapism in the emergent setting. EXPERT OPINION After a thorough overview of the literature regarding the treatment of ischemic priapism in the emergent setting, we conclude that intracavernosal phenylephrine is superior to other agents due to its demonstrated efficacy and limited systemic side effects.
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Affiliation(s)
- Bobo A Graham
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Almajed Wael
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Conlon Jack
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Morenas A Rohan
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Hellstrom J G Wayne
- Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
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9
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Azbell RCG, Desai PC. Treatment dilemmas: strategies for priapism, chronic leg ulcer disease, and pulmonary hypertension in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:411-417. [PMID: 34889382 PMCID: PMC8791181 DOI: 10.1182/hematology.2021000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sickle cell disease is a disorder characterized by chronic hemolytic anemia and multiorgan disease complications. Although vaso-occlusive episodes, acute chest syndrome, and neurovascular disease frequently result in complication and have well-documented guidelines for management, the management of chronic hemolytic and vascular-related complications, such as priapism, leg ulcers, and pulmonary hypertension, is not as well recognized despite their increasing reported prevalence and association with morbidity and mortality. This chapter therefore reviews the current updates on diagnosis and management of priapism, leg ulcers, and pulmonary hypertension.
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Affiliation(s)
- Roberta C G Azbell
- The Ohio State University Wexner Medical Center, Department of Internal Medicine, Columbus, OH
- Division of Hospital Medicine, Columbus, OH
| | - Payal Chandarana Desai
- The Ohio State University Wexner Medical Center, Department of Internal Medicine, Columbus, OH
- Division of Hematology and Oncology, Columbus, OH
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10
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Hequet O, Fort R, Driss F. Red blood cell exchange in an emergency in sickle cell disease. Transfus Apher Sci 2020; 59:102996. [PMID: 33189570 DOI: 10.1016/j.transci.2020.102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Red blood cell exchange (RBCEx) has become a standard therapy to remove abnormal red blood cells (RBCs) in patients with sickle cell disease (SCD). In the last few decades, numerous RBCEx procedures have been performed chronically during regular programs, while numerous procedures have also been performed in an emergency for several indications, this therapeutic option being very efficient in vital and emergency situations. In both groups of indications, large amounts of sickle RBCs have to be removed, which requires great precision and the setting of specific hematological targets. The aim of this review is to discuss the aims, clinical and biological targets, and the requirements and precautions when performing RBCEx in an emergency. Moreover, we analyze how improvement of the techniques as well as the clinical and biological targets has led to optimization of the procedures in emergency settings. We also consider the outstanding issues that require additional investigation.
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Affiliation(s)
- O Hequet
- Apheresis Unit, Etablissement Français du Sang Auvergne Rhône-Alpes, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
| | - R Fort
- Department of Internal Medicine, CHU Edouard Herriot, Lyon, France; Laboratoire LIBM EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard, Lyon, France; Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - F Driss
- Biological Hematological Unit, Centre Hospitalier universitaire Bicêtre, le Kremlin-Bicêtre, France
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11
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Gupta G, Kumar D, Trivedi M. Acute Lymphoblastic Leukemia in a Child Presenting Primarily with Priapism. J Indian Assoc Pediatr Surg 2020; 25:52-54. [PMID: 31896902 PMCID: PMC6910052 DOI: 10.4103/jiaps.jiaps_214_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/31/2019] [Accepted: 04/20/2019] [Indexed: 12/28/2022] Open
Abstract
Priapism is an uncommon presentation in children and adults with a chronic myeloid type of leukemia. Its association is rarely found in an acute lymphoblastic type of leukemia (ALL). Timely management is important to prevent irreversible complications. We report a case of ALL with presenting complaint of priapism.
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Affiliation(s)
- Garima Gupta
- Department of Pediatrics, NDMC Medical College, New Delhi, India
| | - Deepak Kumar
- Department of Pediatrics, University College of Medical Sciences, New Delhi, India
| | - Maharishi Trivedi
- Department of Pediatrics, University College of Medical Sciences, New Delhi, India
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12
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Fort R. Recommendations for the use of red blood cell exchange in sickle cell disease. Transfus Apher Sci 2019; 58:128-131. [PMID: 30879904 DOI: 10.1016/j.transci.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Sickle cell disease (SCD) is a genetic disorder characterised by a single mutation of the beta globin gene, causing the production of an abnormal haemoglobin called sickle haemoglobin (HbS). In its deoxygenated form, HbS polymerises, causing major rheological disorders, which presents clinically as periodic vaso-occlusive crises, chronic haemolysis and chronic vascular dysfunction. Patients often resort to a background treatment, and transfusion remains the cornerstone in the management of the disease, significantly reducing morbidity and mortality. The aim of red blood cell exchange (RBCX) is to improve tissue oxygenation by increasing haemoglobin levels while lowering HbS levels. RBCX can be performed by manual or automated exchange, and each technique has its own set of advantages and disadvantages. This article will outline the transfusion indications for the main complications of SCD, as well as the most appropriate strategy to use.
