What Is Priapism?

This JAMA Patient Page describes the diagnosis, prevention, and treatment of priapism.

Priapism in a Young Adult With Sickle Cell Disease

This article presents a case study focusing on priapism in a patient with sickle cell disease, with repeated emergency department (ED) visits and hospitalizations. The patient was successfully identified and treated by the ED nurse practitioner (NP) with aspiration of the corpus cavernosum. Priapism is a persistent penile erection that continues for an extended time. There is some argument about what that length of time is, but generally, the consensus is more than 4 hr beyond sexual stimulation or unrelated to sexual stimulation or sexual interest (Bivalacqua et al., 2022). Priapism is a fairly common but underrecognized complication of sickle cell disease. It represents a urological emergency in which timely diagnosis and appropriate treatment are vital to preserving penile tissue and sexual function. The diagnosis is made clinically with a comprehensive history, physical examination, and appropriate laboratory test values. Initial management can be conservative with hydration and analgesics or, if necessary, more invasive with needle aspiration to promote detumescence. Permanent tissue damage or erectile dysfunction can result if priapism is unrecognized, untreated, or not treated immediately. The NP plays an integral role in treating and preventing permanent damage. Patient education should focus on instructions for preventing priapism and managing episodes at home.

Priapism in children: an experience of the modified Winter procedure

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.

Diagnosis and Management of Priapism

This JAMA Clinical Guidelines Synopsis summarizes the 2022 American Urological Association/Sexual Medicine Society of North America guidelines on diagnosis and management of priapism.

Treatment dilemmas: strategies for priapism, chronic leg ulcer disease, and pulmonary hypertension in sickle cell disease

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.

Priapism in COVID-19: A thromboembolic complication

SARS-CoV-2 (COVID-19) infection is frequently associated with thromboembolic complications. In this case report, we describe the diagnosis and management of priapism as a thromboembolic complication of severe COVID-19.

Neurofibromatosis-1 and Rhabdomyosarcoma: An Unusual Recurrence

Neurofibromatosis-1 has a known increased risk of malignancy with rhabdomyosarcoma occurring in up to 6% of patients. Here we report on an 8-year-old male with a history of Neurofibromatosis-1 and previously treated stage 3, group III bladder/prostate embryonal rhabdomyosarcoma (diagnosed at 18 months old) who presented with penile swelling concerning for priapism. Imaging and subsequent biopsy confirmed embryonal rhabdomyosarcoma of the penile corporal bodies. Penile rhabdomyosarcoma is exceedingly rare, with less than 15 case reports in the literature. Our patient received chemoradiation per D9803 with organ preserving local control and is doing well 3 months after treatment.

[Considerations on priapism]

Priapism is a rare pathological penile erection, and there are some inadequacies in its definition, classification, diagnosis, and therapeutic strategies. In this article, we sum up our years of experience with priapism and put forward some new views and ideas about its definition, classification, pathophysiologic process, pathological change, diagnostic essentials, therapeutic measures, indications of successful treatment, and post-therapeutic rehabilitation of erectile function. We also describe the clinical features, diagnosis and treatment of some special types of priapism, such as intermittent seizure, sleep-related painful erection, and tumor-related priapism, hoping to help urologists and andrologists in the further understanding and management of priapism.

[Priapism is an emergency]

The term priapism describes erections of >4 hours that arise in the absence of or last well beyond sexual stimulation. Ischaemic priapism is the most common form and treatment success is strongly dependent on the duration of priapism. The aetiology is widely variable as a result of which several specialisms can be confronted with this condition. Over the past few years, urologists increasingly have to deal with patients who do not suffer from erectile dysfunction, but nevertheless use intracavernous injections with priapism as a result. These men are often reluctant to see a doctor due to shame and ignorance, which often leads to delayed treatment. According to current guidelines, early prosthesis implantation is recommended if the priapism lasted >36 hours. Treatment of stuttering priapism should be focused on prevention of subsequent episodes. Non-ischaemic priapism generally follows a mild course and can initially be approached conservatively.

Urologic Emergencies

Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney.

