High-flow Priapism Research Articles

Priapism in South West Nigeria—Short and Intermediate-Term Outcomes

Abstract Background: Priapism is usually defined as penile erection that lasts more than 4 h beyond sexual stimulation and orgasm or is unrelated to sexual stimulation. The overwhelmingly more common low-flow priapism is typically painful, while high-flow priapism is typically painless. Interventions are varied depending on the aetiology and timing of the presentation. The outcome in most cases depends on the timing of the intervention. Objective: This study aimed to review the presentation and short- and intermediate-term outcomes of treatment of priapism in patients in Southern Nigeria. Materials and Methods: This was a retrospective 10-year study conducted from 2010 to 2019 of all adult patients diagnosed with priapism who were admitted to the adult urology units in two Government University Teaching hospitals in South West Nigeria. Results: The records of 61 patients were analysed. The mean age was 27.54 years ± 6.22 with a range of 15–56 years. The median duration of symptoms before presentation was 36 h with a range of 2 to 336 h. Eleven patients (18%) presented within 24 h of onset of symptoms. Sickle cell disease (SCD) and idiopathic aetiology were the most common causes of priapism, accounting for 44 (72.1%) and 8 (13.1%) respectively. Corporal aspiration resolved the priapism in 22 (36.1.%), while corpora–glandular shunt was the final treatment in 36 (59.1%). Fifty-seven per cent had erectile dysfunction (ED), while penile gangrene with autoamputation was observed in one patient (1.6%). Sixty-six per cent and 62% of patients who presented within < 36 h and 36–72 h, respectively, experienced normal erection at 6 months after surgery. Erectile function got progressively worse after 72 h, with all patients with ischemic priapism lasting more than 1 week developing ED. There was no statistically significant relationship between the variants of SCD and the risk of ED in patients who presented within 72 h. Conclusion: The incidence of ischemic priapism was high, with sickle cell disease being the most common cause. The risk of ED was significantly worse after 72 h. The aetiology of priapism did not significantly influence the risk of ED.

Trends and outcomes of hospitalized patients with priapism in Germany: results from the GRAND study.

We aimed to provide evidence on the trends and in-hospital outcomes of patients with low- and high-flow priapism through the largest study in the field. We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2008-2021), and performed multiple patient-level analyses. We included 6,588 men with low-flow and 729 with high-flow priapism. Among patients with low-flow priapism, 156 (2.4%) suffered from sickle cell disease, and 1,477 (22.4%) patients required shunt surgery. Of them, only 37 (2.5%) received a concomitant penile prosthesis implantation (30 inflatable and 7 semi-rigid prosthesis). In Germany, the total number of patients with low-flow priapism requiring hospital stay has steadily increased, while the number of patients with high-flow priapism requiring hospital stay has decreased in the last years. Among patients with high-flow priapism, 136 (18.7%) required selective artery embolization. In men with low-flow priapism, sickle cell disease was associated with high rates of exchange transfusion (OR: 21, 95% CI: 14-31, p < 0.001). The length of hospital stay (p = 0.06) and the intensive care unit admissions (p = 0.9) did not differ between patients with low-flow priapism due to sickle cell disease versus other causes of low-flow priapism. Accordingly, in men with high-flow priapism, embolization was not associated with worse outcomes in terms of length of hospital stay (p > 0.9), transfusion (p = 0.8), and intensive care unit admission (p = 0.5). Low-flow priapism is an absolute emergency that requires shunt surgery in more than one-fifth of all patients requiring hospital stay. On the contrary, high-flow priapism is still managed, in most cases, conservatively.

Diagnosis and X-ray endovascular methods of treatment of arterial priapism in children

Diagnosis and X-ray endovascular methods of treatment of arterial priapism in children

Erección prolongada dolorosa

Priapism is a prolonged and painful penile erection, which occurs without prior sexual stimulation. There are two main types, high-flow priapism and low-flow priapism. Although on most occasions the underlying cause will be unknown, it may be the first manifestation of serious disease. In the pediatric patient with prolonged erection we must differentiate between recurrent penile erection and the different types of priapism since each entity requires a specific management and implies a different prognosis.

