Abstract
IntroductionPriapism is an uncommon disorder of involuntary prolonged erection beyond sexual excitement or desire. Herein, we present a rare case of priapism resulting from traditional circumcision under regional anesthesia with dorsal penile nerve block by xylocaine, which was successfully treated by intracavernosal injection of metaraminol bitartrate.Case descriptionA 37-year-old man visited our out-patient department for a penile erection, which had been observed during the surgery, lasting for 21 days. 10 days after circumcision, he accepted simple corporeal aspiration in another hospital but it had no effect. In our hospital, he was injected intracavernosally twice a day, with 2 mg metaraminol bitartrate diluted in 1 ml normal saline every time. Complete resolution of penile tumescence was achieved after injection for 7 days, no complications were observed.Discussion and evaluationPriapism developed following circumcision is very uncommon. This particular case was diagnosed as high-flow non-ischemic priapism, and is the first reported event of priapism resulting from circumcision which was finally successfully treated with the efficient and minimally invasive method of intracavernosal injection of metaraminol bitartrate.ConclusionsIntracavernous injection of metaramino bitartrate might be a simple, effective and safe method for relief of priapism associated with circumcision. Yet, more clinical studies are needed to validate the effectiveness of intracavernosal metaramino bitartrate for post-circumcision priapism.
Highlights
Priapism is an uncommon disorder of involuntary prolonged erection beyond sexual excitement or desire
Priapism developed following circumcision is very uncommon. This particular case was diagnosed as high-flow non-ischemic priapism, and is the first reported event of priapism resulting from circumcision which was successfully treated with the efficient and minimally invasive method of intracavernosal injection of metaraminol bitartrate
Intracavernous injection of metaramino bitartrate might be a simple, effective and safe method for relief of priapism associated with circumcision
Summary
Priapism is a rare condition defined as a persistent penile erection arising from dysfunction of the mechanisms regulating penile tumescence and flaccidity, and the etiology is still unclear. To the best of our knowledge, this particular case is the first reported event of priapism resulting from circumcision which was successfully treated with an efficient and minimally invasive method, intracavernosal injection of metaraminol bitartrate. Intracorporeal instillation of metaraminol, which is an alpha-adrenergic agent, contracts penile arteries and the arterial flow in the corpus cavernosum decrease, and effective to priapism This method was widely practiced in impotent patients who develop priapism as a complication of pharmacologically induced penile erection (Brindley 1986). Tsai and Hong found that intracavernosal injection of 10–25 pg metaraminol is a simple, effective and safe method for immediate relief of intraoperative penile erection It can be used in patients with either regional block or general anaesthesia (Tsai and Hong 1990). After 2 months of follow-up, no recurrent priapism is found, and the erectile function is general normal
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