Complication Of Priapism Research Articles

Management of priapism: a case report.

Priapism is a pathologic condition of persistent penile erection in absence of sexual excitation, is a true erectile disorder. Although it is not common, it carries a major significance as possible complications of the disorder include penile fibrosis and permanent erectile dysfunction. All health care professionals should appreciate the importance of priapism and follow current principles of treatment to avert the complications of priapism

Priapism associated with typical and atypical antipsychotic medications

Priapism is a urologic emergency, and a urologic consultation should be obtained as early as possible. Its etiologies are numerous and diverse. Patients who use antipsychotic drugs should be informed about the complications of priapism, especially those patients with a history of prolonged erections associated with other alpha-adrenergic blocking agents or a history of sickle cell disease. If antipsychotic medication is considered to be needed in the treatment of patients with a history of priapism, physicians should select a drug with a low peripheral alpha-adrenergic blocking property. Physicians should be aware of this rare but potentially serious complication of antipsychotic drugs. Early intervention and appropriate treatment are essential to prevent permanent impotence and other serious complications.

Priapism in sickle-cell disease; incidence, risk factors and complications - an international multicentre study.

To define the incidence, risk factors and complications of priapism in a large population of patients with sickle-cell anaemia in five centres in the UK and Nigeria, as priapism is common among these patients, but the precise characteristics of the condition in this population are poorly documented. A questionnaire was developed and administered to patients with sickle-cell disease. Questions were designed to define the incidence, nature, precipitants, duration, treatment and complications of priapism. A distinction was made between acute (severe) priapism and the recurrent, 'stuttering' type. The questionnaire was completed by 130 patients (mean age 25 years, sd 11, range 4-66) from the five centres; 102 (78%) were homozygous Hb SS genotype, 19 (15%) were Hb SC genotype and two (1.5%) were Hb Salpha-thalassaemia. Of the patients, 46 (35%) reported a history of priapism, and of these, 33 (72%) had a history of stuttering priapism, while 24 (52%) had had an acute episode of priapism. The mean age of onset of priapism was 15 years, with 75% of patients having the first episode before their 20th birthday. Sexual activity was the most frequent precipitating factor, with fever and/or dehydration being the next most common. Of the 46 patients, 10 (21%) with a history of priapism reported having erectile dysfunction. A similar proportion reported dissatisfaction with sexual intercourse, including a fear of engaging in sexual activity. The incidence of priapism among patients with sickle-cell anaemia is high (35%). The implications of priapism for erectile and sexual function are significant and documented in this large series. The treatment of this condition in these patients remains unstandardised. This study highlights the need for an increased awareness of the problems associated with priapism among patients, families and medical professionals.

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.

Penile gangrene : a complication of priapism.

Penile gangrene : a complication of priapism.

Medical treatment of neurogenic impotence

The present modalities available for the medical treatment of patients with neurogenic impotence include: 1) intracavernosal injection of vasoactive agents, 2) topical application of vasoactive drugs via paste or plaster, including intraurethral application and 3) oral administration of vasoactive drugs. Intracavernosal injection pharmacotherapy represents the most common form of treatment. Patients enter a pharmacologic erection program including: 1) initial office testing, during which the safety and efficacy of vasoactive drugs is established and the appropriate technique of self-injection is taught, 2) initial home use by the patient, during which safety and efficacy at home is established and 3) longterm home use and longterm follow-up by the doctor or the nurse to monitor longterm safety and efficacy. Patients with neurogenic impotence may require several special considerations when performing intracavernosal injections. In cases of upper extremity weakness or when there is a lack of upper extremity fine motor control, it may be more appropriate for the partner to perform the intracavernosal injections. Patients with neurogenic impotence must be cautioned against the complication of priapism, a frequent development in the presence of normal hemodynamic parameters. A literature review of satisfaction, complications and drop-out incidence, as well as our personal experience with 62 such patients, confirms the safety, reliability and effectiveness of the intracavernosal injection therapy. Alternative systems for the delivery of vasoactive agents to the corpora include topical application via plasters or paste and intraurethral application via ointments. Vasoactive agents utilized in alternative delivery systems have included nitroglycerin, prostaglandin E2 and minoxidil. The main advantage is the lack of invasiveness while the main disadvantage is the reduced effectiveness of the penile erection. Oral drugs, like yohimbine and trazodone, are prescribed by some urologists, but results have not been predictable. Intracavernosal injection pharmacotherapy remains the most effective and safe medical treatment available for patients with neurogenic impotence.

Auto-Injection of the Corpus Cavernosum with a Vasoactive Drug Combination for Vasculogenic Impotence

Intracavernous injection of papaverine hydrochloride with phentolamine mesylate rapidly produces transitory penile tumescence, which can be followed by erection and coitus provided there is sexual stimulation. Coital penetration was possible in 59 of 62 patients with impotence of divers etiologies (vascular, diabetic, iatrogenic and Peyronie’s disease) who underwent injection and were sent home to attempt coitus. One patient had a prolonged erection that was treated successfully with aspiration of a corpus. When coitus was successful the patient was offered training in self-injection. With self-injection 18 patients have had satisfactory coitus without a noteworthy complication; 5 for more than 12 months. The long-term effects of intracavernous injections remain unknown. Intracavernous injection of vasoactive substances (chemical prosthesis) may become a useful alternative treatment. Administration should be restricted to urologists able to manage the possible complication of priapism.