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The Urologic Clinics of North America Nov 2021Priapism is defined as a persistent penile erection lasting more than 4 hours. Priapism is a rare condition but when present it requires prompt evaluation and definitive... (Review)
Review
Priapism is defined as a persistent penile erection lasting more than 4 hours. Priapism is a rare condition but when present it requires prompt evaluation and definitive diagnosis. Priapism has 2 pathophysiologic subtypes: ischemic and nonischemic. Ischemic priapism accounts for a majority of cases reported. Ischemic priapism is a urologic emergency and requires intervention to alleviate pain and prevent irreversible damage to erectile tissues. This article highlights current guidelines and the contemporary literature on priapism.
Topics: Humans; Male; Practice Guidelines as Topic; Priapism
PubMed: 34602176
DOI: 10.1016/j.ucl.2021.07.003 -
JAMA Aug 2023
Topics: Male; Humans; Priapism; Erectile Dysfunction; Penis
PubMed: 37471069
DOI: 10.1001/jama.2023.13377 -
The Medical Clinics of North America Mar 2018Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis,... (Review)
Review
Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney.
Topics: Acute Disease; Emergencies; Female; Female Urogenital Diseases; Fournier Gangrene; Humans; Male; Male Urogenital Diseases; Nephrolithiasis; Paraphimosis; Penis; Priapism; Referral and Consultation; Rupture; Spermatic Cord Torsion; Urinary Retention; Urologic Diseases
PubMed: 29406065
DOI: 10.1016/j.mcna.2017.10.013 -
JAMA Apr 2024
Topics: Humans; Male; Priapism; Ischemia; Penis
PubMed: 38512275
DOI: 10.1001/jama.2023.26934 -
Emergency Medicine Clinics of North... Nov 2019The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent... (Review)
Review
The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent conditions and a thorough understanding of the anatomy and physiology is central to recognition of these conditions. Physicians should have a high clinical suspicion for penile emergencies and perform a thorough physical examination to make a proper diagnosis. Prompt diagnosis and proper management are essential for minimizing dysfunction of this vital organ.
Topics: Emergencies; Humans; Male; Paraphimosis; Penile Diseases; Penis; Phimosis; Priapism
PubMed: 31563196
DOI: 10.1016/j.emc.2019.07.001 -
The American Journal of Emergency... Oct 2021Priapism is a severe urologic condition requiring emergency management. Ischemic priapism is the most common subtype which is characterized by a long-lasting, painful,...
Priapism is a severe urologic condition requiring emergency management. Ischemic priapism is the most common subtype which is characterized by a long-lasting, painful, and rigid erection which can be caused by medications with alpha-adrenergic properties such as hydroxyzine. Typically, medication-induced priapism is reported at therapeutic doses and few case reports exist implicating medication overdose as the cause. We report a case of a patient taking hypercompliant doses of hydroxyzine hydrochloride for worsening insomnia (200-600 mg), including the night before admission. Blood-gas analysis of blood from the right corpora was completed and revealed a pH of 6.736, pCO of 147, HCO of 18.6 and a base excess of 17.7. The patient required aspiration and 560 μg of intracavernosal phenylephrine to achieve sustained detumescence. Emergency physicians should be aware of this risk as priapism is a medical emergency and this is the first report with hydroxyzine after an intentional overdose to our knowledge.
Topics: Adult; Histamine H1 Antagonists; Humans; Hydroxyzine; Male; Priapism; Sleep Initiation and Maintenance Disorders
PubMed: 33836933
DOI: 10.1016/j.ajem.2021.03.066 -
Urologie (Heidelberg, Germany) Jun 2024Priapism is defined as penile erection lasting more than four hours that is unrelated to sexual arousal. Priapism is classified based on the oxygenation of the penile... (Review)
Review
Priapism is defined as penile erection lasting more than four hours that is unrelated to sexual arousal. Priapism is classified based on the oxygenation of the penile tissue into ischemic and non-ischemic subtypes. As the most common form, ischemic priapism is usually associated with pain and carries a significant risk of permanent loss of erectile function; thus, rapid intervention is necessary. Initial therapy consists of corporal aspiration and injection of sympathomimetic agents. If detumescence is not achieved, a cavernosal shunt is necessary. Non-ischemic priapism is less common than the ischemic type and is usually the result of perineal trauma. In this subtype, there is usually no pain and treatment is initially conservative. Recurrent (stuttering) priapism is a variant of the ischemic subtype, but is self-limiting and usually occurs during sleep with a duration of less than three to four hours. In the case of prolonged erection, therapy is analogous to that of the ischemic subtype.