HIGH FLOW PRIAPISM IN 7 YEARS-OLD BOY AFTER ACCIDENTALLY CONSUMING APHRODISIAC CHOCOLATE: A CASE REPORT

ABSTRACT&#x0D; Objective: This case report aimed to present our experience of conservative treatments for High Flow Priapism in children. Case(s) Report: A 7 years old boy presented with persistent and painless erections without sexual stimulation for 24 hours, the erection was first noticed when he woke up in the morning after accidentally consuming aphrodisiac chocolate 2 days before admitted to the hospital. There was no previous history of priapism and trauma or other risk factors. Discussion: Laboratory studies were within normal limits. Physical examination revealed a fully erect, nontender penile with rigid corpora cavernosa, soft glans, and erection hardness scale (EHS) 3. A cavernosal blood gas analysis was collected with the following values PH 7.41, pO2 117,7 mmHg, and pCO2 24, 8 mmHg. With diagnosis of High Flow Priapism, he was observed and got conservative treatments; ice and site-specific compression and after that EHS become 1. On follow-up after 2 months reported that patient had normal erections with no further episodes of priapism. Conclusion: High flow priapism in old boy after accidentally consuming aphrodisiac chocolate can managed by conservative therapy with favourable outcome.&#x0D; Keywords: Aphrodisiac chocolate, penile erection, priapism.&#x0D;

Post-Traumatic High-Flow Priapism: Accessory Pudendal Origin of Cavernosal Artery From External Iliac Artery - A Case Report.

High-flow priapism is an uncommon condition typically resulting from penile or perineal trauma, due to laceration of cavernosal artery. We present a case of 24-year-old male who presented with post-traumatic painless priapism. Ultrasound showed hematoma with arterio-cavernosal fistula. On CT Angiogram, the cavernosal artery was seen arising from accessory pudendal artery, which arose from inferior epigastric artery (IEA), branch of external iliac artery (EIA). Catheter angiogram of EIA showed fistulous communication at the base of the penis from a branch of IEA. Selective embolisation of the artery was done using 33% glue (n-butyl cyanoacrylate). Post embolisation, no residual filling of the fistula and partial detumescence of penis was noted. Transarterial embolisation is usually preferred as first line of management in high-flow fistulous priapisms.

Selective embolization in the treatment of high flow priapism -a case report and review of the literature

Selective embolization in the treatment of high flow priapism -a case report and review of the literature

Selective embolization in the treatment of high flow priapism -a case report and review of the literature

Selective embolization in the treatment of high flow priapism -a case report and review of the literature

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.

A Rare Cause of Autoinflation after Penile Prosthesis Insertion: Case Series and Systematic Review

BackgroundIn 2016, we reported the first case of high flow priapism and arteriocavernosal fistula caused by penile prosthesis insertion that mimicked device autoinflation. AimTo raise awareness amongst implanters, we describe further cases from our institution and perform a systematic review of the literature to understand the rarity of this phenomenon. MethodsPatient demographics, management and outcomes were extracted retrospectively. A systematic search of the EMBASE, PubMed and PubMed Central libraries for studies reporting arteriocavernosal fistula mimicking autoinflation since 1946 was performed. OutcomesTo identify and report all known cases of high flow priapism and arteriocavernosal fistula presenting as autoinflation of an inflatable penile prosthesis. ResultsFour patients in total (median age 56, range 46-60 years) were identified. Catastrophic bleeding (1.8L) occurred during revision surgery for presumed autoinflation in Patient 1 and subsequent ultrasound (US) confirmed a fistula which was embolized. Patient 2 redeveloped autoinflation following revision surgery. Ultrasound confirmed high flow priapism from an arteriocavernosal fistula. Patient 3 underwent penile magnetic resonance imaging (MRI) to investigate autoinflation and residual penile curvature. MRI showed a tumescent penis despite a deflated device and the fistula was embolized successfully. Patient 4 with sleep-related painful erections did not improve following insertion of penile prosthesis. Doppler US identified 2 fistulae that was embolized but with no resolution of symptoms. Subsequent embolization of both common penile arteries were done to control his symptoms. No other publications apart from the published abstract from 2016 reporting patient 1 was found. Clinical ImplicationsIf considered prior to revision surgery, the fistula can be managed safely by minimally invasive percutaneous angioembolisation avoiding surgery which can potentially be associated with significant complications. Strengths and LimitationsThe rarity of this phenomenon was supported by a systematic review. Our study however does present the findings from a small number of patients. ConclusionDamage to the cavernosal artery during inflatable penile prosthesis insertion can create an arteriocavernosal fistula that mimics autoinflation, leading to catastrophic intra-operative bleeding or unnecessary surgery.Lee WG, Satchi M, Skrodzka M, et al. A Rare Cause of Autoinflation after Penile Prosthesis Insertion: Case Series and Systematic Review. J Sex Med 2022;19:879–886.

