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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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Katwal S, Ghimire A, Paudel P, Khatiwada B. Traumatic cavernosal artery pseudoaneurysm: a rare cause of erectile dysfunction following pelvic trauma: a case report and comprehensive literature review. Ann Med Surg (Lond) 2024; 86:4222-4226. [PMID: 38989200 PMCID: PMC11230753 DOI: 10.1097/ms9.0000000000002178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/08/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction and importance Erectile dysfunction (ED) resulting from pelvic trauma, particularly cavernosal artery pseudoaneurysm, poses a complex clinical challenge. Traumatic injuries, including blunt force trauma, can lead to diverse vascular complications affecting erectile function. Recognizing and addressing these issues is pivotal for optimal patient management. Case presentation A 40-year-old male presented with gradual-onset ED following a traumatic incident, involving a fall from a bike and subsequent hematoma on the penile shaft. Despite initial successful conservative management, the patient experienced recurrent symptoms. Comprehensive evaluation, including ultrasonography and computed tomography (CT) angiography, revealed a cavernosal artery pseudoaneurysm. The diagnostic journey involved Doppler ultrasound and penile arteriography, confirming the arteriogenic etiology. Clinical discussion Pelvic trauma, a common cause of erectile dysfunction in men under 40, can lead to cavernosal arterial injuries and pseudoaneurysms. This condition often results from blunt perineal trauma or iatrogenic factors, requiring precise diagnostic tools like Doppler ultrasound and penile arteriography. Treatment options include coil embolization and Gelfoam application, emphasizing the importance of timely intervention. Conclusion Successful angiography and coil embolization yielded significant improvement in symptoms for the presented case. This underscores the critical role of accurate diagnosis and tailored interventions in addressing cavernosal artery pseudoaneurysms resulting from pelvic trauma, thereby enhancing patient outcomes and quality of life.
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Affiliation(s)
- Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura
| | | | | | - Bidur Khatiwada
- Department of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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3
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Leong JY, Prebay ZJ, Ebbott D, Li M, Chung PH. Evaluating the management trends for priapism and assessing the risk of priapism after in-office intracavernosal injections: a cross-sectional analysis. Int J Impot Res 2024:10.1038/s41443-024-00861-2. [PMID: 38448610 DOI: 10.1038/s41443-024-00861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024]
Abstract
We describe the management trends of patients suffering from any priapism and evaluate the risks of developing priapism after intracavernosal injections (ICI) performed in office. We queried TriNetX for two separate male adult cohorts - those presenting with any priapism based on International Classification of Disease code, N48.3 (priapism) and those who underwent ICI in office based on Current Procedural Terminology code, 54235 (injection of corpora cavernosa with pharmacologic agent[s]). We evaluated treatment options for these patients after any priapism and described demographic risks for developing priapism after ICI performed in office. There were 17,545 priapism encounters and 26,104 usages of ICI in the office. Most common treatment for any priapism was corporal irrigation/injection of medications (11.3%). Patients presenting with priapism after ICI were younger (age > 65 years, OR 0.44 [95% CI 0.38-0.51], p < 0.01) and had a higher prevalence of mood disorders (20% vs 14%), behavioral disorders (7% vs 2%) and sickle cell disease (6% vs <1%). They were less likely to have diabetes (14% vs 22%), hypertension (33% vs 40%), prostate cancer (13% vs 25%) or have taken sildenafil or tadalafil (29-30% vs 35-38%). For patients administering ICI, proper screening and counseling of priapism is important to reduce complications.