Topics: Humans; Priapism; Male; Penis
PubMed: 38653788
DOI: 10.1007/s00120-024-02338-y -
Hematology/oncology Clinics of North... Dec 2022Patients with sickle cell disease and/or (rarely) trait are at increased risk for developing recurrent episodes of priapism, also known as stuttering priapism, and major... (Review)
Review
Patients with sickle cell disease and/or (rarely) trait are at increased risk for developing recurrent episodes of priapism, also known as stuttering priapism, and major ischemic priapism. Treatment of acute ischemic priapism is reactive; whereas ideal management consists of preventative approaches to ultimately promote the best improvement in patient's quality of life. Leg ulcers in patients with sickle cell disease (SCD) are quite common, with ∼20 % of patients with HBSS reporting either having an active or a past ucler. They can be confused with venous ulcers, with lower extremity hyperpigmentation confounding further the diagnosis. Several factors believed to contribute to the development of leg ulcers in patients with SCD are discussed in this article. Sickle cell liver disease (SCLD) occurs because of a wide variety of insults to the liver that happen during the lifetime of these patients. SCLD includes a range of complications of the hepatobiliary system and is increasing in prevalence with the aging adult sickle population. Liver nodular regenerative hyperplasia (NRH) is more common than realized and underappreciated as a diagnosis and requires liver biopsy with reticulin staining. Undiagnosed, the insidious damage from liver NRH can lead to noncirrhotic portal hypertension or cirrhosis.
Topics: Humans; Male; Adult; Priapism; Quality of Life; Liver Diseases; Anemia, Sickle Cell; Leg Ulcer
PubMed: 36400538
DOI: 10.1016/j.hoc.2022.08.001 -
Sexual Medicine Reviews Jul 2021Pharmacologically induced priapism is now the most common cause of priapism, with approximately 50% of drug-related priapism being attributed to antipsychotic usage. The... (Review)
Review
INTRODUCTION
Pharmacologically induced priapism is now the most common cause of priapism, with approximately 50% of drug-related priapism being attributed to antipsychotic usage. The majority of pharmacologic priapism is believed to result in ischemic priapism (low flow), which may lead to irreversible complications, such as erectile dysfunction. It is imperative that prescribing physicians be aware of potentially inciting medications.
OBJECTIVES
To identify medications, specifically antipsychotics, associated with priapism and prolonged erections and understand the rates and treatment of these side effects.
METHODS
A PubMed search of all articles available on the database relating to priapism, prolonged erections, and antipsychotics was performed.
RESULTS
Various typical and atypical antipsychotic drugs (APDs) have been implicated in pharmacologically induced priapism. In addition to dopaminergic and serotoninergic receptors, APDs have affinities for a wide array of other receptors in the central nervous system, including histaminergic, noradrenergic, and cholinergic receptors. Although the exact mechanism is unknown, the most commonly proposed mechanism of priapism associated with APDs is α-adrenergic blockade in the corpora cavernosa of the penis. Priapism appears in only a small fraction of men using medications with α1-receptor-blocking properties, indicating differential sensitivities to the α-blocking effect among men, and/or additional risk factors that may contribute to the development of priapism. The best predictor for the subsequent development of priapism is a past history of having prolonged and painless erections. The acute management algorithm of APD-induced priapism is the same as for other causes of low-flow priapism.
CONCLUSION
Clinicians should educate patients treated with antipsychotics about the potential for priapism and its sequelae including permanent erectile dysfunction. Appropriate patient education will raise awareness, encourage early reporting, and help reduce the long-term consequences associated with priapism through early intervention. Hwang T, Shah T,Sadeghi-NejadH. A Review of Antipsychotics and Priapism. Sex Med Rev 2021;9:464-471.
Topics: Antipsychotic Agents; Erectile Dysfunction; Humans; Male; Penile Erection; Penis; Priapism
PubMed: 33214060
DOI: 10.1016/j.sxmr.2020.10.003 -
Minerva Urologica E Nefrologica = the... Apr 2020Stuttering priapism is a variation of ischemic priapism, generally transient and self-limiting, occurring during sleep and lasting less than 3-4 hours. It may progress... (Review)
Review
INTRODUCTION
Stuttering priapism is a variation of ischemic priapism, generally transient and self-limiting, occurring during sleep and lasting less than 3-4 hours. It may progress to episodes of complete ischemic priapism in approximately one third of cases, necessitating emergent intervention.
EVIDENCE ACQUISITION
This review aims to provide an up-to-date picture of the pathophysiology and management of stuttering priapism. A search using Medline and EMBASE for relevant publications using the terms "priapism", "stuttering", "diagnosis", "treatment", "fibrosis", was performed.
EVIDENCE SYNTHESIS
Stuttering priapism shares its etiologies with ischemic priapism and a large number of diseases or clinical situations have risk association for developing the disorder. The most common causes are sickle cell disease or other hematologic and coagulative dyscrasias especially in children. In the adult population, idiopathic priapism occurring without any discernible cause is considered to be the most common form in adults. The medical management of priapism represents a therapeutic challenge to urologists. Unfortunately, although numerous medical treatment options have been reported, the majority are through small trials or anecdotal reports. Understanding the underlying pathophysiology and understanding the current and emerging future agents and therapeutic options are mandatory in order to provide the best solution for each patient.
CONCLUSIONS
The goal of management of priapism is to achieve detumescence of the persistent erection in order to preserve erectile function. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.
Topics: Adult; Child; Disease Management; Humans; Male; Priapism
PubMed: 30957473
DOI: 10.23736/S0393-2249.19.03323-X