Case Of Priapism Research Articles

INTRAOPERATIVE PHARMACOLOGICAL ERECTION AS AN AID TO PEDIATRIC HYPOSPADIAS REPAIR

The intraoperative evaluation of erection is a major advance in hypospadias surgery. We determined the advantages of erections induced pharmacologically over those induced by intracorporeal saline injection for evaluating chordee during hypospadias surgery. During the repair of hypospadias or chordee without hypospadias 56 boys 6 months to 13 years old underwent pharmacological erection induced by 14 microg. alprostadil administered intracavernously. Phenylephrine (40 microg. ) was given for detumescence. We monitored the adequacy of erection and detumescence, changes in blood pressure and pulse, and in 3 cases intracorporeal pressure. Intraoperative artificial erection was also induced in 30 patients. Erection occurred within 1 minute of injection. It was judged to be excellent in 47 cases and adequate in 6, while it failed in 3 probably due to injection outside of the corpora. Erection involved the whole penis, in contrast to artificial erection when tourniquet placement altered the erection and left the penile base flaccid. The degree of chordee remained stable during evaluation compared to artificial erection when curvature varied with the force of the saline injection. Erection persisted during chordee repair as long as the corpora were not opened. Detumescence occurred within seconds in all cases in which phenylephrine was given. There were no cases of priapism, and systemic blood pressure and pulse did not change. Intracorporeal pressure during pharmacological erection was 47 to 70 mm. Hg, whereas during artificial erection pressure was 50 to 250 mm. Hg depending on how much saline was injected and how rapidly fluid drained through the tourniquet. Chordee was induced by over injection. Pharmacological erection in hypospadias repair is effective and reliable with no significant complications. It is especially valuable in severe hypospadias and in patients with a large suprapubic fat pad. Artificial erection with saline injection should be performed with only moderate force since over filling is unphysiological and may falsely induce chordee.

Sildenafil citrate-Associated priapism

We report the first case of priapism associated with the use of sildenafil citrate. The patient was a 28-year-old man with mild erectile dysfunction after penile trauma who self-treated with a 100-mg dose of sildenafil citrate, resulting in low-flow priapism. After aspiration and intracorporal injection of alpha-agonists, the priapism resolved. The patient’s erectile function returned to his prepriapism baseline.

Recurrent Priapism During Treatment With Clozapine and Olanzapine

Back to table of contents Previous article Next article Letter to the EditorFull AccessRecurrent Priapism During Treatment With Clozapine and OlanzapineMICHAEL T. COMPTON, M.D., AIDA SALDIVIA, M.D., and SALLY A. BERRY, M.D., PH.D., MICHAEL T. COMPTONSearch for more papers by this author, M.D., AIDA SALDIVIASearch for more papers by this author, M.D., and SALLY A. BERRYSearch for more papers by this author, M.D., PH.D., Atlanta, Ga.Published Online:1 Apr 2000AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We report a case of priapism after the administration of olanzapine in a patient who on two previous occasions had had priapism that was associated with clozapine treatment. The first case of priapism associated with atypical antipsychotics was reported in 1992 and involved clozapine (1). Subsequently, at least five other reports of clozapine-associated priapism have appeared in the literature. The first reported cases of priapism after the administration of olanzapine were published in 1998 (2, 3). Many medications have been associated with priapism, which is thought to be related to α-adrenergic blockade. Olanzapine has a pharmacological profile similar to that of clozapine, with a high affinity for dopamine D1, D2, and D4, serotonin (5-HT) 5-HT2A, 5-HT2C, and 5-HT3, muscarinic, α1-adrenergic, and histamine H1 receptors. This medication is increasingly used because of its proven antipsychotic activity and favorable side effect profile.Mr. A was a 43-year-old man diagnosed with schizoaffective disorder of the bipolar type. He began clozapine therapy for refractory psychosis, which resulted in near-complete remission of his psychotic symptoms. However, he later experienced two episodes of prolonged painful erection, which lasted approximately 12.0 and 13.5 hours. Mr. A’s clozapine treatment was discontinued, and during the next 2 years his condition was stabilized with olanzapine, divalproex, and thiothixene. His medical records indicated that an adequate response was not achieved with the combination of divalproex and olanzapine or divalproex and thiothixene.Mr. A was then hospitalized for exacerbation of his psychosis. He had been noncompliant with his psychotropic treatment for 3 weeks before admission. At admission, his treatment regimen was reinitiated, as previously prescribed, with 25 mg/day of olanzapine, 1000 mg/day of divalproex, and 5 mg/day of thiothixene. The next morning he awoke with a painful erection. With conservative drug management, the priapistic episode began to remit after 5 hours. Mr. A’s penis returned to normal flaccidity after 8 to 10 hours. His dose of olanzapine was discontinued, and he was stabilized with 25 mg/day of thiothixene. This adverse event was reported to the manufacturer and the Food and Drug Administration.This case represents the third published report of priapism associated with the administration of olanzapine of which we are aware. Although thiothixene has been reported to cause priapism, as have many other conventional antipsychotics, the patient did not experience an episode during his stable period with an increased dose of thiothixene. None of his other medications (divalproex, gemfibrozil, or glyburide) have been reported to cause this adverse event. His three priapistic episodes may indicate a sensitivity to the shared pharmacologic properties of clozapine and olanzapine. His most recent priapism was most likely due to the α-adrenergic-blocking capacity of olanzapine. We believe this case may be of heuristic value and caution clinicians who prescribe olanzapine to men with a history of priapism.

