Low-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.

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.

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.

Penile implants in low flow priapism.

Priapism is a persistent or prolonged erection, in the absence of sexual stimulation, that fails to subside. Prolonged ischaemic or low flow priapism is defined as a full or partial erection persisting for more than 4 h and unrelated to sexual interest or stimulation, characterised by little or no cavernous blood flow. Low flow priapism leads to progressive corporal fibrosis, which could, in turn, lead to long-lasting erectile dysfunction if left untreated. Penile prosthesis implantation is recognised as a management option in refractory and delayed low flow priapism for restoring erectile function with high patient satisfaction rates. However, the ensuing corporal fibrotic scarring poses a surgical challenge to clinicians, given the higher complication rates in this patient subset. Postoperative patient satisfaction has been closely linked to preoperative expectations and perceived loss of penile length. Therefore, thorough patient counselling concerning the risk and benefits of penile implants should be a priority for all clinicians. Moreover, there is a lack of consensus on the ideal prosthesis choice and procedural timing in refractory low flow priapism. In this review, we will examine the existing literature on penile implants in patients with priapism and discuss the options for managing complications associated with penile prosthesis surgery.

Priapism at Diagnosis of Pediatric Chronic Myeloid Leukemia: Data Derived from a Large Cohort of Children and Teenagers and a Narrative Review on Priapism Management.

Pediatric chronic myeloid leukemia (CML) is a very rare malignancy (age-related incidence 0.1/100,000) typically presenting with leucocyte counts >100,000/µL. However, clinical signs of leukostasis are observed at diagnosis in only approximately 10% of all cases and among these, priapism is infrequent. Here, we analyze data from pediatric CML registries on the occurrence of priapism heralding diagnosis of CML in 16/491 (3.2%) boys (median age 13.5 years, range 4-18) with pediatric CML. In the cohort investigated, duration of priapism resulting in a diagnosis of CML was not reported in 5 patients, and in the remaining 11 patients, occurred as stuttering priapism over 3 months (n = 1), over 6 weeks (n = 1), over 1-2 weeks (n = 2), over several days (n = 2), or 24 h (n = 1), while the remaining 4 boys reported continuous erection lasting over 11-12 h. All patients exhibited splenomegaly and massive leukocytosis (median WBC 470,000/µL, range 236,700-899,000). Interventions to treat priapism were unknown in 5 patients, and in the remaining cohort, comprised intravenous fluids ± heparin (n = 2), penile puncture (n = 5) ± injection of sympathomimetics (n = 4) ± intracavernous shunt operation (n = 1) paralleled by leukocyte-reductive measures. Management without penile puncture by leukapheresis or exchange transfusion was performed in 3 boys. In total, 7 out 15 (47%) long-term survivors (median age 20 years, range 19-25) responded to a questionnaire. All had maintained full erectile function; however, 5/7 had presented with stuttering priapism while in the remaining 2 patients priapism had lasted <12 h until intervention. At its extreme, low-flow priapism lasting for longer than 24 h may result in partial or total impotence by erectile dysfunction. This physical disability can exert a large psychological impact on patients' lives. In a narrative review fashion, we analyzed the literature on priapism in boys with CML which is by categorization stuttering or persisting as mostly painful, ischemic (low-flow) priapism. Details on the pathophysiology are discussed on the background of the different blood rheology of hyperleukocytosis in acute and chronic leukemias. In addition to the data collected, instructive case vignettes demonstrate the diagnostic and treatment approaches and the outcome of boys presenting with priapism. An algorithm for management of priapism in a stepwise fashion is presented. All approaches must be performed in parallel with cytoreductive treatment of leukostasis in CML which comprises leukapheresis and exchange transfusions ± cytotoxic chemotherapy.

(368) Stuttering Priapism: A Rare Manifestation of Underlying Malignancy

Abstract Introduction First described by Peacock in 1938, malignant priapism (MP) is defined as persistent erection in the absence of sexual stimulation or other triggering factors. The proposed mechanism is due to neoplastic invasion of cavernous sinuses and venous system resulting in poor outflow and painful penile engorgement. Though rare, MP due to penile tumors has been described in cases of hematologic malignancies, primary penile neoplasms, local invasion from urologic primary tumors including prostate and bladder cancer, and penile metastasis from other primary sources. Objective Here we describe a case of metastatic epithelioid sarcoma that presented with recurrent priapism. Methods An otherwise healthy 43 year old male presented with two weeks of intermittent priapism. Initially thought to be traumatic in nature, the patient was managed conservatively with penile irrigation and phenylephrine. Though the patient achieved some improvement in his pain, full detumescence was never achieved. Approximately one month later the patient elected for placement of an inflatable penile prosthesis (IPP) due to persistent incomplete detumescence. At the time of surgery, extensive corporal induration was noted bilaterally. Upon entry into the corpora, copious purulent material was expressed from the tissues and the decision was made to abort the case. Prior to closure, several representative biopsies were collected. Results Blood gas performed at initial presentation was consistent with low flow priapism. Doppler studies showed intact arterial blood flow to the penis bilaterally and pelvic MRI was negative for penile injury though asymmetric enhancement of the corpora was noted incidentally. Surgical pathology revealed an unclassified malignancy and increased proliferation concerning for metastasis. A PET scan was performed which was consistent with widely metastatic disease with mets to the liver, lung, bone, muscles, adrenal glands, brain, and penis. Percutaneous biopsy of an abdominal mass confirmed the diagnosis of epithelioid sarcoma. Despite palliative chemotherapy and radiation the patient succumbed to his cancer just two months after diagnosis. Conclusions Epithelioid sarcoma is a rare soft tissue neoplasm primarily affecting young adult males and representing less than 1% of soft tissue sarcomas. Even rarer is the incidence of metastatic penile tumors, with fewer than 500 cases reported in the literature since 1850. A literature review by Lin YH et al based on reports from 2006 to 2011 suggested that the true incidence of penile metastasis may be higher given that 12% of penile metastasis may be asymptomatic and discovered only at autopsy. To our knowledge, this is the first case of widely metastatic epithelioid sarcoma presenting with priapism secondary to penile metastasis. 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®.