Intermittent Projectile Urethraggia: An Unusual Sequela of a Skateboarding Accident in an Adolescent Male

Our patient suffered a perineal straddle injury, resulting in right cavernosal artery pseudoaneurysm in combination with a cavernosal-urethral fistula. The urethra failed to heal after several weeks, and the patient presented with severe intermittent urethral bleeding. The pseudoaneurysm was successfully treated by coil embolization, with resolution of the bleeding. The patient recovered completely, with normal erectile and voiding function. This type of injury is very rare in the literature: traumatic cavernosal arterial pseudoaneurysm is known to cause high flow priapism, but in this case additional cavernosal-urethral fistula resulted in a severe urethraggia. This is the only case, to our knowledge, of delayed urethral bleeding from cavernosal artery pseudoaneursym in combination with a cavernosal-urethral fistula.

Emergency department management of priapism [digest]

Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents. Evidence-based management and appropriate urologic follow-up of nonischemic and recurrent ischemic priapism maximizes patient outcomes and resource utilization. [Points & Pearls is a digest of Emergency Medicine Practice].

Emergency Department Management Of Priapism

Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents. Evidence-based management and appropriate urologic follow-up of nonischemic and recurrent ischemic priapism maximizes patient outcomes and resource utilization.

Priapism of the Newborn - A Case Report

Neonatal Priapism is a rare condition and its causes differ from that in childhood and adult. Management also is challenging as the ultimate goal is the preservation of normal erectile function. Most of the cases are idiopathic. A spontaneous detumescence occurs in majority of cases, so initially conservative non-surgical treatment is advocated. Here we report a case of a newborn presenting with priapism on the 1st day of life. Detumescence was achieved on the 8th day of life with conservative treatment.

Management of priapism in adult men

This study aims to present the management of priapism in adult men in Port Harcourt, Nigeria. All patients who presented with priapism in 2 hospitals in Port Harcourt from July 2007 to April 2014 were prospectively studied. Treatment was assigned based on clinical presentation. Data analyzed included: age on clinical presentation, risk factor, mode, and outcome of management. There were 18 patients aged 17 to 60 years (median age: 30 years). Three patients (16.7%) presented with stuttering priapism. Most of the patients presented after 24 hours of onset. Sixteen patients (89.9%) had hematological disorders. Five patients (27.8%) took suspected aphrodisiac medications. Seven patients (38.9%) were managed conservatively. The rest achieved detumescence following glandulo-cavernous shunting. Erectile function after treatment was satisfactory in 5 patients (27.8%). The commonest cause of priapism in Port Harcourt was hematological disorder. Most of the patients presented late. Prevalence of erectile dysfunction after treatment was high.

[Clinical and therapeutic aspects of priapism at CHU Gabriel Touré: study of 36 cases]

Le priapisme est une érection prolongée douloureuse et irréductible survenant en dehors de toute stimulation sexuelle et n'aboutissant pas à une éjaculation. C'est une urgence urologique. Au Mali, la drépanocytose, une pathologie endémique joue un rôle de premier plan parmi les étiologies. L'objectif de cette étude est d'analyser les aspects cliniques et thérapeutiques du priapisme. Nous avons réalisé une étude rétrospective de type descriptive portant sur 36 cas de priapisme colligés au service d'urologie du CHU Gabriel Touré sur une période de 6 ans et 4 mois. L’âge moyen de nos patients était de 17 ans. Les tranches d’âge les plus représentées étaient comprises entre (11-20 ans) et (21-30 ans) soit 58%. 11 patients soit 31 % avaient eu un antécédent d’érection prolongée; le délai de consultation à partir du premier signe du priapisme était retardé, 31 % des patients étaient venus dans les 24-72h. Sur les 34 patients qui avaient fait l’électrophorèse de l'hémoglobine, 31 patients soit 91 % étaient porteurs d'hémoglobine anormale S et ou C. 32 patients soit 89% de nos patients avaient eu une ponction des corps caverneux. La détumescence a été obtenue le même jour chez 61 % des patients. Chez 11 patients soit 31 %, l’érection était bonne. Le priapisme est une urgence urologique, dont la fréquence est élevée dans la population drépanocytaire. La drépanocytose était la principale cause dans notre pays, tout praticien doit systématiquement y penser avant toute autre étiologie.