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Affiliation(s)
- Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Zachary J Prebay
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - David Ebbott
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Li
- Center for Digital Health and Data Science, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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4
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Milenkovic U, Cocci A, Veeratterapillay R, Dimitropoulos K, Boeri L, Capogrosso P, Cilesiz NC, Gul M, Hatzichristodoulou G, Modgil V, Russo GI, Tharakan T, Omar MI, Bettocchi C, Carvalho J, Yuhong Y, Corona G, Jones H, Kadioglu A, Martinez-Salamanca JI, Verze P, Serefoglu EC, Minhas S, Salonia A. Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism: a systematic review by the EAU Sexual and Reproductive Health Guidelines panel. Int J Impot Res 2024; 36:36-49. [PMID: 36151318 DOI: 10.1038/s41443-022-00604-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/13/2022] [Accepted: 07/28/2022] [Indexed: 11/09/2022]
Abstract
Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an arterial fistula and embolisation may be required. We conducted a systematic review on behalf of the EAU Sexual and Reproductive health Guidelines panel to analyse the available evidence on efficacy and safety of surgical modalities for IP and NIP. Outcomes were priapism resolution, sexual function and adverse events following surgery. Overall, 63 studies (n = 923) met inclusion criteria up to September 2021. For IP (n = 702), surgery comprised distal (n = 274), proximal shunts (n = 209) and penile prostheses (n = 194). Resolution occurred in 18.7-100% for distal, 5.7-100% for proximal shunts and 100% for penile prostheses. Potency rate was 20-100% for distal, 11.1-77.2% for proximal shunts, and 26.3-100% for penile prostheses, respectively. Patient satisfaction was 60-100% following penile prostheses implantation. Complications were 0-42.5% for shunts and 0-13.6% for IPP. For NIP (n = 221), embolisation success was 85.7-100% and potency 80-100%. The majority of studies were retrospective cohort studies. Risk of bias was high. Overall, surgical shunts have acceptable success rates in IP. Proximal/venous shunts should be abandoned due to morbidity/ED rates. In IP > 48 h, best outcomes are seen with penile prostheses implantation. Embolisation is the mainstay technique for NIP with high resolution rates and adequate erectile function.
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Affiliation(s)
- U Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - A Cocci
- Department of Urology, University of Florence, Florence, Italy
| | | | - K Dimitropoulos
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - L Boeri
- Department of Urology, IRCCCS Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Capogrosso
- ASST-Sette Laghi, Circolo & Fondazione Macchi Hospital, University of Insurbria, Varese, Italy
| | - N C Cilesiz
- Department. of Urology, Istanbul Taksim GOP Training and Research Hospital, Istanbul, Turkey
| | - M Gul
- Department of Reproductive Biology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - V Modgil
- Department of Urology, Manchester Royal Infirmary, Manchester, UK
| | - G I Russo
- Department of Urology, University of Catania, Catania, Italy
| | - T Tharakan
- Department of Urology, Charing Cross Hospital, London, UK
| | - M I Omar
- Department of Urology, University of Aberdeen, Abderdeen, UK
| | - C Bettocchi
- Department of Urology, University of Foggia, Foggia, Italy
| | - J Carvalho
- Department of Psychology and Health Sciences, Universidade Lusofona de Humanidades e Tecnologias, Lisbon, Portugal
| | - Y Yuhong
- Department of Medicine, McMaster University, Hamilton, Canada
| | - G Corona
- Department of Endocrinology, Maggiore-Bellaria Hospital, Bologna, Italy
| | - H Jones
- Department of Endocrinology, Barnsley Hospital, Barnsley, UK
| | - A Kadioglu
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - J I Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - P Verze
- Department of Urology, University Federico II of Naples, Naples, Italy
| | - E C Serefoglu
- Department of Urology, Bahceci Health Group, Istanbul, Turkey
| | - S Minhas
- Department of Urology, Imperial College, London, UK
| | - A Salonia
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.
- University Vita-Salute San Raffaele, Milan, Italy.
