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Veterinary Sciences Sep 2022A 5-year-old recently castrated male Doberman dog presented for prolonged erection of one week's duration with associated pain and dysuria. This was the fourth episode...
A 5-year-old recently castrated male Doberman dog presented for prolonged erection of one week's duration with associated pain and dysuria. This was the fourth episode within a year. Each episode was associated with an unusual event, which was stressful for the dog. Castration performed two months prior to the final episode did not prevent recurrence. Due to tissue necrosis, penile amputation and urethrostomy had to be performed. The dog recovered fully. Prolonged erection that persists beyond or that is unrelated to sexual stimulation is called "priapism". This term refers to the Greek god Priapus, a god of fertility, memorialized in sculptures for his giant phallus. In humans, depending on the mechanism involved, priapism is classified as nonischemic or ischemic. Because prognosis and treatment are different, priapism must be determined to be nonischemic or ischemic. Nonischemic priapism is a rare condition observed when an increase in penile arterial blood flow overwhelms the capacity of venous drainage; it is often associated with penile trauma, and does not require medical intervention. Ischemic priapism is associated with decreased venous return. In humans, ischemic priapism accounts for 95% of cases, the majority of which are idiopathic. Ischemic priapism is a urological emergency; simple conservative measures such as aspiration of blood from the corpora cavernosa and intracavernosal injection of an adrenergic agent are often successful. Stuttering priapism, also called recurrent or intermittent priapism, is a particular form of ischemic priapism reported in humans that is characterized by repetitive episodes of prolonged erections. Management consists of treating each new episode as an episode of acute ischemic priapism, and preventing recurrence with oral medications such as dutasteride and/or baclofen, gabapentin, or tadalafil. To the authors' knowledge, this case is the first report of stuttering priapism in a dog.
PubMed: 36288131
DOI: 10.3390/vetsci9100518 -
Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines.Urology Research & Practice Jul 2023The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines.
OBJECTIVE
The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines.
METHODS
Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms.
RESULTS
Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism.
CONCLUSION
It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.
PubMed: 37877823
DOI: 10.5152/tud.2023.22209 -
Sexual Medicine Reviews Apr 2021Priapism is rare yet has the potential to inflict significant suffering on patients, often with lasting consequences such as erectile dysfunction, corporal muscle... (Review)
Review
INTRODUCTION
Priapism is rare yet has the potential to inflict significant suffering on patients, often with lasting consequences such as erectile dysfunction, corporal muscle necrosis, and a loss of sexual function. Although rare, it is a pathology that has received little focus in the literature, particularly that caused by malignancy, and it is in this form that the long-term prognosis becomes particularly poor.
AIM
This review looks at malignant priapism in detail moving from the etiology and pathogenesis through investigations and management to provide an up-to-date picture.
METHODS
In so doing, more than 30 articles are reviewed and examined from databases such as PubMed. Significant cases are provided as examples to provide a comprehensive review of a topic that receives little attention but can cause significant patient morbidity.
MAIN OUTCOME MEASURE
The main outcome measure was the use of aspiration, sympathomimetics, and surgery as the main treatment modalities and how each one is used with regard to both the underlying etiology of the priapism and also the prognosis. We look at the need for treatment and how that relates to quality of life and erectile function thereafter.
RESULTS
Solid tumor invasion-both primary and secondary-and hematologic malignancies represent the key etiologies of malignant priapism and aggressive treatment is needed. Recovery of erectile function can occur if intracavernosal phenylephrine is quickly administered or distal shunts are placed; however, the prognosis is often poor, and subsequent chemotherapy treatment is often required.
CONCLUSION
The importance of a clear history and examination cannot be understated, and although the prognosis is often poor, this review hopes to give clinicians better understanding to be able to recognize malignancy as a potential cause of priapism. Ralph O, Shroff N, Johnson MJ, et al. Malignancy: A Rare, Important and Poorly Understood Cause of Priapism. J Sex Med 2021; 9:312-319.