The use of color duplex ultrasound and magnetic resonance imaging in the dissolution of idiopathic recurrent priapism in patient with congenital penile curvature--a case report

Priapism, penile erection characterized as prolonged and devoid of sexual stimulation or excitement is a rare condition. It is critical to distinguish between low- and high-flow priapism, because the treatment algorithm differs markedly for these 2 conditions. The diagnosis is made clinically and confirmed with color Doppler ultrasonographic imaging (CDUS). We present a 21 year old men with high-flow priapism and left lateral congenital penile curvature. A duplex Winter shunt procedure was employed with corporeal irrigation of heparin solution and adrenalin solution instillation, but the priapism returned 12 hours after. Following several days slow instillation of phenilephrine or adrenaline solution accompanied by oral flutamide therapy resulted in complete detumescence. We used both CDUS and magnetic resonance imaging (MRI) before and after treatment of priapism. Although CDUS has been the primary modality for cross-sectional imaging of the penis, the superior soft-tissue contrast and spatial resolution afforded by MRI provide an opportunity to advance imaging evaluation of this organ.

High flow priapism: diagnosis and treatment in pediatric population

PURPOSE

To present three cases of arterial high flow priapism (HFP) and propose a management algorithm for this condition.

MATERIALS AND METHODS

We studied three children with post-traumatic arterial HFP (two patients with perineal trauma and one with penis trauma).

RESULTS

Spontaneous resolution was observed in all the patients. The time of resolution by a return to a completely flaccid penis was different: 14, 27 and 36 days in each case.

CONCLUSIONS

Absence of long-term damaging effects of arterial HFP on erectile tissue combined with the possibility of spontaneous resolution associated with blunt perineal trauma are suggestive signs for the introduction of an observation period in the management algorithm of HFP. Such a period may help to avoid unnecessary surgical intervention. Thus, these cases reinforce the decision to manage these patients conservatively and avoid angiographic embolization as a first therapeutic choice.

A rare but significant cause of priapism in the elderly: multiple myeloma

Priapism is a rare symptom with diverse etiological factors. Although most cases in adults are secondary to drug use and intracavernosal injections, blood dyscrasias and hypercoagulable states, vasculitis, penile metastases, neurological conditions, spider bites, carbon monoxide poisoning, and total parenteral nutrition may also result in priapism. We report a case of recurrent and refractory priapism in a 61-year-old man which was diagnosed as multiple myeloma after emergence of hypercalcemia and renal failure due to progression of the underlying pathology. The value of the initial diagnostic approach is emphasized.

Priapism: new concepts in medical and surgical management

Advances have recently been made in both medical and surgical management of priapism, and these offer improvements in the level of care afforded such patients. Further developments can be expected based on ongoing progress, particularly in the area of molecular science, which is the primary source for driving novel therapeutic approaches. Continued action to address the health care administrative concerns of those most commonly affected by priapism, specifically individuals with sickle cell disease, is also appropriate. All successes in these arenas ensure that afflicted individuals avoid the health burdens of priapism and preserve sexual function.

Priapism due to a single dose of quetiapine: a case report

Priapism is characterized by a prolonged and painful erection in the absence of sexual desire and arousal. Priapism is a rare and serious side effect of psychotropic drugs, and is thought to be attributable to blockage of alpha-1 adrenergic receptors in the corpus cavernosum. Although priapism is commonly associated with typical antipsychotics, there are some (but not many) case reports of priapism due to atypical antipsychotics. This side effect has been reported in patients taking ziprasidone, risperidone, clozapine, quetiapine, aripiprazole, and olanzapine. Not all antipsychotics bind to alpha-1 adrenergic receptors with the same intensity; as compared to other antipsychotics, quetiapine has an intermediate affinity. Priapism could be considered an idiosyncratic reaction, because it is correlated neither with the dose nor duration of psychotropic drug use. Herein we present a case of priapism caused by a single 300-mg dose of quetiapine, and a brief review priapism in the light of this case.

