Case Of Priapism Research Articles

Contemporary management of ischemic priapism: A 12-year population-based analysis from a large US database.

Priapism is a urological condition characterized by a persistent erection. The management varies based on its subclassifications. Despite established clinical guidelines for ischemic priapism, there is a lack of large-scale research focused on patient characteristics and management strategies. To analyze the contemporary management of ischemic priapism in the US, exploring patient demographics and clinical characteristics, as well as predictors of erectile dysfunction (ED) and penile prosthesis implantation (PPI). We performed a retrospective analysis of the PearlDiver Mariner database, reviewing records from 2010-2021. Adult males diagnosed with ischemic priapism were included. Data analysis covered demographic, clinical variables, and management strategies. Predictors of de novo ED and PPI were evaluated using multivariable logistic regression analysis. Of 36,120 patients, most (93%) received only medical management, and a minority underwent surgical interventions (penile shunt surgery [PSS], PPI or both). Medical management was typically effective, as 67.08% of the patients in this group experienced only one episode of priapism. However, de novo ED occurred in 16.57% of these patients. The majority of patients undergoing PPI had an inflatable prosthesis (81%). Older age (odds ratio, OR 1.02), the presence of metabolic diseases (OR 1.39), neurogenic disorders (OR 1.72), solid pelvic malignancies (OR 1.09), and multiple episodes of priapism were identified as significant predictors of de novo ED (all p<0.05). Similarly, age (OR 1.03), the presence of metabolic diseases (OR 1.23), solid pelvic malignancies (OR 1.99), and multiple episodes of priapism were associated with higher likelihood of PPI (all p<0.05). Most cases of ischemic priapism are managed with the medical therapy. Less than 3% of patients with ischemic priapism receive PPI, and when this occurs an inflatable prosthesis is favored. Age, specific comorbidities, and multiple episodes of priapism appear to be significant predictors of ED and PPI.

Review of the role of imaging in the diagnosis of priapism.

Imaging has a specific role in the diagnosis and management of priapism. The primary imaging modality is ultrasound with colour Doppler (CDUS) which can accurately assess the hemodynamics of the cavernosal arteries. This is particularly useful in equivocal cases and can help differentiate ischemic from non-ischemic priapism as well as confirm the presence and location of arterio-venous fistulae post penile trauma. Furthermore, CDUS is invaluable in the post treatment follow up of non-ischemic priapism. Contrast enhanced magnetic resonance imaging (MRI) can demonstrate the extent of cavernosal necrosis in ischemic priapism and in conjunction with computer tomography (CT) has an important role in excluding underlying malignancy. MRI and CT angiography are used to evaluate pudendal arterial anatomy, which can be extremely variable and aids in the management of non-ischemic priapism. In selected cases of non-ischemic priapism, catheter angiography and transcatheter embolization of arteriovenous fistulae is an effective treatment. This review will examine the specific roles of different imaging modalities in the subtypes of priapism as well as highlight some of the pitfalls encountered in imaging.

50 years of inflatable penile implants: Where do we stand in France?

IntroductionWith 50 years’ experience, inflatable penile implants are the preferred option for erectile dysfunction refractory to pharmacological and mechanical treatment. Technical and surgical improvements have optimized patient success and satisfaction. However, multi-factorial dissatisfaction persists. ObjectiveThe aim of this study is to provide an overview of available technological improvements and innovations, as well as the perioperative management and complications of inflatable penile implant surgery. MethodA literature review was carried out over the last twenty years to answer 4 questions: what are the different inflatable penile implants available in 2023, for which indications, results and complications. ResultsFour companies propose inflatable penile implants in France. The main improvements have been in the various components of the prosthesis with better cylinder extension, more ergonomic reservoirs, and more manageable pumps, leading to a better durability. Indications have been extended to patients suffering from Peyronie's disease and in emergency cases of priapism. In response to demand from the transgender population, specific phalloplasty implants have been developed. New options are being developed for difficult cases of retracted penis. Results show a high satisfaction rate. Currently the main challenge is the management of infection with the development of rescue protocols using antibiotics to preserve implants – or replace them in a single operation. ConclusionAfter 50years’ experience, improvements in penile implants led to effective, satisfactory and safe treatment and can be proposed in new indications. Further development is sill necessary to offer solutions in difficult cases.