Penile Doppler ultrasound study in priapism: A systematic review.

Penile Doppler ultrasound (PDU) is suggested to be an alternative to blood gas analysis (BGA) from the corpora cavernosa in differentiating between high- and low-flow priapisms, with limited supportive evidence. To compare penile Doppler ultrasound study and blood gas analysis in the diagnosis of priapism, through a systematic review of the literature. Studies were identified by literature search of Medline, Scopus, Cochrane and ClinicalTrials.Gov. Studies were included if their participants had priapism evaluated by Penile Doppler ultrasound, and reported data on the blood gas analysis or pudendal artery angiography (PAA). Two authors independently extracted the articles using predetermined datasets, including indicators of quality. Correlation of penile Doppler ultrasound with blood gas analysis and pudendal artery angiography. Twelve studies were included. Three studies compared Penile Doppler ultrasound to blood gas analysis and pudendal artery angiography. Penile Doppler ultrasound was used as adjunctive to blood gas analysis to differentiate low flow from high flow priapism, guidance for embolization, etiological diagnosis in three studies. Compared to pudendal artery angiography, penile Doppler ultrasound had a sensitivity of 40-100% and a specificity of 73%, to localize vascular injury and anatomical abnormalities (two studies). Penile Doppler ultrasound was also used for the follow-up after the treatment of priapism (two studies). No study reported an impact on functional results or a delay of management due to penile Doppler ultrasound use. We reviewed evidence on penile Doppler ultrasound study in priapism. Penile Doppler ultrasound study performance was comparable to blood gas from corpus cavernosum. It is recommended to use doppler as an alternative diagnostic tool. Our systematic review had limitations. Firstly, the number of cases in the included studies was small. Secondly, these studies were all retrospective. Lastly, few data were reported with regards to hemodynamic parameters of penile Doppler ultrasound, and the majority of studies did not describe these in detail. Evidence supports that penile Doppler ultrasound is a reliable way for differentiating high-flow and low-flow priapism. We recommend penile Doppler ultrasound study as an alternative of blood gas analysis from corpus cavernosum, especially when the latter is not available. 3.

Bibliometric trends in priapism research publications

To explore the cooperation of authors, institutions, countries and find hot topics of priapism. Papers about priapism were retrieved from the Web of Science Core Collection (WoSCC). VOSviewer and CiteSpace were used to conduct the bibliometric analyses. Network maps were generated to evaluate the collaborations between different keywords, institutions, authors and countries. A total of 2485 articles related to study of priapism were identified. We observed gradually increasing in the number of publications from 1970 to 2012, and the trend was to be relatively stable in the past ten years. Journal of Urology (322 papers) owned the highest number of publications and Journal of Urology was the most co-cited journal. Burnett, AL (106 papers) was the top most productive authors and the largest numbers of citations (1703 co-citations) during the past decades. There were active collaborations among the top authors. The USA was the leading contributor in this field with 820 papers. Cooperation between countries and between institutions was observed. The main hot topics included matters related to priapism, management, erectile dysfunction, penile erection, penis, diagnosis and high-flow priapism. This paper uses visualization tools to draw a knowledge map of priapism research, and provides a new perspective and direction for priapism research by clarifying the time series, development context, research hotspots, knowledge network structure and the status of major scholars in priapism.

