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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 -
Frontiers in Immunology 2020Sickle cell disease (SCD) is a genetic disease caused by a single mutation in the β-globin gene, leading to the production of an abnormal hemoglobin called hemoglobin S... (Review)
Review
Sickle cell disease (SCD) is a genetic disease caused by a single mutation in the β-globin gene, leading to the production of an abnormal hemoglobin called hemoglobin S (HbS), which polymerizes under deoxygenation, and induces the sickling of red blood cells (RBCs). Sickled RBCs are very fragile and rigid, and patients consequently become anemic and develop frequent and recurrent vaso-occlusive crises. However, it is now evident that SCD is not only a RBC rheological disease. Accumulating evidence shows that SCD is also characterized by the presence of chronic inflammation and oxidative stress, participating in the development of chronic vasculopathy and several chronic complications. The accumulation of hemoglobin and heme in the plasma, as a consequence of enhanced intravascular hemolysis, decreases nitric oxide bioavailability and enhances the production of reactive oxygen species (ROS). Heme and hemoglobin also represent erythrocytic danger-associated molecular pattern molecules (eDAMPs), which may activate endothelial inflammation through TLR-4 signaling and promote the development of complications, such as acute chest syndrome. It is also suspected that heme may activate the innate immune complement system and stimulate neutrophils to release neutrophil extracellular traps. A large amount of microparticles (MPs) from various cellular origins (platelets, RBCs, white blood cells, endothelial cells) is also released into the plasma of SCD patients and participate in the inflammation and oxidative stress in SCD. In turn, this pro-inflammatory and oxidative stress environment further alters the RBC properties. Increased pro-inflammatory cytokine concentrations promote the activation of RBC NADPH oxidase and, thus, raise the production of intra-erythrocyte ROS. Such enhanced oxidative stress causes deleterious damage to the RBC membrane and further alters the deformability of the cells, modifying their aggregation properties. These RBC rheological alterations have been shown to be associated to specific SCD complications, such as leg ulcers, priapism, and glomerulopathy. Moreover, RBCs positive for the Duffy antigen receptor for chemokines may be very sensitive to various inflammatory molecules that promote RBC dehydration and increase RBC adhesiveness to the vascular wall. In summary, SCD is characterized by a vicious circle between abnormal RBC rheology and inflammation, which modulates the clinical severity of patients.
Topics: Anemia, Sickle Cell; Animals; Duffy Blood-Group System; Erythrocytes; Extracellular Traps; Hemoglobin, Sickle; Hemolysis; Humans; Inflammation; Mice; Oxidative Stress; Reactive Oxygen Species; Receptors, Cell Surface
PubMed: 32231672
DOI: 10.3389/fimmu.2020.00454 -
Cureus Jan 2022Priapism is defined as an erection that lasts longer than four hours, is unrelated to sexual interest or stimulation, and is unrelieved by orgasm. The ischemic subtype...
Priapism is defined as an erection that lasts longer than four hours, is unrelated to sexual interest or stimulation, and is unrelieved by orgasm. The ischemic subtype is a urologic emergency and is often caused by medication side effects, most notably selective serotonin reuptake inhibitors and trazodone. We present the case of ischemic priapism thought to be caused by the recent initiation of gabapentin.
PubMed: 35174036
DOI: 10.7759/cureus.21241 -
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 -
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 -
Abdominal Radiology (New York) Jul 2020This article reviews the anatomy and magnetic resonance imaging (MRI) appearance of the penis. The recommended technique for MRI of the penis is outlined, with... (Review)
Review
This article reviews the anatomy and magnetic resonance imaging (MRI) appearance of the penis. The recommended technique for MRI of the penis is outlined, with discussion of the benefits and drawbacks to imaging the penis after artificial erection. Common penile pathologies are reviewed, with a summary of their clinical features, MRI appearance, and treatment. The ability to demonstrate the erectile bodies and vasculature helps to evaluate vascular pathologies such as priapism, Mondor disease, and cavernosal thrombosis. MRI is also a useful tool to assess for traumatic abnormalities of the penis, with the depiction of soft tissue anatomy and fascial layers allowing for evaluation of penile fracture and penile contusion. Malignant disease of the penis is also reviewed, including squamous cell carcinoma, urethral carcinoma, metastases, and rare neoplasms. Staging of these neoplasms is addressed, with discussion of how MRI can be used to assess the extent of tumor involvement. MRI also clearly demonstrates the tunica albuginea, which allows for evaluation of Peyronie's disease.
Topics: Fascia; Humans; Magnetic Resonance Imaging; Male; Penile Induration; Penis
PubMed: 31701192
DOI: 10.1007/s00261-019-02301-y