DOXAZOSIN AND PRIAPISM

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Jan 2000DOXAZOSIN AND PRIAPISM MANUEL URRUTIA AVISRROR, ISABEL ALVAREZ FERNANDEZ, ANA SÁNCHEZ SÁNCHEZ, ALFONSO CARVAJAL GARCÍA-PANDO, LUIS MARTÍN ARIAS, and JAVIER GARCÍA DEL POZO MANUEL URRUTIA AVISRRORMANUEL URRUTIA AVISRROR More articles by this author , ISABEL ALVAREZ FERNANDEZISABEL ALVAREZ FERNANDEZ More articles by this author , ANA SÁNCHEZ SÁNCHEZANA SÁNCHEZ SÁNCHEZ More articles by this author , ALFONSO CARVAJAL GARCÍA-PANDOALFONSO CARVAJAL GARCÍA-PANDO More articles by this author , LUIS MARTÍN ARIASLUIS MARTÍN ARIAS More articles by this author , and JAVIER GARCÍA DEL POZOJAVIER GARCÍA DEL POZO More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)68018-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "DOXAZOSIN AND PRIAPISM." The Journal of Urology, 163(1), p. 238 References 1 : Prazosin-induced priapism. Br J Urol1989; 64: 205. Google Scholar 2 : Preservation of potency after treatment for priapism. Scand J Urol Nephrol1996; 30: 313. Google Scholar 3 : Physiology of penile erection. Physiol Rev1995; 75: 191. Google Scholar From the Centro Regional de Farmacovigilancia de Castilla y León, Instituto de Farmacoepidemiología, Facultad de Medicina, Valladolid, Spain© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byDODDS P, BATTER S and SERELS S (2018) Priapism Following Ingestion of TamsulosinJournal of Urology, VOL. 169, NO. 6, (2302-2302), Online publication date: 1-Jun-2003. Volume 163Issue 1January 2000Page: 238 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordspriapismprostatic hyperplasiadoxazosinpenisMetricsAuthor Information MANUEL URRUTIA AVISRROR More articles by this author ISABEL ALVAREZ FERNANDEZ More articles by this author ANA SÁNCHEZ SÁNCHEZ More articles by this author ALFONSO CARVAJAL GARCÍA-PANDO More articles by this author LUIS MARTÍN ARIAS More articles by this author JAVIER GARCÍA DEL POZO More articles by this author Expand All Advertisement PDF downloadLoading ...

Diagnosis and treatment of priapism: experience with 5 cases

Objectives. Priapism is a rare disease, but needs early intervention and appropriate management. We present 5 cases, 2 of nonischemic high-flow priapism and 3 of ischemic low-flow priapism.Methods. Focusing on the differential diagnosis of priapism between the nonischemic high-flow type and the ischemic low-flow type, we reviewed the medical records of 5 patients.Results. Of the examinations carried out, cavernosography, blood gas analysis of cavernosal blood, color Doppler ultrasound, and internal pudendal arteriography were useful in differentiating the type of priapism. Complete detumescence of the penis in 2 cases of high-flow priapism and 3 cases of low-flow priapism was achieved by selective embolization with gelform and by glandular-cavernosal shunting, respectively. No recurrence was observed in any patient, and postoperative erectile function was preserved in 4 patients and is unknown in 1.Conclusions. These results indicate that angiographic studies provide the most reliable information for the differentiation of the type of priapism. However, color flow Doppler ultrasound and cavernosal blood gas determination can obviate the need for angiographic studies and are noninvasive. Although conservative treatment or even expectant management may be feasible with high-flow priapism, aggressive treatment should be carried out for low-flow priapism immediately after initial treatment fails to achieve detumescence of the penis. Selective embolization of the internal pudendal artery may be the treatment of choice for patients with high-flow priapism.

