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Almekaty K, Taha AE, Ragab M, Ibrahim IM, Rashed A, Eid A, Moubasher A, Zahran MH. The relationship between Coronavirus Disease-19 (COVID-19) and ischemic priapism: a case-control study. Int J Impot Res 2024:10.1038/s41443-024-00929-z. [PMID: 38862624 DOI: 10.1038/s41443-024-00929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
This multicentre retrospective study was conducted in 3 university hospitals in Egypt between April 2020 and June 2022. The aim was to assess the relation between Coronavirus Disease-19 (COVID-19) and ischemic priapism. Forty-three ischemic priapism patients were diagnosed and divided into two groups (30 in group I with ischemic priapism only, and 13 in group II with both ischemic priapism and COVID-19). Further sub-classification of COVID-19 patients according to the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection severity was done. Cavernosal aspiration was successful in 25 patients (83.3%) in group I and 12 (92.3%) in group II. Long term follow-up proved moderate to severe erectile dysfunction in 6 patients (20.0%) and 1 (7.7%) in group I and II, respectively. All those with severe erectile dysfunction were managed by distal shunt and prepared for penile prosthesis placement. The median duration of ischemic priapism was significantly longer in patients with severe erectile dysfunction [19 vs. 7 h, P = 0.01]. There was no statistically significant difference between both groups regarding patients' age (p = 0.8), required priapism management (p = 0.4), priapism recurrence (p = 0.1), and erectile dysfunction severity (p = 0.5). Ischemic priapism in COVID-19 patients can occur not only in severe, but also in mild or even asymptomatic cases. COVID-19 did not influence the ischemic priapism treatment protocol and post-treatment erectile function. COVID-19 and ischemic priapism seem to have a coincidence relation rather than a causal.
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Affiliation(s)
- Khaled Almekaty
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed E Taha
- Microbiology and Immunology Unit, Department of Pathology, College of Medicine, Jouf University, Sakaka, 72388, Saudi Arabia.
| | - Maged Ragab
- Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Ayman Rashed
- Urology Department, 6th of October University, 6th of October, Egypt
| | - Ahmed Eid
- Emergency and Traumatology Department, Tanta University, Tanta, Egypt
| | - Amr Moubasher
- Dermatology and Andrology Department, Assiut University, Assiut, Egypt
- Urology Department, St George's Hospital, London, UK
| | - Mohamed H Zahran
- Mansoura Urology and nephrology center, Mansoura University, Mansoura, Egypt
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Tristão LS, Bresler R, Modesto VA, Fernandes RDC, Bernardo WM. Urological complications of COVID-19: a systematic review. Int Braz J Urol 2022; 49:24-40. [PMID: 36512453 PMCID: PMC9881803 DOI: 10.1590/s1677-5538.ibju.2022.0281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/29/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE COVID-19 continues to be an urgent World issue. Receptors of angiotensin converting enzyme 2 (ACE2), gateway of SARS-CoV-2, are present in the lungs, bladder, prostate, and testicles. Therefore, these organs face high risk of damage caused by the virus and this mechanism may explain non-respiratory symptoms of the disease. MATERIALS AND METHODS This systematic review, guided by the PRIMSA statement, was proposed to elucidate possible urological complications of COVID-19. Searches were carried out in Medline (PubMed), Cochrane (CENTRAL), Embase, MedRxiv and LILACS. Bias analysis was made using the specific Newcastle-Ottawa Scale for each study design. RESULTS Search was carried out until April 2022, and 8,477 articles were identified. Forty-nine of them were included in this systematic review. There is evidence that lower urinary tract symptoms and acute scrotum may be signs of COVID-19 in men, although in a small proportion. Also, the disease may have a transitory impact on male fertility, evidenced by several alterations in sperm counts. However, it must be clarified whether this impact is transitory, or may last for longer periods. Several patients showed reduction of total value of testosterone. Two authors linked low levels of testosterone with worse outcomes of COVID-19, suggesting that the hormone may be used as an early biomarker of the severity of the disease. Moreover, it is extremely unlikely that SARS-CoV-2 is transmitted by semen. CONCLUSION This systematic review identified possible repercussions of COVID-19 in the urinary as well as in the male reproductive system.