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Affiliation(s)
- Romain Fort
- Department of Internal Medicine, CHU Edouard Herriot, Lyon, France; Laboratoire LIBM EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard, Lyon, France; Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France.
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Ballas SK. Sickle cell disease: Classification of clinical complications and approaches to preventive and therapeutic management. Clin Hemorheol Microcirc 2018; 68:105-128. [PMID: 29614627 DOI: 10.3233/ch-189002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure that has no established cure in adult patients. Cure has been achieved in selected children with sickle cell anemia (SCA) using allogeneic bone marrow transplantation or cord blood transplantation. SCD is essentially a triumvirate of (1) pain syndromes, (2) anemia and its sequelae and (3) organ failure, including infection. Pain, however, is the hallmark of SCD and dominates its clinical picture throughout the life of the patients. The prevalence of these complications varies with age from infancy through adult life. However, pain, infections and anemia requiring blood transfusion occur throughout the life span of affected patients. The overall medical care of patients with SCD in developed countries has improved such that their life expectancy has almost doubled since 1951. Currently, there are at least five major approaches for the general management of SCD and its complications. These include (i) symptomatic management, (ii) supportive management, (iii) preventive management, (iv) abortive management, and (v) curative therapy.
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Affiliation(s)
- Samir K Ballas
- Department of Medicine, Cardeza Foundation for Hematologic Research, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Falcone M, Gillo A, Capece M, Raheem A, Ralph D, Garaffa G. The management of the acute ischemic priapism: A state of the art review. Actas Urol Esp 2017; 41:607-613. [PMID: 28528136 DOI: 10.1016/j.acuro.2017.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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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Kousournas G, Muneer A, Ralph D, Zacharakis E. Contemporary best practice in the evaluation and management of stuttering priapism. Ther Adv Urol 2017; 9:227-238. [PMID: 28932276 DOI: 10.1177/1756287217717913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/07/2017] [Indexed: 12/22/2022] Open
Abstract
Stuttering priapism is rare and under-investigated clinical entity. Although it shares similarities with ischaemic priapism, by definition, stuttering priapism has distinct characteristics that advocate for a different management in the clinical setting. Therefore, the management of stuttering priapism aims primarily to prevent recurrence rather than the resolution of spontaneous attacks. A multimodal approach and the individualization of each case are essential because of the diversity of the condition and the plethora of proposed therapeutic strategies. Understanding the underlying pathophysiology and familiarity with contemporary, past and emerging future agents and therapeutic options are required in order to provide an optimal solution for each patient. In addition, patient counselling and the option to combine therapeutic strategies and challenge second-line therapies are essential weapons in the armament of the urologist. Although further clinical trials and studies are mandatory in order to obtain solid data and provide recommendations, all therapeutic options are analysed, with specific interest in the potential advantages and disadvantages. A structured evaluation procedure is also described.
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Affiliation(s)
- Georgios Kousournas
- St Peter's Andrology Centre London, University College Hospital of London, UK
| | - Asif Muneer
- St Peter's Andrology Centre London, University College Hospital of London, UK
| | - David Ralph
- St Peter's Andrology Centre London, University College Hospital of London, UK
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Seideman CA, Gitlin JS. T-shaped Shunt With Intracavernosal Tunneling for a Pediatric Case of Refractory Ischemic Priapism. Urology 2016; 110:220-222. [PMID: 27693479 DOI: 10.1016/j.urology.2016.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
We present the first reported case of refractory pediatric priapism treated by intracavernosal tunneling T shunt. A 12-year-old male, with sickle cell disease, presented with 72 hours of painful erection. The patient failed conservative measures including aspiration, injection of phenylephrine, as well as distal shunt procedure. A T-T shunt was performed, as previously described in the adult literature. There was immediate resolution of the erection with no complications. At 1-year follow-up, he reports no subsequent episodes of priapism and normal erections. T shunt with tunneling can be performed in select cases of severe pediatric refractory ischemic priapism.
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Habibi A, Arlet JB, Stankovic K, Gellen-Dautremer J, Ribeil JA, Bartolucci P, Lionnet F. [French guidelines for the management of adult sickle cell disease: 2015 update]. Rev Med Interne 2016; 36:5S3-84. [PMID: 26007619 DOI: 10.1016/s0248-8663(15)60002-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sickle cell disease is a systemic genetic disorder, causing many functional and tissular modifications. As the prevalence of patients with sickle cell disease increases gradually in France, every physician can be potentially involved in the care of these patients. Complications of sickle cell disease can be acute and chronic. Pain is the main symptom and should be treated quickly and aggressively. In order to reduce the fatality rate associated with acute chest syndrome, it must be detected and treated early. Chronic complications are one of the main concerns in adults and should be identified as early as possible in order to prevent end organ damage. Many organs can be involved, including bones, kidneys, eyes, lungs, etc. The indications for a specific treatment (blood transfusion or hydroxyurea) should be regularly discussed. Coordinated health care should be carefully organized to allow a regular follow-up near the living place and access to specialized departments. We present in this article the French guidelines for the sickle cell disease management in adulthood.