PRIAPISM INDUCED BY CHLORPROMAZINE

SUMMARYPriapism is a pathologically prolonged and painful penile erection, usually unassociated with sexual desire or intercourse. Causes include certain oral medications, although the mechanism for drug‐induced priapism is unknown. We describe two cases of priapism attributed to chlorpromazine who have presented within the past two years.

Penile Prosthesis Implantation in the Treatment of Peyronie's Disease

pg. MUSE, while excellent erection is achieved after intracavernous injection of 6 pg. alprostadil. The transportation of alprostadil from the corpus spongiosum to the corpora cavernosa relies on the communicating channels between them and the retrograde flow from the circumflex and dorsal veins to the corpora cavernosa. Factors that may affect the efficacy of this flow include the number and size of communicating channels between the cavernosum and spongiosum, the number and size of emissary veins that would allow retrograde flow, temperature of the penis (for example, a cold penis may shut down the communicating channels), and the pressure gradient between the spongiosum and cavernosum (for example a partial erection in the cavernosum may impede, while a constriction device at the penile base after MUSE application may facilitate the transfer to the cavernosum). Williams et al report that in a clinical setting 64% of patients achieved an erection sufficient for intercourse, of whom 6Wo reported intercourse at least once during home treatment. In 61% of these patients (390 of 635) MUSE administrations were successful. While many patients in this study did not achieve adequate erection from MUSE administration, Bettochi et al report a case of priapism which lasted 20 hours. Interestingly, their patient discovered that a 20-minute hot bath greatly enhanced erectile response. I believe that a hot bath relaxes the mind of the patient and the penile smooth muscle, which allows some penile elongation and opening of communicating channels, resulting in increased flow of alprostadil to the cavernosum. Therefore, if a patient is interested in MUSE therapy, I would advise him to take a hot bath and then place a constriction (rubber) band at the base of the penis while MUSE is administered. The patient should also stand or sit for 10 minutes, which would increase pressure in the dorsal and pudendal veins and, thus, facilitate retrograde flow of alprostadil from the circumflex veins to the corpora cavernosa. Tom F. Lue, M.D.

Safety and efficacy of sildenafil citrate in the treatment of male erectile dysfunction

Sildenafil citrate, an oral therapy for erectile dysfunction, is a selective inhibitor of cyclic guanosine monophosphate (cGMP)—specific phosphodiesterase type 5 (PDE5), the predominant isozyme metabolizing cGMP in the corpus cavernosum. Chemically, it is a compound of the pyrazolo-pyrimidinyl-methylpiperazine class. Sildenafil has no direct relaxant effect on human corpus cavernosum but enhances the relaxant effect of nitric oxide (NO) on the corpus cavernosum by inhibiting PDE5, which is responsible for degradation of cGMP in this tissue. When sexual stimulation causes local release of NO, inhibition of PDE5 by sildenafil increases concentrations of cGMP in the corpus cavernosum, causing smooth muscle relaxation and blood flow into the penis, resulting in an erection. Sildenafil at recommended doses has no effect in the absence of sexual stimulation. The drug is rapidly absorbed after oral administration, with absolute bioavailability of 40%. Its pharmacokinetics are dose proportional over the recommended dosage range. Maximum plasma concentrations are reached within 30 to 120 minutes after oral dosing in the fasting state. Sildenafil is cleared predominantly by the hepatic microsomal isoenzymes CYP3A4 (major route) and CYP2C9 (minor route). Clinical studies assessed the effect of sildenafil on the ability of men with erectile dysfunction to engage in sexual activity and, specifically, to achieve and maintain an erection sufficient for satisfactory sexual intercourse. Sildenafil was evaluated at doses of 25, 50, and 100 mg in randomized, double-masked, placebo-controlled clinical trials of up to 6 months' duration. The drug was administered to hundreds of patients aged 19 to 87 years having erectile dysfunction of various etiologies for a mean duration of 5 years. Sildenafil was associated with statistically significant improvement in erectile function compared with placebo. Adverse effects reported at a rate of > 2% were headache, flushing, dyspepsia, nasal congestion, urinary tract infection, abnormal vision, diarrhea, dizziness, and rash. No cases of priapism were reported. The use of sildenafil is contraindicated in men who are taking organic nitrates, because of the potential for a precipitous decrease in blood pressure. Postmarketing reports and surveillance have revealed at least 39 deaths with sildenafil use in men having a history of heart disease, men taking nitrate medications, and men in poor physical health due to lack of exercise. Many of the men who experienced serious adverse effects or death had a variety of concomitant diseases and were taking multiple medications.