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Affiliation(s)
- Luca Schiliró Tristão
- Faculdade de Ciências Médicas de SantosDepartamento de Medicina Baseada em EvidênciasSantosSPBrasilDepartamento de Medicina Baseada em Evidências, Faculdade de Ciências Médicas de Santos (FCMS-UNILUS), Santos, SP, Brasil,Correspondence address: Luca Schiliró Tristão, MD, Departamento de Medicina Baseada em Evidências, Faculdade de Ciências Médicas de Santos – UNILUS, R. Oswaldo Cruz, 179 – Boqueirão Santos, SP, 11045-101, Brasil. Telephone: +5511 9 6915-6070 E-mail:
| | - Rafael Bresler
- Faculdade de Ciências Médicas de SantosDepartamento de Medicina Baseada em EvidênciasSantosSPBrasilDepartamento de Medicina Baseada em Evidências, Faculdade de Ciências Médicas de Santos (FCMS-UNILUS), Santos, SP, Brasil
| | - Victoria Andrade Modesto
- Faculdade de Ciências Médicas de SantosDepartamento de Medicina Baseada em EvidênciasSantosSPBrasilDepartamento de Medicina Baseada em Evidências, Faculdade de Ciências Médicas de Santos (FCMS-UNILUS), Santos, SP, Brasil
| | - Roni de Carvalho Fernandes
- Divisão de UrologiaSanta Casa de São PauloSão PauloSPBrasilDivisão de Urologia, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Wanderley Marques Bernardo
- Faculdade de Ciências Médicas de SantosDepartamento de Medicina Baseada em EvidênciasSantosSPBrasilDepartamento de Medicina Baseada em Evidências, Faculdade de Ciências Médicas de Santos (FCMS-UNILUS), Santos, SP, Brasil,Faculdade de Medicina da Universidade de São PauloDepartamento de Medicina Baseada em EvidênciasSão PauloSPBrasilDepartamento de Medicina Baseada em Evidências, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Connelly ZM, Whitaker D, Dullea A, Ramasamy R. SARS-CoV-2 Effects on the Male Genitourinary System. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2022; 10:199-209. [PMID: 36051611 PMCID: PMC9428573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
SARS-CoV-2 infection arose in 2019 and has changed life as we know it. With our ever-advancing knowledge, therapies, and vaccines, more functions of the SARS-CoV-2 virus are being investigated outside of its pulmonary invasion. Here, we set out to review the current and pertinent literature on the impact of SARS-CoV-2 on the male genitourinary system including the bladder, lower urinary tract, prostate, testis, and penis. The biggest newsworthy stake was if SARS-CoV-2 could be transmitted through semen. Although initially thought to occur, more recent studies have opposed this hypothesis. Outside of the reproductive spread of SARS-CoV-2, multiple studies in this review highlight where the virus resides and what effect it may be having on this genitourinary system including increased voiding problems, viral persistence months after systemic clearance, and rare penile complications post-infection. Long-term outcomes are still needed to fully understand how SARS-CoV-2 infection can alter the genitourinary system.
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Affiliation(s)
- Zachary M Connelly
- Department of Surgery, Louisiana State University Health ShreveportShreveport, LA, USA
| | - Dustin Whitaker
- Department of Urology, University of Tennessee KnoxvilleKnoxville, TN, USA
| | | | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of MedicineMiami, FL, USA
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Mascarenhas L, Hron D, Cleveland B, Dahm P, Boothby A. SARS-CoV-2: A Novel Precipitant of Ischemic Priapism. Fed Pract 2022; 39:e0286. [PMID: 36425347 PMCID: PMC9648577 DOI: 10.12788/fp.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Priapism is a disorder that occurs when the penis maintains a prolonged erection in the absence of appropriate stimulation. Conditions that result in hypercoagulable states and hyperviscosity are associated with ischemic priapism. COVID-19 is increasingly associated with coagulopathy. To date, there are 6 reported cases of priapism occurring in patients with COVID-19, 5 occurring in the setting of critical illness. CASE PRESENTATION We present a case of ischemic priapism which we suspect resulted from COVID-19-associated coagulopathy in a patient without severe COVID-19 presentation. CONCLUSIONS Although there have been only a handful of reported cases of COVID-19-associated coagulopathy leading to ischemic priapism, it is possible that the true incidence is much higher. While our case highlights the importance of considering COVID-19 infection in the differential diagnosis of ischemic priapism, more research is needed to understand incidence and definitively establish a causative relationship.