Stuttering priapism: case report and bibliographic review

OBJECTIVE

To review the presentation, physiopathology, diagnosis and therapeutic alternatives of stuttering priapism with the contribution of a new clinical case.

METHODS

A 25 year old man, studied in another center for recurrent episodes of priapism for about 18 months. These episodes occur daily, significantly interfering with patient's quality of life.

RESULTS

Initially he was treated with Bicalutamide 50mg/24h with no improvement. Blood test, penile Doppler ultrasound and selective arteriography of pudendal arteries showed no abnormalities. Tadalafil 5mg/24h was given for two months without response. Subsequently were treated with Diazepam 10 mg/24h and Terbutaline 5 mg/24h allowing control of the disease, remaining asymptomatic at present.

CONCLUSIONS

Stuttering priapism is a rare form of presentation of this disease, caused by an alteration in the regulatory mechanisms of erection mediated by 5PDE and cGMP. Several drugs have been proposed in treatment with variable effectiveness, though there is no series long enough to recommend either as first choice. The use of inhibitors 5PDE so long, has been used successfully by some groups. Knowledge of these alternatives is important for the treatment of this complex and unusual pathology.

Evaluation of patients after treatment of arterial priapism with selective micro-embolization

OBJECTIVE

Arterial (high-flow) priapism is characterized by a prolonged non-painful erection without sexual arousal as a result of unregulated inflow of blood to the corpus cavernosum. Treatment is based on decreasing this elevated inflow, primarily by means of selective arteriography and embolization. The aim of this study was to evaluate the treatment of patients with arterial priapism.

MATERIAL AND METHODS

In the period between 1990 and 2004, 10 patients with arterial priapism were admitted to our department. The mean age when priapism developed was 32 years (range 11-62 years). Eight patients were treated with selective embolization, one was operated on and one refused treatment. Nine patients completed a standardized questionnaire which included the International Index of Erectile Function (IIEF-5). The mean follow-up time after treatment was 70 months.

RESULTS

All patients treated with selective embolization achieved reduced tumescence. Six out of eight patients had an improved IIEF-5 score after treatment. In nine men, the etiology of the arterial priapism was perineal trauma. In one case, an anomaly with an accessory artery to the corpus cavernosum was diagnosed, which required surgery, and in one case recurrence of the priapism necessitated a second embolization.

CONCLUSIONS

Selective embolization results in reduced tumescence and an improvement in erectile function in patients with arterial priapism. Trauma to the perineum was the main etiology in this study.

Posttraumatic high-flow priapism: case report, current management options and literature review

A rare case of posttraumatic high-flow priapism is presented. A 20-year-old man underwent diagnostic procedure with color Doppler sonography and angiography. On color Doppler sonography and selective and supraselective angiographic images, arteriocavernosal fistula and pseudoaneurysm were detected in the proximal part of the right cavernous body. Complete detumescence of the penis was achieved by selective embolization with microcoil. No recurrence was observed and postoperative erectile function was incompletely restored. The clinical, diagnostic and therapeutic peculiarities of this rare condition are presented, along with review of the literature on the topic.

Recurrent priapism in sickle cell trait with protein S deficiency

We report the case of a young Omani man, a regular blood donor, who presented twice in two months, with painful penile erection lasting more than 12 hours. The patient is known to have sickle cell trait [HbS 34.6%]. Although the first episode of penile erection settled with aspiration of blood and local injection of epinephrine, on the second occasion necessitated cavernosal glandular shunting. A subsequent investigation revealed a mild protein S deficiency. Although priapism is known to occur in sickle cell disease, it is unusual in sickle cell trait. Association of mild protein S deficiency with erythrocytosis could have precipitated the onset of priapism.

[Diagnosis and treatment of priapism: a report of 15 cases]

OBJECTIVE

To improve the diagnosis and treatment of priapism.