High-flow priapism in pediatric population: Case series and review of the literature

IntroductionPriapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3–1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. Patients and methodsMulticentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. Literature review. ResultsA total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. ConclusionsHigh-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

Priapismo de alto flujo en población pediátrica: serie de casos y revisión de la literatura

IntroductionPriapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. Patients and methodsMulticentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. Literature review. ResultsA total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. ConclusionsHigh-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

High Flow Priapism on ¹⁸FDG PET/CT in a Patient with Urothelial Carcinoma: Case Report

We studied a 52-year-old man diagnosed with a high-grade urothelial carcinoma of the upper urinary tract treated with nephroureterectomy and chemotherapy who presented a benign high-flow priapism with intensive 18F-fluorodeoxyglucose (FDG) uptake as an unusual finding in the positron emission tomography (PET)/computed tomography (CT) that also showed mediastinal and lumbo-aortic node involvement and liver metastases. Upon examination, the patient had a painless erection that lasted for five days with no episode of recurrence at two-month follow-up.

A case report of pediatric high-flow priapism: the management of a rare condition

Background: High-flow priapism is extremely rare, especially in childhood and usually occurs after a penile or perineal trauma. It must be differentiated from low-flow priapism, which requires urgent treatment. Treatment options of high-flow priapism include conservative approach, embolization, and surgical ligation. Case Presentation: A 6-year-old boy presented with a semi-rigid and painless penile erection. With the diagnosis of high-flow priapism, he underwent conservative therapy. After 4 weeks of conservative treatment, priapism was no longer existed, and no recurrence occurred during the 2-year follow-up. Conclusion: Conservative approach should be applied before the invasive interventions as it is easy to apply and has no side effects.

Design and Implementation of a Low-Cost Priapism Reduction Task Trainer.

This low-cost priapism reduction task trainer is designed to instruct emergency medicine (EM) resident physicians. Priapism is a true urologic emergency that EM physicians must be able to diagnose and treat in order to prevent significant tissue damage and loss of erectile function. Given the nature of the condition, priapism treatment is often both physically invasive and psychologically upsetting. Simulation allows learners to practice invasive or rare procedures in a safe and educational environment. At present, there are few inexpensive and easily created task trainers for priapism reduction. Our goal was to create an inexpensive, reusable task trainer that allows learners to practice the skills needed for priapism reduction. By the end of this educational session, learners should be able to 1) Verbalize the difference between low-flow and high-flow priapism 2) Describe the landmarks for a penile ring block and cavernosal aspiration/injection 3) Demonstrate the appropriate technique for performing a penile ring block, cavernosal aspiration, and cavernosal injection. Using inexpensive and commonly found materials, we were able to successfully create a partial task trainer for teaching priapism reduction techniques including administering local anesthesia, medication injection, and realistic cavernosal aspiration with simulated blood return. As part of a standard EM residency didactics curriculum, this task trainer has been used to teach post graduate year (PGY) 1-4 resident learners. After an introductory didactic session, participants were given the opportunity for hands-on skills-based practice using the simulated task trainer. Learners were asked to complete a post-session survey to assess the educational value of the station and the task trainer. We were able to successfully create a low cost, easy to build partial task trainer for priapism reduction that allowed learners to perform local anesthesia, medication injections, and corporal aspiration. Twenty-five residents (ten PGY-1, five PGY-2, five PGY-3, five PGY-4) participated in a single didactic session and completed a post-session survey. The majority (68%, N=17) of participants had never previously treated a patient with priapism. On average, participants rated their comfort managing a patient with priapism before the session to be 1.76 on a 5-point Likert-scale (where 1=not at all comfortable and 5=extremely comfortable). Following the session, participants' comfort increased to 3.76 on the same scale. Participants rated the usefulness of the priapism model for teaching priapism reduction techniques to be 4.64 on a 5- point scale (where 1=not at all useful and 5=extremely useful). Using inexpensive and commonly found materials, we were able to successfully create a partial task trainer for teaching priapism reduction techniques including local anesthesia, medication injection, and cavernosal aspiration. Learners reported that the educational session greatly increased their confidence in caring for patients presenting with priapism. Additionally, they found the priapism model to be extremely helpful for teaching reduction techniques. Our model was successful in teaching a procedure that providers may encounter in clinical practice yet most resident learners had not yet had the opportunity to perform in training. Penile anesthesia, priapism reduction, urologic emergencies.