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Capogrosso P, Dimitropolous K, Russo GI, Tharakan T, Milenkovic U, Cocci A, Boeri L, Gül M, Bettocchi C, Carvalho J, Kalkanlı A, Corona G, Hatzichristodoulou G, Jones HT, Kadioglu A, Martinez-Salamanca JI, Modgil V, Serefoglu EC, Verze P, Salonia A, Minhas S. Conservative and medical treatments of non-sickle cell disease-related ischemic priapism: a systematic review by the EAU Sexual and Reproductive Health Panel. Int J Impot Res 2024; 36:6-19. [PMID: 35995858 DOI: 10.1038/s41443-022-00592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
Conservative and medical treatments are considered the first step in ischemic priapism (IP) management, although there is no clear evidence regarding their efficacy. We conducted a systematic review on behalf of the EAU Guidelines panel on Sexual and Reproductive health to analyse the available evidence on the efficacy and safety of conservative and medical treatment for non-sickle cell disease-related IP. Databases searched for relevant literature investigating efficacy and safety of conservative measures and medical treatment for IP included Medline, EMBASE, Cochrane Libraries and clinicaltrial.gov published up to September 2021. Overall, 41 retrospective, 3 prospective single-arm studies and 3 randomized controlled trials met the inclusion criteria. Intracavernous injection with sympathomimetic (ICIs) agents were the most frequently utilized treatment with efficacy ranging from 0 to 100% of cases. The combination of ICIs with corporeal aspiration with or without irrigation with saline was successful in 70 to 100% of cases. Oral treatment with β2 receptor agonist (e.g., terbutaline) showed mild to moderate efficacy. Conservative methods including ice pack, exercise, cold enema and ejaculation depicted lower effectiveness in resolving priapism (1-55%). Longer time interval from the onset to the resolution of IP was associated with higher rate of erectile dysfunction at follow-up (30-70%), especially after 24 h.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Kostas Dimitropolous
- Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Tharu Tharakan
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, UK
- Section of Investigative Medicine, Department of Medicine, Imperial College London, London, UK
| | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Andrea Cocci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Murat Gül
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | | | - Joana Carvalho
- CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal
| | - Arif Kalkanlı
- Department of Urology, Taksim Training & Research Hospital, Instanbul, Turkey
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | | | - Hugh T Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK
| | - Ates Kadioglu
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Juan Ignacio Martinez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda. Lyx Institute of Urology. Universidad Francisco de Vitoria, Madrid, Spain
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Paolo Verze
- Department of Medicine and Surgery "Scuola Medica Salernitana", University of Salerno, Fisciano, Campania, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy.
- University Vita-Salute San Raffaele, Milan, Italy.
| | - Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, UK
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6
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Uzair M, Waheed T, Imran M, Ali S, Ali A, Habib M. Priapism in children: an experience of the modified Winter procedure. Int Urol Nephrol 2023; 55:3015-3020. [PMID: 37542596 DOI: 10.1007/s11255-023-03728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Priapism in children is a rare disease, which seldom presents during the pediatric surgery practice. It is, however, a surgical and urological emergency. Early diagnosis and prompt management can prevent the devastating sequelae of this potentially fatal condition. MATERIALS AND METHODS A prospective study was conducted between March 1st, 2007 and February 28th, 2019 at the Department of Pediatric Surgery, Khyber Teaching hospital, Peshawar. All the patients between 3 and 15 years of age, with the diagnosis of priapism, were enrolled in the study with ethical approval. RESULTS A total of ten patients were enrolled in the study period from March 1st, 2007 to February 28th, 2019. The age ranged between 3 and 15 years and the mean age of presentation was 8 years. The mean duration of symptoms was 4 h. The mean hospital stay was 4 days. The modified Winter procedure by creating a corporoglanular shunt was performed in all cases. Successful detumescence was achieved in eight patients, while two patients needed further detumescence and manual evacuation. Symptomatic relief was achieved in all the children. CONCLUSION Priparism in children is a rare urological emergency that can lead to permanent erectile dysfunction if prompt medical intervention is not done. The modified Winter procedure technically is a less invasive procedure to achieve satisfactory clinical outcome in terms of achieving good erectile functions.
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Affiliation(s)
- Muhammad Uzair
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Tariq Waheed
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Muhammad Imran
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Sajjad Ali
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Amjad Ali
- Department of Paediatric Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Murad Habib
- Department of Paediatric Surgery, The Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
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van der Velde MGAM, Tiellemans SMB, de Lil H, Nieuwenhuizen L. The value of leukapheresis for treatment of priapism as presenting feature of chronic myeloid leukemia-Case report and review of literature. EJHAEM 2022; 3:1100-1115. [PMID: 36467799 PMCID: PMC9713041 DOI: 10.1002/jha2.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 06/17/2023]
Abstract
Priapism is a rare presenting feature of chronic myeloid leukemia (CML) in male patients. Treatment aims to relieve symptoms and to prevent erectile dysfunction. Several treatment modalities exist, however no standard treatment is recommended. We evaluated literature concerning different treatment approaches and evaluate the value of leukapheresis in treatment of priapism. The literature search resulted in 57 included articles, consisting of 53 studied patients. Patients had a mean age of 25.3 years, average time from onset to presentation at the hospital was 2 days, and mean white blood cell (WBC) count was 344 × 109/L. Most patients (67.9%) were treated with a combined approach (different modalities were radiological, urological, and oncological treatment). Twelve patients, with a mean WBC count of 365 × 109/L, received leukapheresis. Only two of them reported erectile dysfunction after treatment. Priapism is an urological emergency requiring urgent multidisciplinary treatment. We highlight the importance of local urological therapy combined with systemic therapy for CML. Therapeutic leukapheresis should be applied when available and with no other contraindications.