METHODS

We analyzed the types, causes, treatment and prognosis of 15 cases of priapism. The patients ranged in age from 20 to 66 (mean 46) years, their erection lasting 10-172 (mean 28.4) hours. Among them, 6 cases resulted from in taking vaso-active agents, 1 had transitional cell carcinoma of the bladder metastasized to the penis, 2 had leukemia, 3 had a traumatic history and the other 3 had unknown causes.

RESULTS

Of the total number, 12 fell into the ischemic low-flow type and 3 the non-ischemic high-flow type. Follow-up lasted 1-26 months. In the 12 cases of the ischemic low-flow type, 7 were cured by 2-6 mg metaraminol injection at the root of the cavernous body and, when necessary, the perfusion of heparinized saline at the glans and the root of the cavernous body of the penis, and 2 achieved detumescence after glandular cavernosal shunting. The 2 cases caused by leukemia and 1 by metastasis of transitional cell carcinoma underwent penectomy, but with unfavorable prognosis. Of the 3 high-flow type cases, 1 was cured by selective embolization of the internal pudendal artery and the other 2 discharged after conservative treatment, but developed ED on follow-up.

CONCLUSION

Cavernous blood gas analysis and color duplex ultrasonography are helpful to the accurate and timely diagnosis of priapism. Cavernosal decompression and intracavernosal injection of aramine can be applied to most of the patients. If conservative treatment fails to achieve detumescence of the penis, surgery should be performed immediately for both types of priapism.

Post traumatic prepubertal high-flow priapism: a rare occurrence

High-flow or arterial priapism is an uncommon condition resulting from perineal or penile trauma. The classical features are a painless erection of the cavernous bodies while the corpus spongiosum stays flaccid. This case highlights a 11-year-old boy who presented with painless semi rigid erection of 3 days duration following a blunt skateboard injury to his perineum. Following failed conservative treatment, the patient underwent bilateral internal pudendal angiography with localization and embolization. Follow up in 1 month showed patient to have normal nocturnal and reflexogenic erections. Medical and surgical treatments for high-flow priapism have been described in literature with varying degree of success and complications. The current accepted standard of care is pelvic angiography and super-selective embolization of internal pudendal artery.

Stuttering priapism associated with hereditary spherocytosis

Stuttering priapism is a clinical phenomenon that occurs commonly in certain patient populations, including sickle cell anemia and other hematologic dyscrasias. Although the mechanism is still not completely understood, treatment is focused on prevention of recurrence in the outpatient setting, and immediate detumescence and minimizing corporal fibrosis in the acute setting. We present a case of stuttering priapism in a 44 year-old male with hereditary spherocytosis and discuss the pathophysiology and clinical management of this entity.

Erectile Dysfunction

Erectile dysfunction has been defined by the National Institutes of Health as the inability to achieve and/or to maintain an erection for satisfactory sexual intercourse. It may result from psychological or organic causes. With the advent of oral pharmacotherapy, the diagnostic approach has significantly changed over the past decade. The number of patients examined at the radiology clinics has also been decreased. However, evaluation by imaging modalities, such as color Doppler ultrasound, cavernosography, and angiography, still remains the cornerstone of the diagnostic workup of the patients with erectile dysfunction. The aim of this review was to focus briefly on the penile anatomy, the pathophysiology of erection, and radiological techniques for investigating vascular causes of erectile dysfunction and findings on different radiological methods.

Risperidone-induced priapism

A 31-year-old patient suffering from schizophrenic psychosis was treated with risperidone, and developed priapism which required surgical intervention and resulted in long-term erectile dysfunction.

Priapism in children: treatment with embolotherapy

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.

Successful superselective arterial embolization for post-traumatic high-flow priapism

We report a case of high-flow priapism treated successfully with superselective embolization of the cavernous artery. An 18-year-old man presented to our hospital 12 days after having been struck in the perineum by the corner of a skateboard. Immediately after the injury, he suffered painless sustained incomplete erection. High-flow priapism was diagnosed on the basis of cavernosal blood gas analysis and color Doppler ultrasonography findings. Right internal pudendal arteriography showed blood pooling in the cavernosum as a result of a broken artery. We identified the precise position of the arterial-venous fistula and embolized it superselectively with gelatin sponge particles. The fistula disappeared completely. One year later, the patient's erectile function was completely restored, and there had been no recurrence of the priapism. According to the American Urological Association guidelines, conservative treatment should be attempted first for high-flow priapism. In our review of the literature, superselective arterial embolization could be an alternative treatment after more than 3 weeks of conservative treatment.