Chronic myeloid leukaemia and priapism in a boy: A dramatic case with favourable functional outcome

In this work the authors describe a case of priapism lasting approx. 15 hours presenting chronic myeloid leukaemia in a 15-year-old boy. Aspiration of the corpora cavernosa was carried out and the boy remained in intensive care for 2 months, after which a Doppler examination was performed. This showed a moderate flow in the left artery and a poorer situation in the right.

High-flow priapism associated with Fabry's disease in a child: A case report and review of the literature

We report a case of priapism in an 11-year-old boy known to have Fabry's disease. High flow was confirmed by color flow Doppler ultrasound and intracorporal blood gas measurements. Successful treatment was achieved by unilateral percutaneous Gelfoam embolization of the left internal pudendal artery. Previously reported cases of priapism associated with Fabry's disease were identified through a MEDLINE search of the English literature and review of the publications. Five reported cases of priapism associated with Fabry's disease were found, including those of 3 children. A report of a child with high-flow priapism that did not respond to conventional treatment including cavernovenous shunting was noted. Priapism associated with Fabry's disease may be caused by unregulated high arterial inflow. Early recognition of the underlying pathophysiology may identify those cases that would be amenable to percutaneous embolization therapy and may obviate the need to pursue other ineffective conventional treatments.

Perineal abscess after embolization for high-flow priapism

High-flow priapism is unusual and is most often due to blunt perineal trauma with resultant laceration of the cavemosal artery, creating an arteriocavernosal fistula. Although few cases have been reported, the consensus on management appears to be embolization of the fistula with autologous clot, alone or in combination with Gelfoam. We present a case of high-flow priapism treated in this manner. The embolized pseudoaneurysm evolved into an abscess that eventually spread to the perineum. The rarity of this entity and the postprocedural morbidity are reported.

Preservation of potency after treatment for priapism.

Impotence is the most serious complication of priapism. In order to study its incidence and risk factors, the final outcomes of 124 cases of priapism in previously potent patients were analyzed and correlated with the duration of symptoms, age of the patients, aetiology and modality of treatment. Thirty-nine per cent of the patients became impotent. The duration of symptoms before treatment correlated markedly with the risk of impotence, in that 92% of those whose priapism had lasted less than 24 h remained potent but only 22% of those for whom it had lasted longer than 7 days. The younger the patients the better the prognosis, so that 88% of those younger than 30 years preserved their potency but only 40% of those older than 50 years. The prognosis was poorest when heparin therapy or a combination of alcohol drinking and psychopharmaceuticals was the aetiological factor behind priapism. Only 31% of patients preserved their potency after conservative treatment for priapism, whereas 69% of those treated with small glandocorporeal shunts did so. Priapism is an emergency state, in which immediate procedures are necessary to ensure detumescence as soon as possible. If puncture with lavation and intracorporeal injection of alpha-sympathomimetics does not restore detumescence, small glandocorporeal shunts should be performed.

Pediatric priapism associated with Mycoplasma pneumoniae

Objectives. Priapism in the pediatric population is rare and most commonly occurs secondary to sickle cell disease or hematologic malignancy. We present a case of a 12-year-old boy with priapism who required aggressive surgical therapy for adequate detumescence. This patient had a recent viral upper respiratory infection and titers for Mycoplasma pneumoniae were indicative of infection. We propose that a hypercoagulable state was induced by the M. pneumoniae infection, which resulted in the priapism.Methods. A 12-year-old boy with a recent upper respiratory illness presented to his pediatrician with priapism. After failing conservative management, the patient ultimately required a surgical shunt for detumescence. Serum was sent to detect antibodies against M. pneumoniae.Results. The child failed to respond to corporeal irrigations and bilateral Winter shunts. He underwent an El-Ghorab procedure the following morning, which resulted in a flaccid penis. Serum M. pneumoniae antibodies were detected and indicated moderate infection.Conclusions. We propose that this 12-year-old boy had priapism secondary to infection with M. pneumoniae. M. pneumoniae infection can produce a hypercoagulable state, especially in selected areas of the circulation. This is the first reported case of priapism associated with M. pneumoniae.