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Affiliation(s)
- A Habibi
- Unité des maladies génétiques du globule rouge (UMGGR), service de médecine interne, centre de référence de la drépanocytose, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Université Paris-Est Créteil (Upec), avenue du Général-de-Gaulle, 94010 Créteil cedex, France; Équipe 2, IMRB, Inserm U955, Créteil, France.
| | - J-B Arlet
- Service de médecine interne, centre de référence de la drépanocytose, hôpital européen Georges-Pompidou, AP - HP, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris Descartes, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - K Stankovic
- Service de médecine interne, centre de référence de la drépanocytose, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - J Gellen-Dautremer
- Unité des maladies génétiques du globule rouge (UMGGR), service de médecine interne, centre de référence de la drépanocytose, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
| | - J-A Ribeil
- Faculté de médecine, université Paris Descartes, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Département de biothérapie, centre de référence de la drépanocytose, hôpital Necker - Enfants-malades, AP - HP, 149, rue de Sèvres, 75743 Paris cedex, France
| | - P Bartolucci
- Unité des maladies génétiques du globule rouge (UMGGR), service de médecine interne, centre de référence de la drépanocytose, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Université Paris-Est Créteil (Upec), avenue du Général-de-Gaulle, 94010 Créteil cedex, France
| | - F Lionnet
- Service de médecine interne, centre de référence de la drépanocytose, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
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Kalathia J, Agrawal S, Chipde SS, Agrawal R. Homocysteinemia: A rare cause of priapism. Urol Ann 2016; 8:118-21. [PMID: 26834419 PMCID: PMC4719504 DOI: 10.4103/0974-7796.171497] [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] [Indexed: 11/24/2022] Open
Abstract
Priaprism is a persistent painful erection that continuous beyond or is unrelated to sexual stimulation. Majority of cases are idiopathic (46%), alcohol and drug related (21%), perineal trauma (12%), sickle cell anemia and hypercoagualable state related (11%). We report case of priapism caused by hyperhomocysteinemia with favorable outcome with only few cases so far reported in the literature to the best of our knowledge. A 31 year-old male referred to our institution with non resolving priaprism for the last 6 days. Immediate distal shunt (Al-ghorab) was created but it could not achieve the detumescence. The penile Doppler showed no flow into the corpora, so a proximal shunt (Quackels) was made which achieved satisfactory detumescence. On thorough evaluation for the cause of priaprism, only homocysteine level was found to be significantly raised (40.46 µmol/L), being the unusual and rare cause for priaprism. The patient was discharged on homocheck. In the follow-up the patient is on vacuum assisted device for the erectile dysfunction and has been advised for the penile implant. Priaprism being a urological emergency should be thoroughly evaluated even for the rare causes and should be timely intervened to avoid the unavoidable consequences of permanent erectile dysfunction.
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Affiliation(s)
- Jaisukh Kalathia
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Santosh Agrawal
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Saurabh Sudhir Chipde
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Rajeev Agrawal
- Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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Abstract
Hemoglobin disorders such as the thalassemias and sickle cell disease have been present in Germany since the arrival of immigrants from the eastern Mediterranean region, Africa, and Asia in the 1950s. These hereditary diseases not only require very complex treatment, but also render screening for asymptomatic carriers necessary, in order to prevent the birth of an affected child in the next generation. Pediatricians, internists, general practitioners, and gynecologists have to rise to this challenge.
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Affiliation(s)
- R Dickerhoff
- Klinik für Kinder-Onkologie, -Hämatologie und Klinische Immunologie, Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland,
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20
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Ballas SK, Lyon D. Safety and efficacy of blood exchange transfusion for priapism complicating sickle cell disease. J Clin Apher 2015; 31:5-10. [DOI: 10.1002/jca.21394] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/23/2014] [Accepted: 02/24/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Samir K. Ballas
- Cardeza Foundation for Hematologic Research; Department of Medicine; Jefferson Medical College, Thomas Jefferson University; Philadelphia Pennsylvania
| | - David Lyon
- Cardeza Foundation for Hematologic Research; Department of Medicine; Jefferson Medical College, Thomas Jefferson University; Philadelphia Pennsylvania
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Abstract
Priapism is a prolonged erection that persists beyond or is unrelated to sexual stimulation. It is associated with significant morbidity: psychological, socioeconomic, and physical, including pain and potentially irreversible compromise of erectile function. There are three major types of priapism: ischemic, nonischemic, and stuttering. Establishing the type of priapism is paramount to safely and effectively treating these episodes. Ischemic priapism represents a urological emergency. Its treatment may involve aspiration/irrigation with sympathomimetic injections, surgical shunts, and as a last resort, penile prosthesis implantation. Nonischemic priapism results from continuous flow of arterial blood into the penis, most commonly related to penile trauma. This is not an emergency and may be managed conservatively initially, as most of these episodes are self-limiting. Stuttering priapism involves recurrent self-limiting episodes of ischemic priapism. The primary goal of therapy is prevention, but acute episodes should be managed in accordance with guidelines for ischemic priapism. In this paper we review the diagnosis and treatment of the three priapism variants, as well as discuss future targets of therapy and novel targets on the horizon.