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Affiliation(s)
- Marleen G. A. M. van der Velde
- Department of Internal MedicineMáxima MCVeldhoven/EindhovenThe Netherlands
- Department of Health Services ResearchCAPHRI School for Public Health and Primary CareAging and Long Term Care, MaastrichtLimburgThe Netherlands
| | | | - Heleen de Lil
- Department of Internal MedicineMáxima MCVeldhoven/EindhovenThe Netherlands
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8
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Rahoui M, Ouanes Y, Kays C, Mokhtar B, Mrad Dali K, Sellami A, Ben Rhouma S, Nouira Y. Erectile function outcomes following surgical treatment of ischemic priapism. Ann Med Surg (Lond) 2022; 77:103696. [PMID: 35638068 PMCID: PMC9142696 DOI: 10.1016/j.amsu.2022.103696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
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9
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Sudyka J, Wick JY. Treating Erectile Dysfunction with Prescription Medications & Natural Products: A Pharmacist's Guide. Sr Care Pharm 2021; 36:632-644. [PMID: 34861904 DOI: 10.4140/tcp.n.2021.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Stigma surrounding erectile dysfunction creates a difficult environment for appropriate management. Knowledge of the condition and treatment options presents a unique opportunity for pharmacists to optimize a safe and affordable plan that meets patient needs.
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KÖLÜKÇÜ E, PARLAKTAŞ BS, ULUOCAK N, DERESOY F, KATAR M, UNSAL V. Dapsone can be a new treatment option for reducing the detrimental effect of priapism. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.963439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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11
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Masterson JM, Zhao H, Choi E, Kim HH, Anger JT. Characteristics and Long Term Follow up of Men Who Suffer Ischemic Priapism Secondary to Recreational Use of Intracavernosal Injectable Medications. Urology 2021; 156:163-168. [PMID: 34273403 DOI: 10.1016/j.urology.2021.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/01/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To better understand patient experience, risk factors, culture, and ED outcomes surrounding recreational ICI use that led to ischemic priapism. METHODS After IRB approval, men presenting for ischemic priapism secondary to recreational ICI use from January 2010 to December 2018 were contacted by mail and then via telephone. Standardized questions were asked of all study participants on the topics of erectile function (IIEF-5), sexual practices, and at-risk behavior at the time of priapism. Qualitative data analysis was performed using grounded theory methodology. RESULTS 14 men age 24-59 were successfully recruited. All men described themselves as men having sex with men (MSM) and one (7.1%) as having both male and female sexual partners. Average follow up IIEF-5 among participants was 13 (SD 4.0). Eleven men (78.6 %) described illicit drug use at the time of priapism. Qualitative data analysis yielded several preliminary themes: concomitant drug use, naivety, peer pressure, and delay in seeking treatment. Men frequently reported illicit drug use in group sex scenarios and ICI use under pressure to perform sexually or to counteract effects of illicit substances. CONCLUSIONS Recreational ICI in this cohort was part of a lifestyle of risky behavior. Methamphetamine use and group sex encounters strongly motivate recreational ICI use. Substance abuse centers may offer an entry point into this population for counseling and primary prevention.
