Case Of Priapism Research Articles

Priapism in a 15-year-old boy with major beta-thalassemia.

Received May 2007 Accepted September 2007 INTRODUCTION Priapism (painful erection longer than 6 hours) is an uncommon disease that is almost always due to thromboembolic problems. It may occur at any age. The predisposing factors for priapism include thromboembolic disorders such as sickle cell anemia (SCA, the most common cause), sicklebeta-thalassemia, diseases of the central nervous system and the spinal cord, metastatic cancers, trauma, iatrogenic factors, and infectious diseases (malaria and rabies).(1) We present an adolescent patient with major beta-thalassemia who suffered from an episode of priapism. To our knowledge, no other cases of priapism have been reported in association with major beta-thalassemia, to date.

Priapism in paediatric patients with sickle cell disease - a report of three cases at the University of Port Harcourt Teaching Hospital

Background: Priapism is an abnormal persistent erection of the penis which may be painful or not painful. Approximately two-thirds of all paediatric patients who have priapism also have sickle cell disease (SCD). The aim of this study is to review all the cases of priapism admitted into the paediatric emergency room of the University of Port Harcourt Teaching Hospital (UPTH) over a 5-year period and to determine the prevalence, presentation, precipitating factors and management of cases seen. Method: The admission register in the Children\'s emergency ward was reviewed from January 2001 to December 2005. All the cases of sickle cell disease were extracted. The folders of the patients with priapism were studied and data analysed. Results: Of the 185 SCD cases, three (1.6%) had priapism. They were adolescents aged 17years, 11years and 10 years 9months respectively. Two patients had never attended a sickle cell clinic, never been on routine drugs nor received advice on oral liberal fluids intake. One patient had stuttering priapism, 24hours before the event. Two of them had glanulo-cavernous shunts, with early detumescence on Day 3 and 4 respectively, while the patient who was managed conservatively had detumescence after 12 days. Conclusion: Priapism is an uncommon presentation of SCD in our environment. With prolonged duration, priapism has severe sequelae of impotence and erectile dysfunction, thus, its presentation and management should be known by patients and parents or care givers. Surgical intervention is recommended as it is more effective and results in shorter hospital stay. Keywords : Priapism, Sickle cell disease, Glanulo-cavernous shunt, Conservative management Port Harcourt Medical Journal Vol. 2 (1) 2007: pp. 74-77

Post‐surgical high‐flow priapism treated by embolization

Perineal and penile traumas are the commonest cause of high-flow priapism. The clinical symptom of this disease is generally a prolonged, painless, and semirigid penile erection without any other urogenital symptoms. In contrast, high-flow priapism is a quite uncommon condition after transurethral surgery and it may be presented with an unusual clinical manifestation. Herein, we report the first case of priapism associated with massive urethral hemorrhage requiring blood transfusion after internal urethrotomy. High-flow priapism was successfully treated by autologous clot embolization and the priapism associated with massive urethral hemorrhage resolved.

Recurrent priapism during treatment with clozapine, quetiapine and haloperidol

The following is a letter to the editor that represents a case of recurrent priapism. The patient received clozapine, quetiapine and haloperidol and had the adverse reaction of priapism, one episode of which required surgical intervention. This case highlights the need for physicians to be aware of the potential for this serious adverse effect and to be especially mindful to carefully monitor those patients who have already had one episode of priapism as they may be at risk for recurrence.

Classic Citations: Priapism: Reasons for Failure by Frank Hinman Jr

In his article from 1960, Frank Hinman Jr [1] through the description of seven cases of idiopathic priapism gave the features of this disease. All seven patients had had previous transient episodes of priapism and prolonged sexual excitement before the final episode; erection of the corpora cavernosa sparing of corpus spongiosum; presence of dark thick blood, without clots, inside the corpora and refilling with bright blood after aspiration; limited subsidence after aspiration and eventual nonrefilling after it; and partial or complete erectile dysfunction after the episode.