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 Case of Low-Flow Priapism as a Complication of COVID-19 Infection

On 11 March 2020, the World Health Organisation (WHO) declared the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) (COVID-19) a pandemic. With a global incidence of over 414 million cases, as of 16 February 2022, it presents a significant burden on healthcare. COVID-19 is primarily considered a respiratory illness; however, a wide range of presentations have been reported including a tendency for thrombotic complications. We report a case of a 58-year-old man who presented with dyspnoea, pyrexia and dry cough. Upon admission, he was noted to be in a severe type 1 respiratory failure with bilateral pulmonary infiltrates suggestive of COVID-19 infection. Rapid transfer to intensive therapy unit (ITU) ensued with intubation and ventilation. The patient was noted to have developed priapism one day following admission with subsequent aspiration by the Urology team, achieving detumescence. Priapism is a state of persistent penile erection that continues for four hours beyond sexual stimulation. Our case highlights the role of thrombosis, dysregulation of the clotting cascade and acute disseminated intravascular coagulation (DIC) as shared pathologies in priapism and COVID-19 infection. We put forth an example of one of the extra-pulmonary manifestations of the COVID-19 secondary to the pro-thrombotic state associated with the COVID-19 infection.

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.

Pathophysiology and Grayscale Ultrasonography of Penile Corporal Fibrosis.

Penile corporal fibrosis may occur secondary to explantation of an infected penile prosthesis, severe penile trauma, refractory low-flow priapism, Peyronie's disease, or chronic intra-cavernous injection of vasoactive drugs. Other etiologies of corporal fibrosis, presenting primarily with erectile dysfunction, can develop in chronic smokers, hypertensive patients, alcoholics, diabetics, and after radical prostatectomy. Corporal erectile tissue fibrosis is a significant pathophysiologic component of erectile dysfunction; however, current ultrasound-based penile imaging protocols do not directly assess it. To determine if grayscale ultrasonography (US) is a suitable imaging modality to identify and assess penile corporal erectile tissue fibrosis. A PubMed literature review was performed for studies that detailed ultrasonographic methods and findings of pathologies causing penile corporal fibrosis. Our main outcome measure was the ultrasonographic findings of pathologies causing penile corporal fibrosis. Grayscale US demonstrates the capability to detect and localize the fibrotic changes of the corpora cavernosa. Ultrasonographic findings capture penile corporal tissue heterogeneity including diffuse, circumscribed, or localized patterns. Overall, grayscale US may be a useful and convenient imaging modality to assess penile corporal fibrosis secondary to explantation of an infected penile prosthesis, priapism, penile trauma, chronic intra-cavernous injection of vasoactive drugs, diabetes, Peyronie's disease, and vascular disease. While limited by the skill and knowledge of the US operator, the combined knowledge of pathophysiology and US may help clinicians identify and manage the underlying etiology of penile corporal fibrosis. Kim J, Drury R, Morenas R et al. Pathophysiology and Grayscale Ultrasonography of Penile Corporal Fibrosis. Sex Med Rev 2022;10:99-107.

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.

41 Low Flow Priapism as A Complication of Covid-19 Infection

On 12 March 2020 the World Health Organisation (WHO) declared a pandemic of SARS-COV-2(Covid 19). We report a case of a 58-year-old man who presented with dyspnoea, pyrexia and a dry cough. Upon admission he was noted to be in a severe Type 1 Respiratory Failure with Bi-lateral pulmonary infiltrates suggestive of Covid 19 infection. Rapid transfer to ITU ensued with Intubation, Ventilation and Inotropic support. Priapism was noted a day into admission which was subsequently aspirated by the Urology team, achieving detumescence. Priapism is a state of persistent penile erection that continues for 4 hours beyond sexual stimulation. We describe the role of thrombosis, dysregulation of the clotting cascade and acute disseminated intravascular coagulation (DIC) as shared pathologies in priapism and Covid 19 infection. We highlight the importance of vigilance for extra-pulmonary manifestations of Covid-19 and feel that the pro-thrombotic phenomena exhibited by Covid-19 infection affects distal vasculature in the same manner as Low Flow Priapism and hence explains why our patient suffered from this particular urological complication