(019) Malignant Priapism: Case Report and Update on Management Protocols

Abstract Introduction Malignant priapism is a rare condition characterized by persistent erection resulting from the invasion or metastasis of a primary neoplasm. Penile metastases arise from the genitourinary tract 64% of the time (bladder: 28.6%, prostate: 27.9%, kidney: 6.9%, ureter: 0.5%) with colorectal adenocarcinoma, lung cancer, melanoma, and hematologic diseases comprising the remainder. Malignant priapism is reported to occur in 20-53% of patients with penile metastasis. The mechanism of malignant priapism remains unknown. The most accepted theory is an invasion of the corpus cavernosum as well as associated venous systems with malignant cells. This can occur from either hematogenous or lymphatic spread from the source tumor. Resulting derangement of arterial or veno-occlusive mechanism causes priapism. Both ischemic and non-ischemic priapism can occur. Objective While treatment guidelines for priapism in non-malignant cases have been established, there is currently no guideline for treating malignant priapism. This study aims to present three cases of malignant priapism resulting from advanced genitourinary cancers and evaluate the efficacy of palliative penectomy as a treatment modality for relieving symptoms associated with malignant priapism. Methods We conducted a retrospective analysis of three cases of malignant priapism associated with advanced genitourinary cancers. Data were collected from medical records, including patient demographics, primary tumor characteristics, clinical presentation, treatment modalities, complications, and outcomes. The main treatment approach utilized in all cases was palliative penectomy. Symptom relief and complications were assessed as primary outcomes. Results All three patients presented with progressive penile pain, and imaging studies confirmed the presence of metastatic disease involving the penile structures. Palliative penectomy was performed in all cases, resulting in sustained relief of symptoms. No major complications were reported during the surgical procedures. Follow-up assessments showed improved quality of life in terms of pain relief, but all patients died within a short period following penectomy owing to the advanced predisposing malignancy. (figure 1) Conclusions Treatment of malignant priapism needs to be individualized to the needs of the patient. No matter the primary or secondary nature of the disease, current data suggest that malignant priapism is associated with poor outcomes, and emphasis should be put on palliative care. Although new radiation techniques have shown favorable outcomes, penectomy should be considered the last resort in clinical management. Revisions to the existing management guidelines for priapism are necessary to address its occurrence in malignant contexts. (figure 2) Disclosure No.

Эмболизация артериокавернозной фистулы при артериальном приапизме: клинический случай

Arterial priapism occurs much less frequently than venous (non-ischemic, low-flow) priapism. Considering the absence of ischemia of the cavernous bodies in arterial priapism, emergency surgical intervention is usually not indicated, and a wait-and-see approach is acceptable. In the absence of spontaneous resolution of arterial priapism, invasive treatment may be performed upon the patient’s desire. Currently, the method of choice is super-selective embolization of branches of the internal pudendal, cavernous, or helical artery. This article presents a clinical case of arterial priapism, in which super-selective embolization of the cavernous artery with PVA (polyvinyl alcohol) embolization agent was performed, resulting in complete resolution of priapism after the operation.

Management of Ischemic Priapism in a 14 Year Old Patient

Introduction: Priapism can occur in all age groups, including neonatales, children and adolescents. Pediatric priapism treatment is similar to adult priapism treatment, but there are no guidelines for the management of priapism, which is not common in children. &#x0D; Case presentation: We present a pediatric low-flow priapism case who was unresponsive to conservative methods and underwent T-shunt operation&#x0D; Conclusions: In the present case, we wanted to emphasize when distal shunt surgery, which is rarely performed in pediatric patients, is necessary and how it is managed.