Management of priapism in a child with sickle cell anemia; successful outcome using epidural analgesia

To describe the successful management of priapism secondary to sickle cell anemia in a child using neuraxial analgesia provided via an epidural catheter. A seven-year-old male presented with chest crisis and priapism which, following hemoglobin electrophoresis led to a new diagnosis of sickle cell anemia. Epidural management was attempted as an alternative to surgery after failure of more conventional medical and surgical methods to treat the priapism. The patient's clinical condition improved with this intervention and together with further conservative therapy resulted in complete resolution of the priapism. Priapism is a well described complication of sickle cell anemia that is painful and difficult to manage. Surgical intervention is the last therapeutic resort and often results in significant long-term morbidity. This case highlights how select cases of priapism can be successfully managed with epidural neuraxial blockade which not only provides superior analgesia for the often painful conservative treatments, but may also per se impart a direct and salutary therapeutic benefit.

Management of high-flow priapism in paediatric patients: A case report and review of the literature

Priapism is rare in the paediatric population and hence there is little consensus as to appropriate management strategies. This is a report of a case of high-flow priapism in a 9-year-old boy managed expectantly. A review of the literature found 52 previously published cases. This report highlights the diagnostic problems and examines the safety and effectiveness of expectant management in the paediatric population.

Priapismo de baixo débito: tratamento cirúrgico com fístula safeno-cavernosa

Descrided for the first time by Tripé in 1845, priapism is a fairly uncommon presentation in the emergency room, but when it does present, it represents a truly urologic emergency, and in the majority of the cases it can be resolved with medical treatment. In other cases a more aggressive treatment will be needed and surgery can be the only solution for this problem. We present two cases of low-flow priapism that were resolved with a safena-to-cavernosa shunt (Grayack technique).

Embolization for massive urethral hemorrhage

Priapism is the term given to a prolonged, painful penile erection, unaccompanied by sexual desire. Most cases of priapism occur as a result of engorgement of the cavernous body of the penis due to intrinsic or extrinsic venous outflow obstruction, which is termed veno-occlusive priapism. However, in a small number of patients, the cause is related to uncontrolled arterial inflow due to trauma and resultant laceration of cavernosal arteries. This form of disease has been termed high-flow priapism and usually occurs in association with genitoperineal trauma. Most incidents of high-flow arteriogenic priapism result from genitoperineal trauma, such as that caused by sliding on a wooden bar or falling astride a ladder. We experienced a patient with a high-flow priapism due to urethral trauma caused by a misplaced Foley catheter. The treatment consisted of superselective arterial embolization of the bilateral internal pudendal arteries using metallic microcoils, which resulted in the subsequent detumescence of the penis with no complications. This case showed that bilateral arteriocavernosal fistulae can be successfully treated by superselective arterial embolization.

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.

Sildenafil citrate ingestion and prolonged priapism and tachycardia in a pediatric patient

Introduction. Little is known about the toxicity of sildenafil overdose in the pediatric population. We present a case of prolonged priapism and tachycardia due to unintentional sildenafil overdose in a child. Case report. A 19-month-old male ingested up to six 50 mg Viagra tablets 45 minutes prior to presentation at the emergency department. Initial vital signs included temperature 98.2°F, blood pressure 90/58 mmHg, heart rate 140, respirations 20, and oxygen saturation of 100% on room air. The child weighed 10.4 kg. Physical exam revealed a happy, smiling, laughing toddler who was cooperative with all aspects of his exam. He had mild facial flushing and an erect penis which was normal in color and had a capillary refill of two seconds. Precordial palpation did not show evidence of increase dynamic force, his heart sounds were regular, and no ectopy was noted. His peripheral pulses were strong and regular in all four extremities. No gastrointestinal decontamination was performed. The patient was started on maintenance IV fluids and admitted to the pediatric floor for observation. The patient had a non-painful tumescent penis and mild tachycardia for about 24 hours post-ingestion. The child never had pain from the constant erection. Sildenafil concentration drawn approximately seven hours after ingestion was 3900 ng/ml (reporting limit 24 ng/ml) and N-desmethylsildenafil level was 1700 ng/ml (reporting limit 24 ng/ml). Conclusion. This case of pediatric sildenafil ingestion (up to 30mg/kg) initially resulted in facial flushing and priapism. The child had asymptomatic tachycardia and prolonged priapism that persisted until hospital discharge approximately 24 hours after ingestion. The erection was non-painful and required no urologic intervention, most likely representing a high flow state. In this ingestion, only supportive care was required.