Low-flow priapism needs recognition and early correct treatment

Low-flow priapism is a rare condition whereby there is a persistent, painful erection. The patient often presents late because of embarrassment. Failure to recognise this as an emergency and instigate immediate treatment may lead to cavernosal tissue ischaemia, fibrosis and subsequent long-term impotence. A case of low-flow priapism, that demonstrated a lack of urgency and understanding is discussed. An internet-based literature search provided a treatment regimen with resolution of tumescence.

[Spontaneous high flow arterial priapism of old males(one case report and review)]

OBJECTIVES

To investigate the correlation between corpus cavernosum disruption and high-flow priapism for the understanding of high-flow priapism and its treatment.

METHODS

To report the clinical data of a case of spontaneous idiopathic high-flow priapism.

RESULTS

The diagnosis was made as right cavernosal artery disruption after angiography. The result of cavernosal blood gas analysis was normal. The penis became detumescent after the gelatin embolization treatment was performed.

CONCLUSIONS

Spontaneous high-flow priapism of old people(non-ischemic) is rare in clinic. Blood gas analysis and angiography are needed to find the hemorrhage site when conservative treatment fails. Gelatin embolization or cavernosal artery ligation are usually effective in the subsequent treatment.

Priapism in the Oncology Setting

CASE STUDY

N.L. is a 20-year-old Caucasian man with no significant medical history. He presented to the hospital with a two-day history of feeling ill with intermittent nausea, vomiting, blurred vision, and headache. He also noted slurred speech and left-upper-quadrant fullness for almost a month.

High-flow priapism: An overview of diagnostic and therapeutic concepts

We describe the case of a 23 year-old man with high-flow priapism following blunt perineal trauma. He was treated successfully with super-selective embolization with a resorbable material (gel foam). We will review the pathophysiology, etiology, and diagnosis and treatment approaches of high-flow priapism based on a review of the medical literature.

[High flow priapism. Case report]

OBJECTIVE

We report the case of a patient consulting with a four-year history of priapism, its diagnosis and subsequent therapeutic management.

METHODS

We reviewed the literature for etiology, types of presentation, discussion of the clinical and radiological findings, and differential diagnosis.

RESULTS

The patient underwent the embolization of the internal pudendal artery with excellent results.

CONCLUSIONS

The embolization of the internal pudendal artery is an effective treatment for the resolution of high flow priapism secondary to arterial venous fistula.

[Priapism: diagnosis and treatment]

Priapism, prolonged and painful erection, is an exceptional cause of consultation in the pediatric population. High- and low-flow priapism and recurrent prolonged erection must be differentiated, as the prognosis and treatment of these entities differ. Assessment of patients with priapism begins with a detailed history, physical examination, and complete blood cell count. The definitive diagnosis is given by penile Doppler ultrasonography, corpora cavernosa blood gas analysis, and pelvic arteriography. We present two patients who attended our emergency service in the last year and propose an algorithm for the diagnosis and treatment of this entity.

Tricorporal priapism postradical cystoprostatectomy: First sign of recurrent urogenital malignancy

Priapism usually involves the whole length of a corpus or two corpora. Rarely is priapism segmental, especially proximally, and seldomly does it involve all three corpora. The causes of priapism are varied, but priapism due to solid malignancy is an extremely uncommon entity. The usual malignancy is urogenital. The disorder is frequently a manifestation of extensive pelvic extension of the primary disease; less commonly, it is associated with pelvic recurrence after seemingly curative surgery. In cases of malignant recurrence, priapism is rarely the first sign of such recurrence. We report a case of proximal tricorporal priapism, secondary to penile metastasis of a bladder malignancy postradical cystoprostatectomy. In this case, priapism was the first sign of disease recurrence and occurred in the absence of pelvic recurrence. This is the first such report of which we are aware.