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Affiliation(s)
- Helen R Levey
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert L Segal
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, 600 North Wolfe Avenue, Marburg 405, Baltimore, MD 21287, USA
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Donaldson JF, Rees RW, Steinbrecher HA. Priapism in children: a comprehensive review and clinical guideline. J Pediatr Urol 2014; 10:11-24. [PMID: 24135215 DOI: 10.1016/j.jpurol.2013.07.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/30/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We review the English literature between 1980 and 2013 and summarize the clinical classification, aetiology, physiology, and pathophysiology of paediatric priapism. We propose a clinical guideline for the management of priapism in children. PATIENTS Male patients aged ≤ 18 years. RESULTS Priapism, a prolonged penile erection lasting >4 h, is a rare condition in childhood. There are 3 widely accepted types of priapism: 1) ischaemic priapism, the commonest type seen in children; 2) stuttering priapism, recurrent, self-limiting prolonged erections; and 3) non-ischaemic priapism, rare in children, usually due to trauma. Neonatal priapism has also been described. Ischaemic priapism is a urological emergency causing fibrosis of the corpora cavernosa, subsequent erectile dysfunction and penile disfigurement. The commonest causes of priapism in children are sickle cell disease (65%), leukaemia (10%), trauma (10%), idiopathic (10%), and pharmacologically induced (5%). CONCLUSIONS Priapism in children must be assessed urgently. Rapid resolution of ischaemic priapism prevents permanent cavernosal structural damage and is associated with improved prognosis for potency later in life. Stuttering priapism requires careful counselling for episodic management. Chronic prophylaxis may be obtained using α-adrenergic sympathomimetics, phosphodiesterase type 5 inhibitors and, in sickle cell disease, hydroxyurea. Non-ischaemic and neonatal priapism may generally be treated less urgently.
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Affiliation(s)
- James F Donaldson
- Department of Paediatric Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK.
| | - Rowland W Rees
- Department of Urological Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK.
| | - Henrik A Steinbrecher
- Department of Paediatric Urology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire SO16 6YD, UK.
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23
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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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Canguven O, Cetinel C, Horuz R, Tarhan F, Hamarat B, Goktas C. Transient distal penile corporoglanular shunt as an adjunct to aspiration and irrigation procedures in the treatment of early ischemic priapism. Korean J Urol 2013; 54:394-8. [PMID: 23789049 PMCID: PMC3685640 DOI: 10.4111/kju.2013.54.6.394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 03/04/2013] [Indexed: 11/24/2022] Open
Abstract
Purpose Ischemic priapism, a compartment syndrome, requires urgent treatment in order to nourish the corpora cavernosa. As the first step, aspiration of blood and irrigation of the cavernosal bodies is performed to prevent fibrotic activity and secure erectile capability. During aspiration, there are risks of cardiovascular side effects of adrenergic agonists. We aimed to evaluate a transient distal penile corporoglanular shunt technique in place of aspiration and irrigation techniques for treatment of early ischemic priapism. Materials and Methods A transient distal penile shunt was applied to 15 patients with early ischemic priapism between January 2011 and May 2012. Priapism duration, history, causes, pain, and any prior management of priapism were assessed in all patients. A complete blood count and penile Doppler ultrasonography were performed, which showed attenuated blood flow in the cavernosal artery. A sterile closed system blood collection set, which has two needles and tubing, was used for the transient distal penile shunt. Results Ten of 15 patients with early ischemic priapism were successfully treated with this transient shunt technique. No additional procedures were needed after the resolution of rigidity in the 10 successfully treated patients. Conclusions The transient nature of this technique is an advantage over aspiration and irrigation in the treatment of early ischemic priapism. Our results indicate that the technique can be offered for patients with an ischemic priapism episode of no more than 7 hours.
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Affiliation(s)
- Onder Canguven
- Urology Clinics, Kartal Training and Research Hospital, Istanbul, Turkey
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Ramos-Fernandez MR, Medero-Colon R, Mendez-Carreno L. Critical urologic skills and procedures in the emergency department. Emerg Med Clin North Am 2013; 31:237-60. [PMID: 23200334 PMCID: PMC5554872 DOI: 10.1016/j.emc.2012.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The evaluation and management of genitourinary emergencies is a fundamental component of the training and practice of emergency physicians. Urologic procedures are common in the emergency room. Emergency physicians play a vital role in the initial evaluation and treatment because delays in management can lead to permanent damage. This article discusses the most common urologic procedures in which emergency physicians must be proficient for rapid intervention to preserve function and avoid complications. An overview of each procedure is discussed as well as indications, contraindications, equipment, technique, and potential complications.
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Affiliation(s)
- Maria R Ramos-Fernandez
- Department of Emergency Medicine, University of Puerto Rico School of Medicine, 65th Infantry Avenue Km 3.8, Carolina, PR 00985, USA.
