(324) History of Priapism Treatment in the 20th Century

Abstract

Abstract Introduction Priapism, defined as a prolonged erection in the absence of sexual arousal, leads to decreased quality of life, physical health, and increased erectile dysfunction. The modern priapism treatments of vasoconstriction and cavernous aspiration stem from strides made throughout the last century. Objective As a result, we seek to chronicle the history of priapism treatment throughout the 20th century. Methods We reviewed over two dozen academic articles and medical textbooks from 1872 to 1990 with relevant information on priapism treatment. Results In the 19th century, treatment of priapism solely involved symptomatic management with morphine and medicinal leeches. In 1928, Dr. Robert McKay and Dr. John Colston discovered that a thrombotic condition is sufficient to sustain an erection and that removing clots from the penis is sufficient to alleviate the erection. They recommended the newly-discovered anticoagulant heparin as a potential remedy. Dr. Rita Franklin then established in 1940 a positive association between testosterone propionate levels and priapism in eunuchoid men. Priapism therapies improved exponentially beginning in the late 1950s. Dr. H. Stephen Brody conducted the first successful penile aspiration in 1957 by aspirating blood from the base of each corpus cavernosum in a hypotensive patient. This groundbreaking procedure is conducted to this day for patients who do not respond effectively to medication management. Nine years after Dr. Brody’s study in 1966, Dr. Robert Garrett and Dr. Donald Rhamy reported penile flaccidity and sexual satisfaction in five patients who underwent a corpus-saphenous shunt to improve venous drainage. In 1997, Dr. Pierre Bondil and colleagues conducted a novel experiment demonstrating the efficacy of vasoconstrictive alpha agonist agents in decreasing penile blood flow to decrease erections and preserve erectile function. Conclusions The last one hundred years has shown significant innovation in the treatment of priapism. Some of the major developments in the first half of the 20th century included the use of heparin and the establishment of a relationship between testosterone and priapism. The second half of the 20th included treatment still in use today, such as carvenoglandular shunts and vasoconstrictive agents. Therapies from the 20th century will continue to play a vital role in the treatment and research of priapism management. Disclosure No.