Recurrent priapism as the presenting sign of undiagnosed multiple myeloma: A case report

Introduction: Priapism is a urological emergency which poses a high risk of long-term sexual dysfunction for patients if left untreated. Although the majority of priapism cases are secondary to sexual enhancement medications, there are many underlying medical disorders that may lead to unexplained and recurrent cases of priapism. Case Report: We present the case of a 53-year-old male with schizoaffective disorder and chronic lower back pain on no medications who presented multiple times to various emergency departments for recurrent priapism requiring aspiration. Ultimately, the patient presented to the emergency department after a fall, and labs revealed hypercalcemia, with serum protein electrophoresis and bone marrow biopsy confirming multiple myeloma. Conclusion: Multiple myeloma continues to be a rare underlying etiology of recurrent priapism. This case represents the importance of performing a thorough investigation in patients with recurrent priapism for hematologic and oncologic disorders, despite there being no other insidious symptoms or signs.

Priapism associated with anti-seizure medications: a pharmacovigilance study and a review of published cases

ABSTRACT Background Recently, case reports of priapism associated with the use of some anti-seizure medications began to emerge in the literature. We aimed to investigate if there is a potential safety signal of priapism among individual anti-seizure medications and to search the literature for relevant published cases. Research design and methods We conducted a disproportionality analysis using OpenVigil 2.1 to query the United States Food and Drug Administration’s Adverse Event Reporting System (FAERS) database. Literature search was conducted in PubMed/MEDLINE, Scopus and Web of Science up to 12 July 2023. Results We identified positive signal of priapism for valproic acid and its derivatives (n = 23, chi-squared = 59.943, PRR = 4.566), gabapentin (n = 20, chi-squared = 9.790, PRR = 2.060), lamotrigine (n = 16, chi-squared = 8.318, PRR = 2.120), levetiracetam (n = 16, chi-squared = 10.766, PRR = 2.329), topiramate (n = 14, chi-squared = 28.067, PRR = 3.972) and carbamazepine (n = 8, chi-squared = 6.147, PRR = 2.568), as well as published cases of priapism associated with these drugs. We also found published cases of priapism for pregabalin and phenytoin in the literature and FAERS, and at least one reported adverse event of priapism in FAERS for clonazepam, lacosamide, ethosuximide, oxcarbazepine, and vigabatrin in which they were considered primary suspect. Conclusions Our study identified signals for priapism for several anti-seizure medications, but these results need to be confirmed in well-designed pharmacoepidemiological studies.

Case Report: Severe ischemic priapism as the clinical presentation in patient with chronic myeloid leukemia (CML) treated by proximal shunt

Background: Priapism refers to an erection of the penis that persists for four hours or more and is not associated with sexual arousal or stimulation. This condition is thought to be caused by abnormal production of blood cells in the bone marrow, which leads to the release of certain chemicals into the bloodstream. The current article presents a severe ischemic priapism case, and assesses and contrasts the documented instances of patients with chronic myelogenous leukemia (CML) who experienced priapism as their primary clinical symptom over the last two decades. Case presentation: The 21-year-old male patient presented with persistent and painful erections for three days. Further tests revealed he had CML and ischemic priapism. He was treated with distal shunting and proximal shunting with cytoreductive therapy to resolve the symptoms. Conclusions: Priapism is a medical emergency that can cause permanent damage to the erectile tissue if not treated promptly. Prolonged and painful erections can cause ischemia, leading to tissue damage and decreased function. If priapism is caused by an underlying medical condition; delaying treatment can allow the underlying condition to progress and become more difficult to treat.