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Affiliation(s)
| | | | | | - Philipp Dahm
- Minneapolis Veterans Affairs Medical Center, Minnesota
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Malinga DM, Laher AE, McDowall J, Adam A. Coronavirus disease 2019 (COVID-19) and priapism: An unexplored association. Curr Urol 2022; 16:55-62. [PMID: 35789564 PMCID: PMC9245531 DOI: 10.1097/cu9.0000000000000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/16/2022] [Indexed: 01/11/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has an established impact on multiple organ systems, including the vascular and urogenital systems. Vascular effects may include venous thromboembolic disease, which could theoretically be a precursor to priapism-a urological emergency defined as an abnormal condition of prolonged penile erection lasting >4 hours. To better explore this association, we critically appraised all the published COVID-19 cases associated with priapism. Materials and methods After PROSPERO registration (CRD42021245257), a systematic search of Google Scholar, Scopus, Embase, Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Index Medicus, and Cochrane Database of Systematic Reviews was performed using specific search terms. The following study metadata were extracted: age, requirement for respiratory support, cavernous blood gas findings, management of priapism, and patient outcomes. Results Fifteen single-patient case reports were included in this review. Of these, all of the patients presented with ischemic priapism, 9 patients (60.0%) were >60 years of age, 4 (26.7%) reported more than a single episode of priapism, 11 (73.3%) presented with pneumonia, 8 (53.3%) required mechanical ventilation, D-dimer was elevated in 5 of the 6 (83.3%) patients in whom this was reported, and among the 13 patients in whom mortality was reported, 4 (30.8%) died. Conclusions Early reports suggest a prognostic relationship between COVID-19 and coexisting priapism. However, owing to commonalities in their pathophysiology and the small dataset reported in the literature, the probable association between COVID-19 and priapism is still theoretical. Further research is needed to confirm this association.
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Affiliation(s)
- Dominic Mpumelelo Malinga
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdullah E. Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jared McDowall
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ahmed Adam
- Division of Urology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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De Rose AF, Ambrosini F, Genova Gaia L, Mantica G, Terrone C. Ischemic Priapism During Severe SARS-CoV-2 Infection: A Case Report and Literature Review. Res Rep Urol 2022; 14:259-263. [PMID: 35769197 PMCID: PMC9236573 DOI: 10.2147/rru.s369221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Case Presentation Conclusion
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Affiliation(s)
| | - Francesca Ambrosini
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Correspondence: Francesca Ambrosini, Department of Urology - Policlinico San Martino Hospital, University of Genoa, Largo Rosanna Benzi, 10, Genoa, 16132, Italy, Tel +39 3480497079, Email
| | | | | | - Carlo Terrone
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Ischemic Priapism Progressing to Penile Gangrene in a Patient with COVID-19 Infection: A Case Report with Literature Review. Case Rep Med 2022; 2022:8408216. [PMID: 35178095 PMCID: PMC8847035 DOI: 10.1155/2022/8408216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/16/2022] [Accepted: 01/26/2022] [Indexed: 01/21/2023] Open
Abstract
Priapism is considered a rare disorder and even more rare when it occurs as a complication of COVID-19. To the best of our knowledge, only eight studies have reported priapism as a complication of COVID-19. Here, we report the case of a 66-year-old male with COVID-19 who presented with neglected priapism for three days. On local examination, penile erection was apparent in association with blackened areas on the glans penis extending to the midpenile shaft denoting penile gangrene. A clear line of demarcation was noticed at the midpenile shaft. Penile duplex was performed, showing no blood flow in both cavernosal arteries. Penile aspiration was performed, and the cavernosal blood sample showed evidence of ischemic priapism. Given the presence of penile gangrene extending to the midshaft of the penis and the poor general condition of the patient, the decision was made to perform partial penectomy and suprapubic tube placement. We recommend the establishment of a guideline for the diagnosis and prevention of thrombotic diseases in patients with COVID-19 infection as there is increasing evidence of COVID-19-related thrombotic manifestations.
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SARS-CoV-2 Infection as a Determining Factor to the Precipitation of Ischemic Priapism in a Young Patient with Asymptomatic COVID-19. Case Rep Urol 2021; 2021:9936891. [PMID: 34306794 PMCID: PMC8272654 DOI: 10.1155/2021/9936891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/26/2021] [Indexed: 01/13/2023] Open
Abstract
COVID-19 is a disease characterized by respiratory distress, systemic inflammation, multiple organ dysfunction and coagulation disorders, chiefly pulmonary embolism, and deep venous thrombosis. In this case report, we discuss a peculiar case of ischemic priapism in a 36-year-old patient with asymptomatic COVID-19 and no other plausible causes of thrombophilia and/or alternative causes of priapism, as well as discussing possible explanations for such remarkable findings and comparing them to analogous cases recorded in literature. The patient was unsuccessfully treated via cavernous blood aspiration and required several shunting procedures, with no further recurrences and negative testing for pulmonary embolism, deep venous thrombosis, and other causes of thrombophilia.
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