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Affiliation(s)
- John M Masterson
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hanson Zhao
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Eunice Choi
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Howard H Kim
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
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12
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Baumgarten AS, VanDyke ME, Yi YA, Keith CG, Fuchs JS, Ortiz NM, Cordon BH, Pagliara TJ, Ward EE, Jaderlund JW, Teeple CS, Christine BS, Yafi FA, Hudak SJ, Morey AF. Favourable multi‐institutional experience with penoscrotal decompression for prolonged ischaemic priapism. BJU Int 2020; 126:441-446. [DOI: 10.1111/bju.15127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Adam S. Baumgarten
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Maia E. VanDyke
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Yooni A. Yi
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Christopher G. Keith
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Joceline S. Fuchs
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Nicolas M. Ortiz
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Billy H. Cordon
- Division of Urology Mount Sinai Medical Center Miami Beach FLUSA
| | | | - Ellen E. Ward
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | | | | | | | - Faysal A. Yafi
- Department of Urology University of California Irvine Orange CA USA
| | - Steven J. Hudak
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Allen F. Morey
- Department of Urology University of Texas Southwestern Medical Center Dallas TXUSA
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13
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Mishra K, Loeb A, Bukavina L, Baumgarten A, Beilan J, Mendez M, DiGiorgio L, Fu L, Carrion R. Management of Priapism: A Contemporary Review. Sex Med Rev 2020; 8:131-139. [DOI: 10.1016/j.sxmr.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/27/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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14
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Treatment of Priapism Secondary to Drugs for Erectile Dysfunction. Adv Urol 2019; 2019:6214921. [PMID: 31534452 PMCID: PMC6724441 DOI: 10.1155/2019/6214921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/23/2019] [Indexed: 11/18/2022] Open
Abstract
Priapism may present as a side effect in patients treated with medications for erectile dysfunction, in which it should be controlled in a timely manner to avoid complications. There is little information regarding the use of local measures for the treatment of this condition. This study was done with the objective to describe the management of priapism secondary to erectile dysfunction drugs in a cohort of men. Records of emergencies and adverse events were reviewed by two researchers to identify patients diagnosed with erectile dysfunction who received oral or intracavernosal drugs for their illness and presented priapism. Sociodemographic data, clinical background, and information on the duration, management, and evolution of the priapism were extracted. Priapism incidence, percentage of improvement by type of treatment subgroups, and frequency of complications were estimated. 698 patients were treated with PDE-5 inhibitors and 2,135 with intracavernosal drugs. Thirty-one patients (1.4%) reported at least one priapism event during treatment, all with intracavernosal drugs. Treatment with local measures was effective for 10 (32.2%) patients, 1 (3.2%) required terbutaline, 19 (61.2%) used intracavernosal etilefrine, and 1 (3.2%) required drainage and flushing of cavernous bodies. After the priapism episode, 3 (9.6%) patients required an increased dose of the drug in order to achieve satisfactory erection. The results suggest that in men treated for priapism secondary to the use of sexual impotence drugs, initial treatment with local measures and etilefrine can achieve detumescence, decreasing the need for invasive procedures or surgery as a first-line therapy alternative. It is necessary to carry out research studies to confirm this hypothesis.
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Kumar M, Garg G, Sharma A, Pandey S, Singh M, Sankhwar SN. Comparison of outcomes in malignant vs. non-malignant ischemic priapism: 12-year experience from a tertiary center. Turk J Urol 2019; 45:340-344. [PMID: 30817276 DOI: 10.5152/tud.2019.75044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Data on outcome of patients with ischemic priapism (IP) due to malignant causes are scant. In this study, we compared outcome of patients with malignant vs. non-malignant IP in adult North Indian men. MATERIAL AND METHODS We analyzed medical records of patients with IP who presented to a large tertiary care referral center from August 2005 to July 2017. RESULTS Data of 71 patients were analyzed. The median age was 30 years (range 17-65). The average duration of symptoms was 4.39 days (range 1-10). Most common etiology was idiopathic in 29 (40.84%), chronic myeloid leukemia (CML) in 24 (33.80%), and drug-induced in 15 patients. Thirty-eight patients underwent distal shunts, while nine patients underwent proximal shunt procedure. Men with malignant priapism (CML) had significantly lower success rates with interventions, prolonged hospital stay, and higher complications (p<0.05). Most complications after shunt surgery were minor (Clavein grade 1 and 2). After shunt surgery, bleeding at shunt site was observed in 14 cases, and wound infection developed in five patients. Prevalence of erectile dysfunction in patients at follow-up was high. CONCLUSION Men with malignant priapism (CML) had significantly lower success rates with interventions, prolonged hospital stay, and higher complications than men with non-malignant priapism.