Priapism Associated With the Switch From Oral to Injectable Risperidone

Priapism is a rare, but serious, side effect of psychotropic medications. Psychotropic medication-induced priapism is believed to be caused by the alpha-adrenergic antagonism of these medications. Among the atypical antipsychotics, cases of priapism or prolonged erection have been associated with clozapine, olanzapine, risperidone, and quetiapine. Risperidone has primarily serotonergic, dopaminergic, and alpha-adrenergic antagonist properties. It has one of the highest affinities for the alpha1-adrenergic receptor blockade among the atypical antipsychotics. To date, there are 17 case reports of risperidone-associated priapism either in monotherapy or in combination with other psychotropics. To our knowledge, there are no published case reports of priapism on the injectable preparation of risperidone. We report a case of a 50-year-old man who developed priapism while being switched from the oral to the intramuscular preparation of risperidone. The importance of early recognition and intervention in cases of priapism is emphasized. The treatment of priapism with benztropine and other methods is discussed.

Recurrent Priapism Associated With Use of Aripiprazole

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Sir: Priapism is one of the most serious adverse effects of psychotropic medications. It may be defined simply as abnormally prolonged erection of the penis (or clitoris) that is usually but not invariably painful. Though it is relatively rare as an adverse effect of psychotropic medication, as many as 25% to 40% of priapism cases are attributable to psychotropics.1,2†‹†‹

Propofol-Induced Priapism, a Case Confirmed with Rechallenge

To report a case of propofol-induced priapism. A 17-year-old male receiving propofol for induction of anesthesia during a cardiac ablation procedure developed priapism that required medical intervention and discontinuation of propofol. The priapism developed after a total propofol dose of 550 mg, lasted for 2 hours, and resolved immediately following medical intervention. The following day, the patient underwent a transesophageal echocardiogram and received a total propofol dose of 40 mg throughout the procedure. He again developed priapism, which resolved within one hour without medical intervention. Priapism experienced by this patient is considered to be drug-induced because of the temporal relationship, recurrence with rechallenge, and dose-response relationship. Using the Naranjo probability scale, we determined that propofol was a highly probable causative agent of priapism in this patient. Although, as of April 4, 2006, this adverse effect has not been previously reported, there is a strong correlation of propofol to priapism in this patient. Clinicians should be aware of this adverse effect.

Priapisme à haut débit non traumatique : traitement par embolisation artérielle

Purpose To report cases of non traumatic high flow priapism treated by arterial embolization. Material and methods Six men presented with non traumatic high flow priapism, the diagnosis was based on colour Doppler ultrasound, cavernous blood gas analysis with arterial blood saturation levels and failed medical or surgical therapy. Four patients had sickle cell disease. The embolization was performed with Gelfoam and was unilateral in one case, bilateral in the other cases. Results Detumescence occurred in a few hours in all cases. One patient had recurrent priapism two years after and was treated by embolization. Transient erectile dysfunction was observed in five cases, permanent in one case. Conclusion Arterial embolization is the treatment of choice in high flow priapism with low rate of permanent erectile dysfunction.

Priapism Following Trazodone Use in a Patient Using Drugs and Alcohol: A Case Study

We present a case of priapism, an urological disorder and medical emergency with a variety of known etiologies, including the use of psychotropic medications. We report here on the first instance to our knowledge, a case of priapism, which occurred following trazodone use in a patient who was actively using alcohol, opiates and benzodiazepines. It is unclear if these drugs act in additive or synergistic manner to cause priapism. Since trazodone is frequently prescribed as a hypnotic in drug abusers, clinicians should be cautious regarding the risk of priapism in this population.