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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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27
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Priapism in an Infant With Sickle Cell Trait After Cardiac Transplant. Urology 2012; 80:928-30. [DOI: 10.1016/j.urology.2012.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 05/17/2012] [Accepted: 06/05/2012] [Indexed: 01/17/2023]
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Ballas SK, Kesen MR, Goldberg MF, Lutty GA, Dampier C, Osunkwo I, Wang WC, Hoppe C, Hagar W, Darbari DS, Malik P. Beyond the definitions of the phenotypic complications of sickle cell disease: an update on management. ScientificWorldJournal 2012; 2012:949535. [PMID: 22924029 PMCID: PMC3415156 DOI: 10.1100/2012/949535] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 04/01/2012] [Indexed: 12/25/2022] Open
Abstract
The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation and Department of Medicine, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, USA.
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Sickling cells, cyclic nucleotides, and protein kinases: the pathophysiology of urogenital disorders in sickle cell anemia. Anemia 2012; 2012:723520. [PMID: 22745902 PMCID: PMC3382378 DOI: 10.1155/2012/723520] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 04/16/2012] [Accepted: 04/22/2012] [Indexed: 02/01/2023] Open
Abstract
Sickle cell anemia is one of the best studied inherited diseases, and despite being caused by a single point mutation in the HBB gene, multiple pleiotropic effects of the abnormal hemoglobin S production range from vaso-occlusive crisis, stroke, and pulmonary hypertension to osteonecrosis and leg ulcers. Urogenital function is not spared, and although priapism is most frequently remembered, other related clinical manifestations have been described, such as nocturia, enuresis, increased frequence of lower urinary tract infections, urinary incontinence, hypogonadism, and testicular infarction. Studies on sickle cell vaso-occlusion and priapism using both in vitro and in vivo models have shed light on the pathogenesis of some of these events. The authors review what is known about the deleterious effects of sickling on the genitourinary tract and how the role of cyclic nucleotides signaling and protein kinases may help understand the pathophysiology underlying these manifestations and develop novel therapies in the setting of urogenital disorders in sickle cell disease.
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Gani J, Radomski SB. Management of erectile dysfunction in patients with sickle cell disease. J Sex Med 2012; 8:2123-7, quiz 2128. [PMID: 21791003 DOI: 10.1111/j.1743-6109.2011.02399.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Johan Gani
- Division of Urology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
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Abstract
INTRODUCTION Priapism is a familiar problem to hematologists, well known for its association with sickle-cell disease (SCD). It also occurs in a variety of other hematological illnesses, nearly all forms of congenital hemolytic anemia, including other hemoglobinopathies and red blood cell membranopathies and enzymopathies. AIM Provide urologists with a comprehensive review of priapism in SCD, with an emphasis on the perspective of a practicing hematologist. METHODS Medline searches through July 2010 were conducted using the terms priapism, erectile dysfunction, and sickle cell. MAIN OUTCOME MEASURES Expert opinion was based on review of the medical literature related to this subject matter. RESULTS In men with SCD, large epidemiological studies have linked the risk of priapism to clinical markers of the severity of intravascular hemolysis. Extracellular hemoglobin and arginase released during hemolysis has been implicated in reducing nitric oxide bioavailability, although the relevance of hemolysis to vascular dysfunction has been challenged by some scientists. Consistent with the role of impairment of the nitric oxide axis, mice genetically deficient in nitric oxide production have also been shown to develop priapic activity. Provocative new data indicate that hemolysis-linked dysregulation of adenosine signaling in the penis contributes to priapism in sickle cell mice. Serious questions have arisen regarding the efficacy of mainstays of textbook dogma for treatment of acute severe priapism, including intravenous fluids, alkalinization, and exchange transfusion, and there is increasing acceptance for early aspiration and irrigation of the corpus cavernosum. CONCLUSION For patients with sickle cell with recurrent priapism, there is very limited evidence for a medical prophylaxis role for hydroxyurea, etilefrine, pseudoephedrine, leuprolide, sildenafil, and other agents. Recent publications have highlighted nitric oxide and adenosine signal transduction pathways as worthy of additional research. Research and clinical management of sickle-cell priapism is strengthened by multidisciplinary collaboration between hematologists and urologists.
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Affiliation(s)
- Gregory J Kato
- National Heart, Lung and Blood Institute, National Institutes of Health-Sickle Cell Vascular Disease Section, Cardiovascular and Pulmonary Branch, Bethesda, MD 20892-1476, USA.
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Ballas SK. Sickle Cell Pain. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Bouya P, Odzébé A, Koumou Moritoua R, Elira Dokékias A. Priapisme aigu drépanocytaire: analyse de 20 cas traités au CHU de Brazzaville. Basic Clin Androl 2010. [DOI: 10.1007/s12610-010-0110-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Résumé
Objectif
Évaluer les résultats des traitements médicaux et chirurgicaux du priapisme drépanocytaire.
Malades et méthodes
Vingt malades ont été traités pour priapisme drépanocytaire dans les services d’urologie—andrologie et d’hématologie du CHU de Brazzaville, du 1er janvier 1995 au 31 décembre 2005. Les méthodes thérapeutiques ont été les injections intracaverneuses d’étiléfrine et les fistules cavernospongieuses.