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Affiliation(s)
- Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, India
| | - Gaurav Garg
- Department of Urology, King George's Medical University, Lucknow, India
| | - Ashish Sharma
- Department of Urology, King George's Medical University, Lucknow, India
| | - Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, India
| | - Manmeet Singh
- Department of Urology, King George's Medical University, Lucknow, India
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Abstract
INTRODUCTION Priapism is a rare yet time sensitive emergency with potentially significant morbidity. A novel task trainer was developed for corpus cavernosa aspiration and phenylephrine injection. The primary aim of this study was to assess model realism and usefulness for emergency medicine resident procedural education. Secondarily, an assessment of comfort level with the procedure before and after intervention was performed. METHODS A priapism model containing corpus cavernosa and spongiosum analogs was constructed. The models and evaluation forms were pilot tested by faculty and then tested for realism and usefulness in a sample of 49 residents after a brief training session. Secondary end points included resident comfort with cavernosa aspiration before and after the session of the model on a visual analog scale. RESULTS Eight faculty pilot tested the procedure model and evaluated it based on a 5-point scale. They unanimously felt that the model was realistic [mean = 4.4, 95% confidence interval (CI) = 3.8-5.0] and useful for resident education (mean = 4.8, 95% CI = 4.4-5.0). The model was then evaluated for realism and usefulness in 49 residents. The model was felt to be realistic (mean = 4.3, 95% CI = 4.0-4.5) and useful for resident education (mean = 4.6, 95% CI = 4.4-4.8). Residents also noted an improvement in comfort performing the procedure before and after simulation session with the mean visual analog scale rating increasing from 34.3 to 83.8 (P < 0.001). CONCLUSIONS An easily constructed priapism task trainer was felt to be realistic and useful for resident education. Secondarily, use of the model in a simulation session can improve resident comfort in an important and infrequent procedure.
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Daily tadalafil for the chronic phase of stuttering priapism: a case report. BMC Urol 2018; 18:54. [PMID: 29855284 PMCID: PMC5984299 DOI: 10.1186/s12894-018-0368-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Recurrent (stuttering) ischemic priapism is a challenging clinical condition. Frequent recurrences result in frequent hospital admissions whereas treatment with a shunting procedure often results in erectile dysfunction. Case presentation A 22-year-old man with stuttering idiopathic priapism developed erectile dysfunction (IIEF-5 score 12) following a Winter’s shunt; he was given tadalafil, 5 mg/daily, for 6 months. This treatment resulted in progressive restoration of erectile function in the 6 months following the shunt as well as in preventing recurrence of priapic episodes over a 24-month follow-up. Conclusions This is the first report in literature of chronic treatment of stuttering priapism with a phosphodiesterase-5 inhibitor being able not only to prevent recurrent priapic episodes but also to restore erectile function following a Winter’s shunt.
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Abstract
Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature. Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed. Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism. If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.
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Becerra-Pedraza LC, Jiménez-Martínez LE, Peña-Morfin I, Nava-Esquivel R, Villegas-Martínez JA. Priapism as the initial sign in hematologic disease: Case report and literature review. Int J Surg Case Rep 2018; 43:13-17. [PMID: 29414500 PMCID: PMC5907689 DOI: 10.1016/j.ijscr.2017.12.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Priapism is an uncommon sign and sometimes considered a diagnosis challenge into systemic disease; this is defined as ≥4 h continuous penile erection, without sexual stimulation. We state that this work has been reported in line with the SCARE criteria PRESENTATION OF CASE: A Mexican 52-year-old man was brought to the emergency room with priapism of six days of evolution. His medical history reported fatigue and waxy pallor had begun a month ago, the rest of interrogation was unremarked. Hyperleukocitosis (>250,000 cells/ml) was documented on his preoperative evaluation, the initial step was hematology consultation due to malignance suspicion, followed by corpora cavernosa drainage-irrigation and surgery penis shunts. After of procedure, we realized bone marrow aspiration, kariotype and cytogenetic analysis, histopathological and moleculars assay reported myeloid hyperplasia compatible with acute phase CML and Philadelphia translocation t(9:22) (q34;q11.2) with P210 BCR-ABL1 fusion transcriber, patient was discharged with dasatinib for maintenance phase. Actually, he has a satisfactory evolution without relapses. DISCUSSION The majority of reported cases shows the individual importance of hematological diseases in priapism as it is shown in the analysis of the literature of 10 years (2006-2016) that we made. It is imperative to consider the type of priapism, and the genetic and demographic patient aspects due to the early and correct approach improves the short and long term outcome of the hematological patients. CONCLUSION Priapism is an uncommon sign of systemic disease. In the presence of warning signs, malignancy should be considered until proven otherwise.