Sildenafil induced priapism

An unmarried 35 years old male, who took 25mg sildenafil daily for 8 days followed by 12.5 mg daily for 4 days, with consultation with a local chemist for nocturnal emission developed priapism. He presented to an urologist after 72 hours where a corporal wash and distal shunt was tried but it did not give any relief to the patient. He had no other identified contributing factors for priapism. A proximal caverno-spongiosal shunting (Quackels cavernoso-spongiosal shunts) was done which subsequently relieved his symptoms. To our knowledge this is the first reported case of priapism resulting from supposedly safe doses of sildenafil in a healthy individual. Distal shunts are associated with high failure rates which may warrant a more proximal shunt. Even when seen after a considerable time a shunt may be useful. After the delayed surgery, relief of pain without complete detumesence suggests a role for watch-full waiting. This case also highlights the existence of unfortunate myths surrounding the omnipotence of sildenafil in all sorts of sex related problems. It points toward an urgent need for steps to prevent unauthorized prescription and misuse of this drug..

Ziprasidone-induced priapism requiring surgical treatment

Both typical and atypical antipsychotic psychotropics have been reported to cause ischemic priapism presumptively secondary to alpha1-adrenergic blockade. This condition is a urologic emergency for if not evaluated and treated appropriately, long-term sequelae include erectile dysfunction and impotence. This paper addresses the first reported case of priapism requiring surgical intervention presumed to be secondary to ziprasidone. Increased clinician and patient education regarding priapism is required in order to minimize this adverse event and to maximize immediate treatment.

Case Report of Priapism in a Patient with Thalassemia Minor.

Background - Priapism is a urologic emergency caused by hematological problems in about 35% of cases. Its occurrence in sickle cell anemia, leukemia /other malignancies and primary thrombocythemias is well established. A very few case reports of priapism occurring in Thalassemia Intermedia especially after splenectomy have been documented in literature. Veno-occlusive priapism (low flow priapism) beyond 4hours is a compartment syndrome requiring emergent medical intervention. The most important late complication of priapism is fibrosis and impotence and their incidence is related to the duration and aggressiveness of treatment of priapism. We report a case of priapism in a patient of Thalassemia minor.Case report- A 42 year Asian male was referred from urology service for a hematologic work-up for recurrent episodes of priapism. He was admitted with a 24 hours-long episode of priapism. The history of priapism dates back to 1998, a few months after marriage, when he was admitted for the first episode of priapism and had a decompressive procedure. Since then, for 6 years, he had intermittent, 15 minutes to 1 hour episodes of penile erection. These episodes usually occur after midnight and were unrelated to sexual activity. He did not have any other medical problems and was not on any medications. He was not on any pro-erectile medications. He denied any history of masturbation. He denied any history of alcohol or illicit drug use. He was unaware of any family history of anemia. On physical examination, he did not have pallor, icterus, lymphadenopathy, skin ulcers or hepatosplenomegaly. The penis was circumcised without any trauma or necrosis. His hemoglobin was 10.5 g/dl, hematocrit 34%, MCV 65fl, RDW14.5 %, reticulocyte count 1.3%, platelets 274k/μl, and WBC 6.9k/μl. Peripheral smear showed poikilocytosis, hypochromia and microcytosis without any sickle cells or nucleated RBCs. Hemoglobin electrophoresis showed Hb A of 94%, Hb A2 of 5.6% and Hb F of 0.4%. His clinical picture, blood count, peripheral smear and electrophoresis were consistent with Thalassemia minor. He was managed by removal of inspissated blood and injection of phenylephrine into the corpora cavernosa. This was repeated a few times and the priapism was relieved and patient discharged.Conclusion- This is the first reported case of priapism in a patient with Thalassemia minor.

Priapism associated with routine use of quetiapine: Case report and review of the literature

We report a case of priapism occurring in a patient taking a standard daily dose of the atypical antipsychotic quetiapine (Seroquel). To our knowledge, this represents the second published report associating quetiapine with priapism, and the first to associate priapism with routine dosing of the drug. Previously published studies have suggested that alpha-adrenergic blockade may be the mechanism of action for this side effect. We report successful management in this case with cavernosal aspiration followed by intracavernosal injection of phenylephrine.