Résultats
1) Cinq patients traités sans succès par transfusion et étiléfrine orale ont été secondairement traités avec succès par la technique deWinter; 2) sur cinq patients traités par injection intracaverneuse d’étiléfrine en première intention, on note trois succès et deux échecs, traités avec succès par la technique de Winter; 3) sur dix patients traités par fistules cavernospongieuses selon Winter en première intention, trois ont récidivé et ont été secondairement traités avec succès par la méthode d’Al-Ghorab. Les résultats fonctionnels à long terme sont: 25 % d’absence d’érection, 25 % d’insuffisance d’érection et 50 % d’érection normale.
Conclusion
Le traitement par injection intracaverneuse d’étiléfrine est efficace avant la 24e heure. Au-delà, les fistules cavernospongieuses donnent les meilleurs résultats.
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Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, Shamloul R. Priapism: Pathogenesis, Epidemiology, and Management. J Sex Med 2010; 7:476-500. [DOI: 10.1111/j.1743-6109.2009.01625.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lionnet F, Arlet JB, Bartolucci P, Habibi A, Ribeil JA, Stankovic K. [Guidelines for management of adult sickle cell disease]. Rev Med Interne 2009; 30 Suppl 3:S162-223. [PMID: 19713011 DOI: 10.1016/j.revmed.2009.07.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sickle cell disease is a systemic disease that can potentially involve all organs. As the prevalence of patients with sickle cell disease increases gradually in France, every physician can be potentially involved in the care of these patients. Complications of sickle cell disease can be acute or chronic. Pain is the main symptom and should be treated quickly and aggressively. Acute chest syndrome is the leading cause of acute death and must be prevented, detected, and treated without delay. Chronic complications are one of the main concerns in adults and should be identified as early as possible in order to prevent sequels. Many organs can be involved, including the bones, kidneys, eyes, lungs... The indications for a specific treatment (blood transfusion or hydroxyurea) should be discussed. Health care should be carefully organized to allow both a regular follow-up near the living place and access to specialized departments. We present in this article the French guidelines for the sickle cell disease management in adulthood.
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Affiliation(s)
- F Lionnet
- Service de médecine interne, centre de référence de la drépanocytose, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France.
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Howard J, Davies SC. Sickle cell disease in North Europe. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 67:27-38. [PMID: 17365983 DOI: 10.1080/00365510601046441] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The numbers of patients with sickle cell disease in Northern Europe are steadily increasing due to migration, leading to a need for improved healthcare services for these patients. We outline the role of neonatal and antenatal screening programmes in the diagnosis of sickle cell disease, clinical aspects of care and the therapeutic options available. The clinical areas discussed in detail are pain management, the management of stroke and other neurological complications and the management of pulmonary and splenic complications. The role of hydroxyurea, blood transfusion and bone marrow transplantation are also discussed.
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Affiliation(s)
- J Howard
- Department of Haematology, Central Middlesex Hospital, London, UK.
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Pack-Mabien A, Haynes J. A primary care provider’s guide to preventive and acute care management of adults and children with sickle cell disease. ACTA ACUST UNITED AC 2009; 21:250-7. [DOI: 10.1111/j.1745-7599.2009.00401.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Olujohungbe A, Howard J. The clinical care of adult patients with sickle cell disease. Br J Hosp Med (Lond) 2008; 69:616-9. [DOI: 10.12968/hmed.2008.69.11.31646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jo Howard
- Guy's and St Thomas' NHS Foundation Trust, London
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Raveenthiran V. A modification of Winter's shunt in the treatment of pediatric low-flow priapism. J Pediatr Surg 2008; 43:2082-6. [PMID: 18970944 DOI: 10.1016/j.jpedsurg.2008.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 02/05/2008] [Accepted: 02/06/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Cavernous shunt operations available for treating priapism are frequently unsuitable for children owing to high chances of persistent venous leak that results in postoperative erectile dysfunction. In this article, a modification of Winter's shunt, which is suitable for treating low-flow priapism in children, is described. METHODS AND PATIENTS Using a large bore needle, multiple punctures were made in the tip of corpora cavernosa through the glans. The needle tracks functioned as temporary cavernoglandular fistula thereby, causing detumescence. This modified technique was used in 7 children all of whom had ischemic priapism. The age range was 9 months to 17 years, and the mean duration of symptom was 11 hours (range, 5-20 hours). RESULTS In all the patients, priapism was successfully relieved by the modified technique. Immediate recurrence of priapism was noted in only one patient. In 5 patients for whom adequate follow-up details are available, postprocedure penile erection was confirmed either by self-reporting or by observation. There were no major complications. CONCLUSION This technical modification of the classical Winter's shunt appears to be a useful alternative in the management of pediatric low-flow priapism. A high chance of retaining erectile capacity after this technique is a significant advantage. Further clinical studies are required to confirm the observations of this preliminary report.