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Affiliation(s)
| | | | - Iran Peña-Morfin
- Department of Surgery, IMSS HGZ/MF 1, La Paz Baja California Sur, México
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Reddy AG, Alzweri LM, Gabrielson AT, Leinwand G, Hellstrom WJG. Role of Penile Prosthesis in Priapism: A Review. World J Mens Health 2018; 36:4-14. [PMID: 29299902 PMCID: PMC5756805 DOI: 10.5534/wjmh.17040] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 12/23/2022] Open
Abstract
Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.
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Affiliation(s)
- Amit G Reddy
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Laith M Alzweri
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Andrew T Gabrielson
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Gabriel Leinwand
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA.
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ASGARI SA, ROSTAMI S, TEIMOORI M. Leech Therapy for Treating Priapism: Case Report. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:985-988. [PMID: 28845411 PMCID: PMC5563882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Priapism is well-defined by persistent, painful penile erection which happens without sexual stimulation. Currently, the hirudotherapy is practiced to treat venous congestion and subsequent compartment syndrome. Here we will report a case of a male with priapism treated by leeches. The case was a 26 yr old young single male referred to the Razi Hospital Emergency Department, Guilan University of Medical Sciences, Rasht, Iran due to long-time spontaneous erections. The patient had no history of mental disorders, trauma or sickle cell anemia. we insert two leeches in each side of penile shaft for two hours, after a one hour break we insert do in same manner for another cycle. At follow-up two days later he had significantly decreased pain, though still had cavernosal swelling and tenderness to palpation. The patient was subsequently discharged after three days of admission. The pain and perineal swelling completely resolved over the course of one month. In this case, chronology indicates that leech therapy was possibly treatment option for priapism. This procedure seems to be non-invasive treatment strategy worth to discussing in such patients.
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Affiliation(s)
- Sayed Aladdin ASGARI
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran,Corresponding Author:
| | - Sadeq ROSTAMI
- Dept. of Urology, Guilan University of Medical Sciences, Rasht, Iran
| | - Mojtaba TEIMOORI
- Dept. of Urology, Guilan University of Medical Sciences, Rasht, Iran
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Ridyard DG, Phillips EA, Vincent W, Munarriz R. Use of High-Dose Phenylephrine in the Treatment of Ischemic Priapism: Five-Year Experience at a Single Institution. J Sex Med 2016; 13:1704-1707. [DOI: 10.1016/j.jsxm.2016.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/03/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
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Yücel ÖB, Salabaş E, Ermeç B, Kadıoğlu A. The Case Report of Priapus and a Modern Approach to an Ancient Affliction. Sex Med Rev 2016; 5:120-128. [PMID: 27687736 DOI: 10.1016/j.sxmr.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/11/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Priapism, taking its name from God Priapus, is total or partial erection lasting longer than 4 hours independent of sexual stimulus and can result in erectile dysfunction. There are three subtypes of priapism. AIM To review the three subtypes of priapism, their pathophysiology, current treatment options, and complications. METHODS The literature including priapism guidelines, review articles, and current trial studies was reviewed and the priapism type of God Priapus was investigated according to the mythology. MAIN OUTCOME MEASURES All three types of priapism were reviewed for etiology, diagnosis, and management. Medical and surgical treatment options were reviewed in relation to the current literature. Special emphasis concerned current treatment strategies and controversial surgical topics. RESULTS Ischemic priapism is the most common type, constituting 95% of all cases, and is an emergency. First-line treatments are blood aspiration and intracavernosal sympathomimetic drug injections. If these fail, then surgical shunt operations are recommended. A T-shunt combined with corporal tunneling is the currently popular option. Immediate penile prosthesis implantation is recommended for patients who present 48 to 72 hours after the onset of a priapism episode. High-flow priapism is caused by irregular arterial cavernosal blood flow, which usually occurs after a blunt perineal trauma. Antiandrogens and selective arterial embolization are the treatment options. Stuttering priapism is repetitive, self-limiting ischemic priapism and frequent in patients with sickle cell anemia. Ketoconazole is safe, cheap, and effective and appears to be a logical and suitable current treatment option to prevent further episodes, which is the primary treatment goal of stuttering priapism. CONCLUSION Priapism is a relatively common condition but not well known by clinicians. The lack and delay of treatment result in irreversible complications such as erectile dysfunction. Each type of priapism should be diagnosed and treated correctly with caution.
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Affiliation(s)
- Ömer Barış Yücel
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Emre Salabaş
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahadır Ermeç
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ateş Kadıoğlu
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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