(411) The “Unfolding” Technique for Penile Prosthesis Implantation in Post-priapism Corporeal Fibrosis

Abstract Introduction `- In neglected cases of ischemic priapism, there is usually severe corporeal fibrosis that can render penile prosthesis implantation later on extremely difficult. - Although many researchers described different approaches to overcome difficulties during surgery, none of them offered satisfactory results. Objective `- to describe a new technique to insert a large sized penile prosthesis in patients suffering from ED after neglected ischemic priapism with resultant severe corporeal fibrosis. Methods `- A new surgical technique was done in 15 patients suffering from ED after prolonged ischemic priapism with severe corporeal fibrosis. - Surgery starts by a circumcision incision, complete degloving &amp; delivery of the penis through a midline perineal incision. - The penile urethra is then dissected away from the ventral surface of both corpora cavernosa - A midline ventral incision is done between both corpora cavernosa. This incision is then deepened till it reaches the inner surface of the tunica albuginea. At this point, the scalpel is then rotated 90 degrees to unfold the core of fibrosis into a flat sheet continuous with tunica albuginea. - The process is then repeated on the other side. - The proximal crura are then dilated in the usual manner by metal dilators. The distal part of the corpora are bluntly dilated by the closed blades of scissors. - After inserting the penile prosthesis, both sheets of fibrosis are closed over both prosthetic rods in the midline and the penile urethra is then fixed back to its position. - The penis is then retuned to its normal anatomical site &amp; the skin is closed. Results `- Successful surgery was achieved in 13 out of 15 patients (86.7%). - 2 patients developed infection that necessitated surgical removal of the rods. - no incidence of urethral injury, crossover or corporal perforation Conclusions `- The new “un-folding” technique is feasible and useful technique in patients with ED after prolonged ischemic priapism - The incidence of complications esp. urethral erosion, crossover and corporal perforation. Disclosure No

(381) Comparing Erectile Dysfunction (ED) Outcomes Following Priapism as an Adverse Effect of Intracavernosal Injectable Medications to Priapism due to Recreational use of Intracavernosal Injectable

Abstract Introduction Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. We previously identified a large portion of ischemic priapism cases presenting to our institution caused by recreational use of intracavernosal injectable medications (ICI) for which patients did not have a prescription. Objective In the present study we identified a nearly equal number of men who presented with ischemic priapism as an adverse effect of ICI for which they did have a prescription. Our goal was to compare erectile function outcomes between these two populations in follow up. Methods Men presenting for ischemic priapism as an adverse effect of prescription ICI from January 2010 to December 2018 were contacted by mail, then via telephone. Standardized questions were asked of all participants on the topic of erectile dysfunction (five-item international index of erectile function (IIEF-5)). IIEF-5 results were compared to our previously described population of men with ischemic priapism caused by recreational use of ICI using the Student’s T-test of means. Results 13 men aged 23 – 68 (mean 51.9) were recruited. Ten men (77%) were white; the remaining three (23%) were black. All men confirmed diagnosis of ED prior to their priapism episodes and all men had their own prescription for ICI from a urologist. Seven men (54%) required phenylephrine irrigation, five (38%) achieved detumescence with cavernosal aspiration and saline irrigation alone, one (8%) required a distal shunt. Mean IIEF-5 for the population at time of phone interview was 12.5 (□ 7.4) signifying mild-moderate ED, which was not significantly different from the mean IIEF-5 of our priapism population due to recreational use of ICI (13.3 □ 4.0; p = 0.87; table 1). Conclusions Men who present with ischemic priapism as an adverse effect of prescription ICI appear to have similar functional outcomes compared to men with ischemic priapism due to recreational use of ICI as assessed by IIEF-5. This could also be interpreted as a better functional outcome considering that this population had pre-existing ED prior to their priapism episode and therefore did not lose erectile function. The adverse effect population also appears to require a shunt in the treatment of their priapism less frequently than the recreational ICI population. Disclosure No

Refractory priapism associated with anti-psychotics. Report of a case for risperidone