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Affiliation(s)
- Venkatachalam Raveenthiran
- Division of Pediatric Surgery, Rajah Muthiah Medical College, Annamalai University, Chidambaram, Tamilnada, India.
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Howard J, Thomas VJ, Rawle H, Cartwright R, Westerdale N. Quality of life and pain management in sickle-cell disease. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17455111.2.3.377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sickle-cell disease is the most common genetic disorder worldwide and is characterized by intermittent severe painful episodes and other complications such as stroke, priapism, cholecystitis and acute chest syndrome. This review outlines the causes and characteristics of pain in children with sickle cell disease, how pain can be assessed and how painful episodes can be prevented. Sickle cell disease can have a significant impact on the patient’s quality of life, and the ways in which this can manifest, how it can be measured and how interventions such as cognitive behavioral therapy can be used to manage it are outlined. Medical management of acute painful episodes both in the community and in the hosptial setting are discussed, including the role of different analgesic and adjuvant agents. Prevention of painful episodes with hydroxycarbamide is discussed.
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Affiliation(s)
- J Howard
- St Thomas’ Hospital, Department of Haematology, London SE1 7EH, UK
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Roberts J, Isenberg DL. Adrenergic crisis after penile epinephrine injection for priapism. J Emerg Med 2008; 36:309-10. [PMID: 18353597 DOI: 10.1016/j.jemermed.2007.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 10/04/2007] [Indexed: 10/22/2022]
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Addis G, Spector R, Shaw E, Musumadi L, Dhanda C. The physical, social and psychological impact of priapism on adult males with sickle cell disorder. Chronic Illn 2007; 3:145-54. [PMID: 18083669 DOI: 10.1177/1742395307081505] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Priapism is defined as prolonged and painful penile erection that does not subside on orgasm. It is considered to be a urological emergency. However, patients do not always seek prompt medical help. The incidence of priapism is increased by sickle cell disease, where it is a complication of the characteristic sickling of the red blood cells. Little is known about the psychological or social implications of this complication or the strategies that sickle cell patients use to manage it. A qualitative study was carried out in order to investigate these topics. Semi-structured interviews were carried out with adult male patients of the Sickle Cell and Thalassaemia Centre in Birmingham in the UK who experienced priapism. These were subsequently analysed using grounded theory. Ten themes were elicited: first occurrence of priapism, pain, precipitants, emotional consequences, self-management, experience of hospital, impact on work and social life, impact on sexual relationships, erectile dysfunction, and disclosure. The dominant experiences were ones of despair, embarrassment, and isolation. Participants described finding it difficult to disclose priapism, with the result that it was often unreported until late in its course. Attempts to manage priapism at home varied, with there being little consensus on their efficacy. The results are discussed with respect to the healthcare services that cater for these patients.
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Affiliation(s)
- Gulen Addis
- Sandwell and West Birmingham Hospitals Sickle Cell and Thalassaemia Centre, City Hospital, Birmingham, B18 7QH, UK.
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Towbin R, Hurh P, Baskin K, Cahill AM, Carr M, Canning D, Snyder H, Kaye R. Priapism in children: treatment with embolotherapy. Pediatr Radiol 2007; 37:483-7. [PMID: 17415602 DOI: 10.1007/s00247-007-0441-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Revised: 02/15/2007] [Accepted: 02/19/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Priapism is defined as involuntary, prolonged penile erection caused by factors other than sexual arousal, and is classified as either low-flow or high-flow. Embolotherapy is an accepted form of therapy in adults with high-flow priapism. Because the differences in etiology, management and outcome are significant, accurate and timely diagnosis is imperative. OBJECTIVE The purpose of this report is to present our experience with embolotherapy for treatment of high-flow priapism in three children. PATIENTS AND METHODS This was a retrospective study. During an 18-month period, three boys ranging in age from 6 to 15 years presented with priapism. All three children were treated with embolotherapy. RESULTS All three children were successfully treated with angiography and embolotherapy. One boy had a presentation that initially raised the possibility of low-flow priapism. No complications occurred, and to date all children are able to maintain normal erections. CONCLUSION Subselective transcatheter embolization is the procedure of choice for high-flow priapism. In cases where priapism persists despite adequate therapy, angiography might be useful to exclude high-flow disease. In children with high-flow priapism, selective occlusion of the penile arteriovenous fistula led to detumescence and normal erectile function.
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Affiliation(s)
- Richard Towbin
- Children's Hospital of Philadelphia, Philadelphia, PA 19103, USA.
