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Hematology. American Society of... Dec 2022Ischemic priapism is a common but underrecognized morbidity affecting about 33% of adult men with sickle cell disease (SCD). The onset of priapism occurs in the... (Review)
Review
Ischemic priapism is a common but underrecognized morbidity affecting about 33% of adult men with sickle cell disease (SCD). The onset of priapism occurs in the prepubertal period and tends to be recurrent with increasing age. Significantly, priapism is associated with an unrecognized high burden of mental duress and sexual dysfunctions. The diagnosis of priapism is clinical. Many episodes of priapism will resolve spontaneously, but when an episode lasts longer than 4 hours, the episode is considered a urologic emergency requiring quick intervention with either corporal aspiration or shunt surgery. Only 3 randomized clinical trials (stilbesterol, ephedrine or etilefrine, and sildenafil) have been conducted for secondary priapism prevention in SCD. All 3 trials were limited with small sample sizes, selection biases, and inconclusive results after completion. The current molecular understanding of the pathobiology of priapism suggests a relative nitric oxide (NO) deficiency secondary to chronic hemolysis in SCD and associated phosphodiesterase type 5 dysregulation. We posit an increase in NO levels will restore the normal homeostatic relationship between voluntary erection and detumescence. Currently, 2 randomized phase 2 trials (1 double-blind, placebo-controlled trial and 1 open-label, single-arm intervention) are being conducted for secondary priapism prevention in men at high risk for recurrent priapism (NCT03938454 and NCT05142254). We review the epidemiology and pathobiology of priapism, along with mechanistic therapeutic approaches for secondary prevention of priapism in SCD.
Topics: Adult; Male; Humans; Priapism; Anemia, Sickle Cell; Sildenafil Citrate; Etilefrine; Hemolysis; Clinical Trials, Phase II as Topic; Randomized Controlled Trials as Topic
PubMed: 36485155
DOI: 10.1182/hematology.2022000380 -
EJHaem Nov 2022Complications associated with sickle cell disease (SCD) that are highly impactful for patients but until recently have been less understood include priapism,...
Complications associated with sickle cell disease (SCD) that are highly impactful for patients but until recently have been less understood include priapism, nephropathy, and neurologic injury. We conducted a retrospective study using US administrative claims data from July 01, 2013 through March 31, 2020 to analyze incidence of these complications, SCD treatment patterns, and healthcare resource utilization (HCRU) and costs among 2524 pediatric and adult patients with SCD (mean [SD] age 43.4 [22.4] years). The most common treatments during follow-up were short-acting opioids (54.0% of patients), red blood cell transfusion (15.9%), and hydroxyurea (11.0%). SCD complications occurred frequently; in the overall population, the highest follow-up incidences per 1000 person-years were for acute kidney injury (53.1), chronic kidney disease (40.6), and stroke (39.0). Complications occurred across all age groups but increased in frequency with age; notably, acute kidney injury was 69.7 times more frequent among ages 65+ than ages 0-15 ( < 0.001). Follow-up per-patient-per-month HCRU also increased with age; however, all-cause healthcare costs were similarly high for all age groups and were driven primarily by inpatient stays. Patients with SCD across the age spectrum have a high burden of complications with the use of current treatments, suggesting unmet needs for treatment management.
PubMed: 36467832
DOI: 10.1002/jha2.575 -
EJHaem Nov 2022Priapism is a rare presenting feature of chronic myeloid leukemia (CML) in male patients. Treatment aims to relieve symptoms and to prevent erectile dysfunction. Several... (Review)
Review
Priapism is a rare presenting feature of chronic myeloid leukemia (CML) in male patients. Treatment aims to relieve symptoms and to prevent erectile dysfunction. Several treatment modalities exist, however no standard treatment is recommended. We evaluated literature concerning different treatment approaches and evaluate the value of leukapheresis in treatment of priapism. The literature search resulted in 57 included articles, consisting of 53 studied patients. Patients had a mean age of 25.3 years, average time from onset to presentation at the hospital was 2 days, and mean white blood cell (WBC) count was 344 × 10/L. Most patients (67.9%) were treated with a combined approach (different modalities were radiological, urological, and oncological treatment). Twelve patients, with a mean WBC count of 365 × 10/L, received leukapheresis. Only two of them reported erectile dysfunction after treatment. Priapism is an urological emergency requiring urgent multidisciplinary treatment. We highlight the importance of local urological therapy combined with systemic therapy for CML. Therapeutic leukapheresis should be applied when available and with no other contraindications.