Priapism is a prolonged erection, usually painful, that occurs in the absence of sexual desire or stimulation, is not relieved by masturbation or intercourse and is the consequence of a mismatch in the regulatory mechanisms that initiate penile erection and those that allow its detumescence. One of the main causes of low-flow priapism is the use of drugs with an α-adrenergic antagonist effect, among which antipsychotic drugs stand out. Our objective is to present a clinical case and review the literature on the use of antipsychotics in medicine, psychiatry and other specialties and their relationship with the dose of the psychoactive drug in the onset of priapism. We present a 23-year-old male patient, single, with a significant history of mild Autism, for which he has received regular treatment with 6 mg daily of risperidone. He started experiencing priapism spontaneously for the last 4 days until a family member took him to the Emergency Room – intense, persistent and painful penile erection. Given the failure of the initial medical treatment for priapism, it was decided to perform multiple distal cavernous-cancellous shunts with improvement after 72 hours and discharge of the patient. We understand that there is a high affinity of antipsychotics for the α 1-adrenergic receptor, risperidone has an α 1 antagonist capacity. In fact, the third cause of priapism cases induced by atypical antipsychotics is secondary to risperidone, including recent cases associated with its parenteral depot presentation RisperdalConsta®.

PD11-05 EFFECTS OF MESENCHYMAL STEM CELL (MSC) THERAPY ON ISCHEMIC PRIAPISM: AN EXPERIMENTAL STUDY

You have accessJournal of UrologyCME1 Apr 2023PD11-05 EFFECTS OF MESENCHYMAL STEM CELL (MSC) THERAPY ON ISCHEMIC PRIAPISM: AN EXPERIMENTAL STUDY Enes Kilic, Aykut Colakerol, Romer Yazar, Sule Ozsoy, Yasar Basaga, Mustafa Zafer Temiz, Ates Kadioglu, Ahmet Muslumanoglu, and Ismail Kandirali Enes KilicEnes Kilic More articles by this author , Aykut ColakerolAykut Colakerol More articles by this author , Romer YazarRomer Yazar More articles by this author , Sule OzsoySule Ozsoy More articles by this author , Yasar BasagaYasar Basaga More articles by this author , Mustafa Zafer TemizMustafa Zafer Temiz More articles by this author , Ates KadiogluAtes Kadioglu More articles by this author , Ahmet MuslumanogluAhmet Muslumanoglu More articles by this author , and Ismail KandiraliIsmail Kandirali More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003251.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Priapism is an erection of the penis that lasts longer than four hours, independent of sexual desire and arousal. Erectile dysfunction develops in 90% of cases of ischemic priapism lasting longer than 24 hours, secondary to fibrosis. The demonstration that MSC prevents fibrosis in different tissues has brought to mind the use of stem cells in diseases with fibrosis in the penile tissue. In this study, it was aimed to show the effect of intracavernosal mesenchymal stem cell therapy (IMSCT) on functional and histological recovery in ischemic priapism model. METHODS: A total of 30 Wistar Albino male rats were included in the study. Rats were divided into three experimental groups as sham, ischemic priapism model, and ischemic priapism + IMSCT. The latter groups were divided into additional subgroups as one-hour and 12 hours ischemic priapism models were applied to animals. Electrophysiologic parameters such as intracavernosal and systemic arterial pressures, and histopathological parameters including smooth muscle to collagen ratio, tissue fibrosis, elastin expression, and tissue e-NOS, n-NOS, i-NOS expressions were statistically compared in main groups and subgroups (Tables 1 and 2). Molecular parameters such as TGF, VEGF, NGF, and BDNF were also compared. RESULTS: In the initial analysis, significant deterioration was detected in most of the parameters in the ischemic priapism model (Table 1). These findings proved our model as an effective procedure. When comparing the model and the model + IMSCT groups, most of the parameters exhibited significant enhancements. (Table 1). During subgroup analyses, we demonstrated significant therapeutic effects of IMSCT, particularly at the in the 1-h model of priapism. CONCLUSIONS: Our study revealed the potential therapeutic activity of IMSCT on the ischemic priapism model, especially in the prolonged ischemic period. Further studies are needed to implicate the IMSCT in clinical practice. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e333 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Enes Kilic More articles by this author Aykut Colakerol More articles by this author Romer Yazar More articles by this author Sule Ozsoy More articles by this author Yasar Basaga More articles by this author Mustafa Zafer Temiz More articles by this author Ates Kadioglu More articles by this author Ahmet Muslumanoglu More articles by this author Ismail Kandirali More articles by this author Expand All Advertisement PDF downloadLoading ...