Topics: Erectile Dysfunction; Humans; Male; Neoplasms; Penile Erection; Priapism; Quality of Life
PubMed: 31902677
DOI: 10.1016/j.sxmr.2019.11.002 -
Expert Opinion on Drug Safety Oct 2019: Treatment options for erectile dysfunction (ED) have evolved over the last two decades, particularly after the introduction of phosphodiesterase type-5 inhibitors... (Review)
Review
: Treatment options for erectile dysfunction (ED) have evolved over the last two decades, particularly after the introduction of phosphodiesterase type-5 inhibitors (PDE5Is). The path, however, has not been straightforward with issues raised regarding safety and toxicity following ED treatments. : A literature review was conducted on current evidence related to the safety of PDE5Is, intracavernosal injections and various older forms of oral therapies. Relevant trials were identified through a literature search of PubMed from 1980 to 2019. : PDE5Is are now recommended as the first line therapy for the treatment of ED due to their efficacy and tolerable side effects. Comparison of the various PDE5Is on safety has not been supported by prime evidence, and consequently, the negative aspects of each inhibitor appear the same as defined in the literature. Other means of therapies for ED are still in the running, and these also present a different range of side effects. While intracavernosal injections have potential to cause priapism and penile fibrosis, intraurethral alprostadil may result in more systematic side effects. Alternative topical ED therapies are generally limited with their local side effects.
Topics: Alprostadil; Animals; Erectile Dysfunction; Fibrosis; Humans; Injections; Male; Penile Diseases; Phosphodiesterase 5 Inhibitors; Priapism; Vasodilator Agents
PubMed: 31433252
DOI: 10.1080/14740338.2019.1659244 -
International Journal of Clinical... Apr 2022Trazodone is prescribed off-label to treat insomnia, especially in older, not depressed adults. At low doses, it blocks histamine-1 (H1) receptors having a hypnotic...
BACKGROUND
Trazodone is prescribed off-label to treat insomnia, especially in older, not depressed adults. At low doses, it blocks histamine-1 (H1) receptors having a hypnotic effect. Unusual but potentially severe side effects of trazodone include suicidal behavior, excess sedation, QT prolongation, and priapism. Three case studies have been published in the last four decades describing trazodone-induced parkinsonism.
CASE PRESENTATION
A 78-year-old Caucasian male with a past medical history of paroxysmal atrial fibrillation (on amiodarone), major depressive disorder, chronic obstructive pulmonary disease, hypothyroidism, and obstructive sleep apnea, was prescribed trazodone for his chronic insomnia. After 1 month, he was seen in the emergency department (ED) with complaints of coarse tremors of his upper extremities and could not write with a pen anymore due to shaking. He noticed dragging of his feet while walking for over a month, which caused him to have multiple falls and significantly impacted his activities of daily living. On clinical exam, the patient had bilateral cogwheel rigidity in ankles and shuffling gait. Trazodone was discontinued, and his symptoms resolved within a week.
CONCLUSION
Trazodone was likely causing parkinsonism in our patient. Amiodarone may have hindered trazodone metabolism causing higher levels in blood. Multiple mechanisms of trazodone's effect on dopamine have been suggested, but the serotonin-dopamine system interaction remains significant. Physicians need to contemplate the benefits and detriments before adding more medications to the list for older adults. Polypharmacy can amplify the adverse effects of a drug that might not be seen in everyday practice.
Topics: Activities of Daily Living; Aged; Depressive Disorder, Major; Humans; Male; Parkinsonian Disorders; Selective Serotonin Reuptake Inhibitors; Trazodone
PubMed: 35102822
DOI: 10.5414/CP204068 -
Translational Andrology and Urology Nov 2022There is a paucity of data on the clinical experience of priapism. Moreover, little work has explored differences in practice patterns between urologists and emergency...
BACKGROUND
There is a paucity of data on the clinical experience of priapism. Moreover, little work has explored differences in practice patterns between urologists and emergency medicine (EM) physicians. Our primary objective was to understand the priapism patient population and identify targets that may guide clinical translational efforts.
METHODS
A retrospective chart review was performed on two priapism datasets from June 2008-July 2018-one focused on patients managed by urology and another on patients managed exclusively by EM physicians. Primary areas of interest included the duration of priapism and acute interventions during the consultation. Time to presentation, prior interventions and evaluation was also documented.
RESULTS
Over the course of 10 years, there were 396 encounters for priapism in 95 unique patients. Urology was consulted 199 times in 83 unique patients and EM physicians managed 197 encounters in 15 unique patients. In the urology cohort, median duration of priapism was 6 hours, and 72% of patients required further intervention. For the EM cohort, median duration of priapism was 4 hours and 89% of patients required further intervention. Amongst all patients, nine patients presented 4 or more times for a total of 294 encounters.