PubMed: 36467799
DOI: 10.1002/jha2.545 -
Psychiatry and Clinical... Dec 2022Priapism is a painful and prolonged erection of the penis without sexual stimulation. Priapism can be seen due to both typical and atypical antipsychotic drug use. A...
Priapism is a painful and prolonged erection of the penis without sexual stimulation. Priapism can be seen due to both typical and atypical antipsychotic drug use. A 51-year-old male who was followed up with a diagnosis of schizophrenia for 30 years and was switched from oral aripiprazole to paliperidone palmitate due to psychotic exacerbation was reported in this study. About 1 month after starting the drug, the patient presented to the emergency department with a painful and prolonged penile erection lasting 3-4 hours. Following the diagnosis of priapism by urology, the patient was relieved by intracavernous adrenaline injection and corpus cavernosum drainage and was referred to psychiatric consultation. Since the patient's examination, history, and laboratory tests could not detect a condition that could cause priapism, it was thought that priapism might be due to antipsychotic medication. One week after stopping paliperidone palmitate injection, the patient had another attack of priapism. Ten days after the second priapism, the patient was started on olanzapine, 10 mg/day, which was increased to 20 mg/day in the follow-up. The patient has been using olanzapine 20 mg/day for the past year. He is still psychiatrically stable and has no signs of priapism. To the best of our knowledge, this is the second case of recurrent priapism associated with paliperidone palmitate use.
PubMed: 38764879
DOI: 10.5152/pcp.2022.21299 -
Radiology Case Reports Feb 2023Priapism is an unintentional prolonged penile erection, lasting equal to or greater than 4 hours, in the absence of sexual stimulation or after having finished it. It is...
Priapism is an unintentional prolonged penile erection, lasting equal to or greater than 4 hours, in the absence of sexual stimulation or after having finished it. It is a rare pathology that can represent a urological emergency. The present report describes the case of a 25-year-old patient who presented priapism after suffering a one-meter fall on the genital area. Patient is a 25-year-old male with macroscopic hematuria without clots, testicular pain 4/10 on the numerical pain scale, stabbing type, without irradiation, secondary to a fall that occurred 3 months earlier, which resulted in a blow to the genital area. He presented an evolution of 20 days with detumescence and erectile dysfunction. Penile Doppler was performed and inverted priapism, arteriolacunar fistula at the base of the left corpus cavernosum, plus severe erectile dysfunction, were diagnosed. After a cavernography and an arteriography, a thrombolysis was performed. The patient continued with anticoagulant treatment with clopidogrel and enoxaparin and did not present complications after thrombolysis. A detailed clinical history, physical examination and a Doppler ultrasound study can provide a clear and timely diagnosis for the patient. Cavernography and arteriography have shown satisfactory results. In the present case, thrombolysis treatment with alteplase provided favorable results.
PubMed: 36439923
DOI: 10.1016/j.radcr.2022.10.066 -
Federal Practitioner : For the Health... Jul 2022Priapism is a disorder that occurs when the penis maintains a prolonged erection in the absence of appropriate stimulation. Conditions that result in hypercoagulable...
BACKGROUND
Priapism is a disorder that occurs when the penis maintains a prolonged erection in the absence of appropriate stimulation. Conditions that result in hypercoagulable states and hyperviscosity are associated with ischemic priapism. COVID-19 is increasingly associated with coagulopathy. To date, there are 6 reported cases of priapism occurring in patients with COVID-19, 5 occurring in the setting of critical illness.