Priapism following splenectomy in an unstable hemoglobin: Hemoglobin Olmsted β141 (H19) Leu→Arg

We report a case of severe priapism occurring in a patient with an unstable hemoglobin, Hb Olmsted (β141 Leu→Arg). This is a rare hemoglobin variant, which until now has been reported only once. The clinical course of the 12-year-old boy was characterized by severe hemolytic anemia leading to splenectomy and cholecystectomy at the age of 3.5 years. The priapism occurred 8 years after splenectomy, during a hemolytic febrile episode and required aspiration of the corpora cavernosa. This report raises the question of the benefit of splenectomy in patients suffering from a chronic hemolytic anemia such as that due to an unstable hemoglobin. This treatment lowers the frequency and the severity of acute hemolytic attacks, but several cases of vascular complications have been reported after splenectomy. © 1996 Wiley-Liss, Inc.

Priapism following splenectomy in an unstable hemoglobin: Hemoglobin Olmsted β141 (H19) Leu→Arg

We report a case of severe priapism occurring in a patient with an unstable hemoglobin, Hb Olmsted (beta 141 Leu-->Arg) This is a rare hemoglobin variant, which until now has been reported only once. The clinical course of the 12-year-old boy was characterized by severe hemolytic anemia leading to splenectomy and cholecystectomy at the of 3.5 years. The priapism occurred 8 years after splenectomy, during a hemolytic febrile episode and required aspiration of the corpora cavernosa. This report raises the question of the benefit of splenectomy in patients suffering from a chronic hemolytic anemia such as that due to an unstable hemoglobin. This treatment lowers the frequency and the severity of acute hemolytic attacks, but several cases of vascular complications have been reported after splenectomy.

Priapism

AbstractPriapism is a prolonged painful erection unaccompanied by sexual desire. Two cases of priapism are described with different aetiologies, management and outcome. Early and appropriate intervention is vital to minimise the likelihood of subsequent impotence. Techniques available include aspiration, intracavernosaladrenergic therapy and surgical shunting procedures.

Priapism, its incidence and seasonal distribution in Finland.

Priapism is regarded as an uncommon disease in white populations, although no previous research has been done into its incidence in a certain geographical area. All cases of priapism in Finland during the years 1975-90 are reviewed here. Its incidence varied from 0.34 to 0.52/100,000 males per year, being very stable during the whole period of 16 years, when cases due to intracorporeal injections for treatment of impotence are excluded. Typical patients were 40-50 years old, and the incidence was higher in the eastern part of the country. Most cases of priapism were seen during the lighter half of the year, between March and August (65%). The use of intracorporeally injected vasoactive drugs for impotence increased the incidence more than two-fold.

Management of Recurrent Priapism With Epinephrine Self-Injection and Gonadotropin-Releasing Hormone Analogue

A case of recurrent priapism in a young black man without sickle cell anemia is reported. Due to almost daily episodes of prolonged painful erections, the patient was instructed in intracorporeal injection using an epinephrine self-injection kit, which provided complete detumescence on 31 occasions. The patient refused surgical intervention and was treated with monthly intra-muscular gonadotropin-releasing hormone analogue. Priapism episodes completely abated by the second and final monthly gonadotropin-releasing hormone analogue injection without recurrence during 4 months of followup. Normal erectile function was maintained during and after gonadotropin-releasing hormone analogue therapy. Epinephrine self-injection and gonadotropin-releasing priapism.

Two Cases of Priapism Caused by Long‐Term Antipsychotic Administration

Abstract: We report two cases of priapism that developed in patients with chronic schizophrenia after long‐term use of antipsychotic drugs. Almost all cases of this type of priapism reported previously have developed within a month after the start of administration of the drugs responsible. However, the present patients had taken a variety of antipsychotics for a long period, and they developed priapism more than one year after the introduction of the causative drugs, which were perphenazine, thiothixene and propericiazine. There are few previous reports of priapism related to each of these drugs. The present cases suggest that priapism may develop at any time after introduction of a variety of antipsychotics.

Priapism of the Clitoris: A Case Report Following Trazodone Use

We report a case of painful priapism of the clitoris lasting 24hours, which was believed to be pathophysiologically associated with the administration of trazodone hydrochloride. Drug-induced unusual erectile activity in the clitoris has been described previously. However, to our knowledge this is the first reported case of drug-induced priapism of the clitoris. Management involved discontinuation of the offending agents and administration of adrenergic agonists to induce clitoral smooth muscle contraction. Clitoral function, proposed to be the ability to engorge and enable extrusion of the glans clitoris, was not obviously adversely affected by the priapistic episode.