Priapism in a Patient with Rectal Adenocarcinoma

Priapism is a very rare complication of malignancy and is usually accompanied by locally advanced or widely metastatic disease. We describe a case of priapism arising in a 46-year-old male with localised rectal cancer that was responding to therapy. This patient had just completed two weeks of neoadjuvant, long-course chemoradiation when he presented with persistent painful penile erection. Assessment and diagnosis were delayed for more than 60 h, and although a cause could not be determined from imaging, a near complete radiological response of the primary rectal cancer was seen. His symptoms were refractory to urologic intervention and were associated with extreme psychological distress. He re-presented shortly thereafter with extensively metastatic disease in the lungs, liver, pelvis, scrotum, and penis; additionally, multiple venous thromboses were identified, including in the dorsal penile veins. His priapism was not reversible and was associated with a considerable symptom burden for the remainder of his life. His malignancy did not respond to first-line palliative chemotherapy or radiation, and his clinical course was further complicated by obstructive nephropathy, ileus, and genital skin breakdown with a suspected infection. We initiated comfort measures, and he ultimately died in hospital less than five months after his initial presentation. Priapism in cancer is usually related to tumour infiltration of the penis and corporal bodies resulting in poor venous and lymphatic drainage. The management is palliative and can include chemotherapy, radiation, surgical shunting, and potentially penectomy; however, conservative penis-sparing therapy may be reasonable in patients with limited life expectancy.

Bilateral Cavernosal Artery Ligation to Treat Ischemic Priapism Following Inflatable Penile Prosthesis Implantation

To describe the first known case of recurrent acute priapism after penile prosthesis implantation. A 60-year-old gentleman with a history of recurrent ischemic priapism without hemoglobinopathy presented with refractory erectile dysfunction and underwent uncomplicated penile prosthesis placement. His course was complicated by early acute ischemic priapism confirmed via ultrasound. Due to his pain, attempts to relieve the priapism using ultrasound-guided phenylephrine injections were attempted but were unsuccessful. He subsequently underwent exploration with confirmation of distal ischemic priapism followed by brisk bright red blood from the proximal corpora upon device externalization. A perineal exploration was performed and the bilateral cavernosal arteries were suture ligated with immediate relief. The device was reimplanted and the patient recovered uneventfully. We report the first known case of ischemic priapism following inflatable penile prosthesis implantation. The details of this case challenge the dogma that priapism is a binary event and instead supports an imbalance between unopposed cavernosal artery inflow possibly due to vascular calcifications and compromised venous outflow due to the presence of the device. Prosthetic urologists should be aware of this rare phenomenon and consider all available approaches on an individualized case-by-case basis.

Priapism as the first symptom of chronic myeloid leukemia: literature review and own clinical case report

Chronic myeloid leukemia is a ph-positive myeloproliferative disease, which is usually manifested by hyperleukocytosis and massive splenomegaly. Chronic myeloid leukemia is rare in childhood and adolescence, it accounts for 2 to 3 % of all leukemias cases. priapism is a rare manifestation of chronic myeloid leukemia and is an urgent urological condition that requires timely treatment to prevent long-term complications, in particular, erectile dysfunction.This review presents the literature information about priapism as the first sign of chronic myeloid leukemia, as well as the first description in the Russian literature of a clinical case of priapism in a 9-year-old patient with chronic myeloid leukemia.