Coronavirus Infection of the Urinary Bladder and Lower Urinary Tract: A Review and Update

COVID-19 infection does affect males and females. Even though the commonest manifestations of COVID-19 infection tend to be related to symptoms associated with the respiratory tract, many other organs of the body also tend to be affected and COVID-19 infection of these other organs could manifest contemporaneously with symptoms of the respiratory tract system in addition to symptoms of the affected organs. At times COVID-19 may initially manifest solely related to non-respiratory tract organs and because the symptoms are non-specific without a high index of suspicion, the diagnosis of COVID-19 infection may be missed initially or there may be delay in the diagnosis which would tend to lead to spreading of the disease. Some of the manifestations of COVID-19 infection of the urinary bladder may include: Lower urinary tract symptoms of urinary frequency, and or urinary urgency, and or nocturia, and or urinary incontinence, or on rare occasions non-visible or visible haematuria, or acute retention of urine. The aforementioned symptoms may occur as De novo (new-onset) symptoms alone or they may be associated with or without fever, with or without respiratory tract symptoms. Some individuals who already have lower urinary tract symptoms could experience worsening of their previous lower urinary tract symptoms and if the clinician does not have a high index of suspicion for the possible development of COVID-19 infection, and the clinician does blame the symptoms on benign prostatic hyperplasia then the diagnosis could be missed or delayed. If the COVID-19 cystitis is associated with COVID-19 infection of the male genital tract then some of the patients could experience scrotal discomfort, swelling of the scrotum, erythema of the scrotum, or low-flow priapism or clinical and radiology imaging features of acute orchitis, or acute epididymitis, or acute epididymo-orchitis. However, if the lower urinary tract symptoms are associated with respiratory tract symptoms all clinicians globally are aware of the fact that a high index of suspicion for COVID-19 infection should be exercised. What is important is that every clinician and every individual should be made aware of the fact that the development of De novo lower urinary tract symptoms or sudden onset of worsening lower urinary tract symptoms should be regarded as possibly due to COVID-19 infection and appropriate tests should be undertaken to confirm or negate the diagnosis of COVID-19 infection quickly. Diagnosis of COVID-19 infection of the urinary bladder can be confirmed the undertaking of various COVID-19 infection tests but COVID-19 PCR test has tended to be a common test that most people use globally.

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.

SARS-CoV-2 infection affects the lower urinary tract and male genital system: A systematic review.

PubMed, Scopus, and ISI Web of Knowledge databases were searched to identify studies published up to December 2020 on the involvement of urinary and male genital systems in COVID‐19. Sixteen studies involving a total of 575 patients (538 males and 37 females) were included in this systematic review. The COVID‐19 phase was available for 479 patients: 426 in the acute and 53 in the recovery phase. De novo lower urinary tract symptoms (LUTS) were observed in 43 patients and deterioration of pre‐existing LUTS in 7. Bladder hemorrhage was observed in three patients and acute urinary retention in one. Regarding the male genital system, scrotal discomfort was observed in 8 patients, swelling in 14, pain in 16, and erythema in 1; low flow priapism was observed in 2 patients. Ultrasound examination identified acute orchitis in 10 patients, acute epididymitis in 7, and acute epididymo‐orchitis in 16. A case–control study reported that patients with moderate COVID‐19 show a significant reduction in sperm concertation, the total number of sperms per ejaculate, progressive motility, and complete motility. In contrast to what is known from the first studies on the subject, this review also includes subsequent studies that give evidence of the involvement of the lower urinary tract and male genital system in COVID‐19.

Outcomes of low-flow priapism and role of integrated penile prosthesis management

BackgroundThe natural history of priapism and predictors of erectile dysfunction (ED) remain vague due to defective reporting, different management techniques and variable follow-up durations. Acquiring more information concerning the prognosis of erectile function after priapism can help to assess the burden of post-priapism ED. Also, it may guide the decision-making process regarding penile prosthesis insertion in refractory and late post-priapism ED. In this study, we tried to evaluate the state of erectile function after recovery and how far penile implant surgery could be integrated in the early and late management of priapism-related ED.MethodsWe included 72 patients with low-flow priapism who were managed via a stepwise approach starting from aspiration through percutaneous distal shunt up to distal shunt. Immediate placement of a penile prosthesis was completed in eight refractory patients, including three that were inserted even before an open distal corporoglanular shunt.ResultsNearly two-thirds (70.3%) of recovered priapism patients developed ED, but penile prostheses were inserted only in 35.5% of ED cases. There were no differences in the short- and long-term complications of immediate versus delayed prosthesis placement except for difficulty with the insertion of the penile prosthesis in delayed procedures.ConclusionsImmediate placement of a penile prosthesis is a good treatment option in the setting of refractory priapism with comparable outcomes to those of patients with post-priapism ED who received prostheses. Immediate penile prosthesis insertion was further justified by the high incidence of post-priapism erectile dysfunction.

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.