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Age Factors
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/therapeutic use
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Anemia, Sickle Cell/complications
- Anemia, Sickle Cell/diagnosis
- Anemia, Sickle Cell/drug therapy
- Anemia, Sickle Cell/epidemiology
- Anemia, Sickle Cell/genetics
- Anemia, Sickle Cell/physiopathology
- Anemia, Sickle Cell/therapy
- Antibiotic Prophylaxis
- Antisickling Agents/administration & dosage
- Antisickling Agents/therapeutic use
- Blood Transfusion
- Child
- Child, Preschool
- Diagnosis, Differential
- Female
- Genotype
- Hematopoietic Stem Cell Transplantation
- Hospitalization
- Humans
- Hydroxyurea/administration & dosage
- Hydroxyurea/therapeutic use
- Ibuprofen/administration & dosage
- Ibuprofen/therapeutic use
- Immunization
- Infant
- Infant, Newborn
- Male
- Morphine/administration & dosage
- Morphine/therapeutic use
- Pain/diagnosis
- Pain/drug therapy
- Pain/etiology
- Pain Measurement
- Penicillins/administration & dosage
- Penicillins/therapeutic use
- Risk Factors
- Stroke/epidemiology
- Stroke/prevention & control
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Rupa Redding-Lallinger
- Division of Hematology/Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
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Burnett AL. Therapy insight: Priapism associated with hematologic dyscrasias. ACTA ACUST UNITED AC 2006; 2:449-56. [PMID: 16474683 DOI: 10.1038/ncpuro0277] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Accepted: 07/12/2005] [Indexed: 11/09/2022]
Abstract
Priapism is defined as a genuine erectile disorder, in which erection persists uncontrollably without sexual purpose. This disorder is often overlooked in comparison to other male sexual dysfunctions, principally because of its seeming rarity. Priapism, however, occurs frequently in certain patient populations, including those with hematologic dyscrasias. Most commonly, priapism affects patients with sickle cell disease. The reported prevalence rate in this group ranges between 29% and 42% of males. The significance of priapism is further emphasized by the fact that this disorder commonly causes erectile tissue damage and leads to the loss of functional erections. These observations highlight the need for proper clinical recognition of priapism in order to enable appropriate management. Here, the current knowledge of priapism as it relates to hematologic and coagulative diseases is discussed, with a focus on the diagnosis and treatment of the disorder.
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Affiliation(s)
- Arthur L Burnett
- Department of Urology, The James Buchanan Brady Urological Institute, Baltimore, MD, USA.
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Abstract
Priapism, an unwanted painful erection of the penis, is a little discussed but common complication of sickle cell disease. What is known about the prevalence of priapism, efficacy of management approaches, and outcome is drawn primarily from retrospective and single-center reports. Priapism occurs in two patterns: prolonged and stuttering (ie, recurrent brief episodes that resolve spontaneously). If priapism persists for 4 hours or more without detumescence, the patient is at risk for irreversible ischemic penile injury, which may terminate in fibrosis and impotence. Large multicenter studies examining the epidemiology and current treatments and well-organized trials of novel therapies are urgently needed for patients who have sickle cell disease and priapism.
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Affiliation(s)
- Zora R Rogers
- Division of Pediatric Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA.
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Lottenberg R, Hassell KL. An Evidence-Based Approach to the Treatment of Adults with Sickle Cell Disease. Hematology 2005:58-65. [PMID: 16304360 DOI: 10.1182/asheducation-2005.1.58] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The application of evidence-based medicine to the management of adults with sickle cell disease (SCD) is currently primarily driven by clinical expertise and patient preference, as there is a paucity of randomized controlled trial (RCT) data to guide decision-making. A summary of SCD management principles in the areas of health care maintenance, transfusion therapy, treatment and prevention of painful episodes, acute chest syndrome, stroke, renal disease, contraception and pregnancy, and priapism is predominantly based on the authors’ interpretation of available observational studies as well as the opinions of experts in SCD. RCTs impacting current practices address use of hydroxyurea to prevent painful episodes and acute chest syndrome, intensity of pre-operative transfusion, transfusion during pregnancy, and angiotensin-converting enzyme inhibitor therapy for proteinuria, but most issues in adult SCD care have not been rigorously studied and management may not be appropriately extrapolated from pediatric data. While challenging clinical problems need to be addressed by RCTs, there is also the need for development of practice guidelines using formal methodological strategies. This brief review is not a substitute for the process but provides a literature-based approach to making treatment decisions when caring for adults with SCD.
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Affiliation(s)
- Richard Lottenberg
- University of Florida College of Medicine, Box 100277 UFHSC, Gainesville, Florida 32610, USA.
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Abstract
With the global scope of sickle-cell disease, knowledge of the countless clinical presentations and treatment of this disorder need to be familiar to generalists, haematologists, internists, and paediatricians alike. Additionally, an underlying grasp of sickle-cell pathophysiology, which has rapidly accrued new knowledge in areas related to erythrocyte and extra-erythrocyte events, is crucial to an understanding of the complexity of this molecular disease with protean manifestations. We highlight studies from past decades related to such translational research as the use of hydroxyurea in treatment, as well as the therapeutic promise of red-cell ion-channel blockers, and antiadhesion and anti-inflammatory therapy. The novel role of nitric oxide in sickle-cell pathophysiology and the range of its potential use in treatment are also reviewed. Understanding of disease as the result of a continuing interaction between basic scientists and clinical researchers is best exemplified by this entity.
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Affiliation(s)
- Marie J Stuart
- Department of Pediatrics, Division of Hematology, the Marian Anderson Sickle Cell Anemia Research Hematology Laboratories, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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