High-flow priapism after T-shunt and tunneling in a patient with ischemic priapism.

Priapism is defined as an erection lasting for more than 4 hours without sexual stimulation. It is grouped into 3 subtypes: ischemic (low-flow), nonischemic (high-flow), and stuttering priapism. Herein we describe a rare event of high-flow state as a result of conversion from a delayed ischemic priapism after a T-shunt with tunneling. To our knowledge, there is a paucity of reported cases, and the pathophysiology is still unclear. Clinicians should be aware of this uncommon but known scenario in case of penile tumescence after shunting procedure for ischemic priapism; penile Doppler ultrasound and selective pudendal angiography represent essential tools for diagnosis and treatment of this rare condition. In delayed ischemic priapism persisting for >36 hours, patients should be counseled about the irreversible damages of the cavernosal muscle and erectile dysfunction to consider an early penile prosthesis implantation with a satisfactory long-term functionaloutcome, decreasing the risks related to a distal shunt procedure.

Superselective embolization for high-flow priapism refractory to medical and surgical treatments

BackgroundThis study aimed to report long-term outcome of superselective embolization in patients with high-flow priapism refractory to medical and surgical treatments.MethodsFrom August 2011 until July 2016, 14 patients with high-flow priapism refractory to local treatments were treated and their charts were retrospective reviewed. Clinical evaluation, color Doppler ultrasonography, arteriography and selective embolization were performed. Follow up was performed in all patients. Fourteen men (18–63 years old) were enrolled, with priapism duration of 14 h to 28 days. Internal pudendal arteries or glutaea inferior arteriae were successfully embolized with gelatin sponge particles, polyvinyl alcohol particles or microcoils.ResultsPseudoaneurysm in right femoral artery was found in one case after intervention. The follow-up 1 week later showed that 13 patients were in good condition, the priapism diminished 1–7 days (mean 3.2 ± 0.5 days) after intervention, and 1 patient received second intervention. Mean follow-up was (range 10.8–69.6) months. One patient had recurrent priapism months after embolization and had his penis surgically removed for severe necrosis.ConclusionsSuperselective embolization is safe and effective in high-flow priapism refractory local treatments, with a good long-term prognosis.

A Rare Case of Recurrent Idiopathic Low-flow Priapism that Developed into a High-flow Priapism

Priapism, according to the American Urological Association is defined as a persistent penile erection that continues hours beyond sexual stimulation; typically, greater than 4 hours. Although priapism is a rare condition and has an unpredictable course in most presentation, it affects 5.36 per 100,000 male subjects per year [1]. Priapism is a urological emergency and delay in treatment or refractory cases can result in cavernous smooth muscle necrosis, fibrosis and penile shortening [2]. There are 2 categories of priapism-namely low-flow (ischemia, veno-occlusive) and high-flow (non-ischemic, arterial) [3,4]. There is a subset of ischemic priapism known as stuttering priapism which presents with recurrent incidences of ischemic priapism varying in length and is usually self-limiting [4]. Low-flow priapism occurs when an occlusive process inhibits the relaxation of the corpus cavernosum, thus the outflow of blood is impaired. The conditions associated with low-flow/ischemic priapism are as follows: sickle cell disease, vasoactive drugs, neoplastic diseases of the penis, urethra, prostate, bladder, kidney, gastrointestinal tract, leukemia, polycythemia, traumatic injury, hyperlipidemic parenteral nutrition, hemodialysis, heparin treatment, Fabry disease and neurologic conditions [3]. On the other hand, high-flow priapism occurs when there is increased arterial blood flow or pooling of blood. Conditions associated with high-flow priapism include traumatic arterio-cavernous fistula, vasoactive drugs, penile revascularization surgery, and neurologic conditions [3]. The mechanism of penile erection is a multifocal phenomenon that involves the nervous system, molecules (nitric oxide, cGMP, calcium), enzymes, and blood vessels. We present an interesting case of a patient with a history of recurrent priapism who converted from a low-flow priapism to a high-flow priapism, thought to be secondary to an arterio-cavernous fistula. Upon further review of PubMed and NIH database, there has been only few of such cases reported. We discuss the diagnostic process and management of high-flow priapism in this report.