CONCLUSIONS
Urology and EM managed a similar number of encounters, but EM patients had a shorter duration of priapism. Understanding the role of the EM physician and the urologist can help tailor joint curriculum efforts for initial priapism management while focusing on more complex management for urology trainees. A small proportion of patients accounted for the majority of visits secondary to recurrent ischemic priapism indicating a need to target prevention of these episodes on an outpatient basis.
PubMed: 36507490
DOI: 10.21037/tau-22-180 -
Hematology/oncology Clinics of North... Dec 2022This overview of reproductive and sexual health care concerns for people with sickle cell disease (SCD) addresses clinical concerns that can be complex and are... (Review)
Review
This overview of reproductive and sexual health care concerns for people with sickle cell disease (SCD) addresses clinical concerns that can be complex and are inherently multidisciplinary. Clinicians must be prepared to initiate reproductive health care discussions, as these intimate concerns may not be volunteered by patients. SCD is associated with delayed onset of puberty, sickle pain during menstruation, disease-specific contraceptive considerations, high-risk pregnancy, priapism, erectile dysfunction, and offspring who inherit a hemoglobinopathy trait from affected parents. Reproductive health considerations are underrecognized, undertreated, and understudied. They need attention in primary care and specialty SCD, urology, and obstetrics and gynecology clinics.
Topics: Humans; Male; Pregnancy; Female; Reproductive Health; Anemia, Sickle Cell; Priapism; Pain
PubMed: 36400542
DOI: 10.1016/j.hoc.2022.07.010 -
Actas Urologicas Espanolas Nov 2021Priapism 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... (Review)
Review
INTRODUCTION
Priapism 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 METHODS
Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020.
RESULTS
A 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.
CONCLUSIONS
High-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.
Topics: Angiography; Child; Humans; Male; Penile Erection; Penis; Priapism; Retrospective Studies
PubMed: 34688599
DOI: 10.1016/j.acuroe.2021.05.001 -
The Journal of Sexual Medicine Jan 2020Priapism is a urologic emergency managed by both emergency medicine (EM) providers and urologists. Attitudes regarding its management and understanding of education of...
INTRODUCTION
Priapism is a urologic emergency managed by both emergency medicine (EM) providers and urologists. Attitudes regarding its management and understanding of education of non-urology trainees in this area are poorly defined.
AIM
The aim of this study was to describe attitudes toward priapism management among multiple stakeholders and define the current state of priapism education among EM residency programs.
METHODS
Surveys were developed and distributed online to EM residency leadership, EM residents, and urology providers. Each solicited attitudes and preferences regarding independent priapism management by EM providers. EM residents were further queried about their educational and clinical experiences in priapism management, and EM residency leadership were surveyed about their educational curricula. Responses among all 3 groups were compared using Fisher's exact tests.
MAIN OUTCOME MEASURE
Quantitative and descriptive responses were solicited regarding EM providers' management of acute ischemic priapism and current priapism curricula for EM residents.
RESULTS
91 EM residency program directors and assistant program directors (31.6% of programs), 227 EM residents (14.7% of programs), and 94 urologists (6.3% of survey recipients) responded. All geographic regions and all years of EM training were represented. Over 90% of all surveyed groups felt that EM providers should independently manage priapism in practice. 17% of senior EM residents felt "not at all" confident in managing priapism; and 25.5% had never primarily managed this entity in training. 81% of programs had a formalized priapism curriculum, of which 19% included treatment simulation. However, 36% of residents felt that current curricula were insufficient.
CLINICAL IMPLICATIONS
Widespread approval from both EM providers and urologists support EM-based management for uncomplicated cases of acute ischemic priapism. Current educational curricula for EM trainees may not be sufficient to prepare them to manage this entity in practice.
STRENGTHS & LIMITATIONS
This is the first study to examine provider attitudes toward EM-based management of priapism and assess the current state of education in this area with input from all key stakeholders. This survey was limited in its scope and the response rate was lower than desired.
CONCLUSION
Urologists support independent priapism management by EM providers, but an educational gap remains for EM trainees who do not feel adequately trained to manage this independently in practice. Dai JC, Franzen DS, Lendvay TS, et al. Perspectives on Priapism Education in Emergency Medicine. J Sex Med 2020;17:159-162.
Topics: Curriculum; Emergencies; Emergency Medicine; Humans; Internship and Residency; Male; Priapism; Surveys and Questionnaires; Urologists; Urology
PubMed: 31735620
DOI: 10.1016/j.jsxm.2019.10.011