Super-selective Gelfoam embolisation in high-flow priapism.

High-flow priapism is a rare condition with limited data in the literature, particularly in Australia. There is therefore no clear consensus regarding treatment. We aim to present our institutional network experience in managing this condition over the last decade with super-selective gelatin sponge (Gelfoam) embolisation of the internal pudendal artery. We retrospectively searched for and reviewed the patient records of all cases of priapism encountered within our multicentre institutional network over the last 10 years. Of these, the cases of high-flow priapism treated with embolisation were analysed in depth and compared with the current literature. Overall, 93 patients in our network were diagnosed with priapism from 1 January 2012 to 1 January 2022. And 89 of these patients (96%) had low-flow priapism and four patients (4%) had high-flow priapism. Of these four patients, two were treated within our network with super-selective Gelfoam embolisation of the internal pudendal artery. Following embolisation, both patients achieved rapid detumescence and returned to baseline premorbid erectile function. There was no report of recurrence or erectile dysfunction on follow-up. Super-selective embolisation of the internal pudendal artery should be considered as a treatment option for high-flow priapism, with Gelfoam as an appropriate temporary embolic agent of choice. We show that it was a safe and effective option for the patients treated in this series, enabling quick and long-term return to baseline erectile function. Our results support data provided by the limited number of cases in the literature.

Post-Operative Priapism: Often Overlooked after Spinal Anaesthesia in Orthopaedic Surgery

Priapism is defined as an abnormal persistent erection of the penis or clitoris. It is unrelated to sexual stimulation and unrelieved by ejaculation. Overall incidence of priapism is 1.5 to 2.9 per 100000 person-year. Defining the etiology of a case of postoperative priapism following orthopedic surgery can be difficult, and many times cannot be determined. We present a rare case report of priapism following an elective open reduction and internal fixation with minimally invasive percutaneous plate osteosynthesis for right lower leg bone fracture performed under spinal anaesthesia in a 21-year-old man and reviewed some literatures and potential etiologies of this rare complication. We also highlighted the problems in delayed recognition of the complication and a good functional outcome despite delayed management.

SARS-CoV-2: A Novel Precipitant of Ischemic Priapism.

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. We present a case of ischemic priapism which we suspect resulted from COVID-19-associated coagulopathy in a patient without severe COVID-19 presentation. 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.

Protracted heparin-induced priapism after myocardial infarction: a case report

Danielė Jonušaitė1, Viktorija Zamaliauskaitė1, Aurimas Opolskis2, Daimantas Milonas2 1 Lithuanian University of Health Sciences, Medical Academy, Faculty of Medicine, Kaunas, Lithuania 2Department of Urology, Medical Academy, Lithuanian University of Health Sciences Abstract Introduction. Priapism is a condition that often requires emergency treatment to spare erectile function. Case report. This is a case report on a patient from the Lithuanian University of Health Sciences Kaunas Clinics with a very rare cause of priapism. The 41-year-old patient was hospitalized with a diagnosis of myocardial infarction, which was being treated with stent insertion, followed by conservative therapy with antiaggregants and heparin. A few hours later after the initiation of the treatment, a genitourinary examination revealed a rare case of heparin-induced priapism. The condition was treated conservatively with multiple cold and mechanical pressure applications, followed by blood aspirations, which led to surgical shunt insertion due to ineffective outcomes. Conclusion. Although the only known pathogenetic mechanism of heparin-induced priapism is associated with heparin-induced thrombocytopenia, the patient’s blood test didn’t reveal any abnormalities so the real pathogenetic mechanism of this priapism case remains unclear. Clinicians should acknowledge the possibility of priapism development after treatment initiation with heparin and inform their patients about this rare adverse effect. Keywords: priapism, heparin, protracted priapism, drug-induced priapism.