CASE PRESENTATION
We present a case of ischemic priapism which we suspect resulted from COVID-19-associated coagulopathy in a patient without severe COVID-19 presentation.
CONCLUSIONS
Although there have been only a handful of reported cases of COVID-19-associated coagulopathy leading to ischemic priapism, it is possible that the true incidence is much higher. While our case highlights the importance of considering COVID-19 infection in the differential diagnosis of ischemic priapism, more research is needed to understand incidence and definitively establish a causative relationship.
PubMed: 36425347
DOI: 10.12788/fp.0286 -
Toxins Nov 2022In India, most snakebite envenomation (SBE) incidents are caused by the "Big Four" snakes which include Russell's viper, common krait, Indian cobra, and saw-scaled...
In India, most snakebite envenomation (SBE) incidents are caused by the "Big Four" snakes which include Russell's viper, common krait, Indian cobra, and saw-scaled viper. Their common envenomation effects include neurotoxicity, myotoxicity, and coagulopathy. However, they also induce rare complications such as priapism, pseudoaneurysm, and sialolithiasis. Ocular manifestations such as optic neuritis develop rarely following envenomations by non-spitting snakes and they may cause temporary vision changes and blindness if untreated. While optic neuritis following Indian cobra envenomation has been reported previously, this was not encountered in victims of common kraits. Hence, for the first time, we report optic neuritis developed in a victim following envenomation by a common krait and compare its clinical features and diagnostic and therapeutic methods used with another case of optic neuritis in a victim of an Indian cobra bite. Both patients received antivenom treatment and made an initial recovery; however, optic neuritis developed several days later. The condition was diagnosed using ophthalmic examination together with computed tomography and/or magnetic resonance imaging methods. Due to very similar clinical features, both patients received intravenous corticosteroids which restored their vision and successfully treated optic neuritis. This case report suggests that the optic neuritis developed in a common krait envenomation is comparable to the one developed following a cobra bite, and therefore, the same diagnostic and therapeutic approaches can be used. This study also raises awareness of this rare complication and provides guidance for the diagnosis and treatment of SBE-induced optic neuritis.
Topics: Male; Animals; Naja naja; Bungarus; Optic Neuritis; Snake Bites; Antivenins
PubMed: 36422979
DOI: 10.3390/toxins14110805 -
The Journal of International Medical... Nov 2022Lamotrigine is an antiepileptic drug that can be used to control many types of seizures as a single-agent or an add-on therapy in patients over 2 years of age. In... (Review)
Review
Lamotrigine is an antiepileptic drug that can be used to control many types of seizures as a single-agent or an add-on therapy in patients over 2 years of age. In addition to common adverse reactions, this current case report describes a paediatric male patient with a rare side-effect of persistent penile erectile due to lamotrigine. Previous studies have shown that it can improve sexual function in adult male patients. This patient suffered from refractory epilepsy and pneumonia. He had taken a variety of antiepileptic drugs for a long time and developed priapism after the dosage of lamotrigine had been increased. The priapism improved after drug withdrawal and sedation. Further research is needed to elucidate the mechanism of this rare side-effect.
Topics: Adult; Humans; Male; Child; Lamotrigine; Anticonvulsants; Priapism; Epilepsy; Triazines; Drug-Related Side Effects and Adverse Reactions
PubMed: 36418928
DOI: 10.1177/03000605221133988 -
Urology Case Reports Nov 2022Penile abscess with involvement of the corpus cavernosum is a relatively rare condition and is typically associated with cavernosography, intracavernosal injections,...
Penile abscess with involvement of the corpus cavernosum is a relatively rare condition and is typically associated with cavernosography, intracavernosal injections, penile prosthesis, open trauma, priapism, and seeding from a distant infection. Less commonly, it can be seen following penile fracture, particularly in patients with identified risk factors of uncontrolled diabetes mellitus or other immunosuppression. We report a case of a healthy 24-year-old man with a penile abscess discovered during repair of a one-month-old, imaging confirmed, neglected penile fracture.
PubMed: 36406007
DOI: 10.1016/j.eucr.2022.102273 -
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