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The Journal of Sexual Medicine Oct 2019Recreational use of intracavernosal injections (ICIs) is a high-risk behavior that involves sharing of these agents by men without physician regulation.
INTRODUCTION
Recreational use of intracavernosal injections (ICIs) is a high-risk behavior that involves sharing of these agents by men without physician regulation.
AIM
To characterize the etiologies and outcomes of priapism at a Los Angeles metropolitan medical center to better understand patterns of usage of recreational ICIs and the public health implications of such practices.
METHODS
With institutional review board approval, we retrospectively reviewed all cases of priapism presenting to the emergency room of a Los Angeles tertiary medical center from 2010 to 2018. We compared outcomes between patients who presented with priapism after recreational ICI and patients who presented with other etiologies.
MAIN OUTCOME MEASURE
We describe patient characteristics, etiologies, and treatments of priapism at our institution.
RESULTS
We identified 169 priapism encounters by 143 unique patients. Recreational ICIs accounted for 82 of the 169 priapism encounters (49%). Patients who used recreational injections were younger than those who presented with other etiologies (43.5 years vs 47.5 years; P = .048) and had delayed presentations (median, 12 hours vs 8 hours; P < .0001). There was no statistical difference across groups in the proportion of patients requiring operative intervention (14.6% of recreational ICI users vs 16.1% of all other patients; P = .23). A total of 36 out of 72 patients who used recreational ICIs (50%) were HIV+.
CLINICAL IMPLICATIONS
Our study adds to the relatively sparse literature on priapism outcomes. We identify and describe a high-risk population that uses recreational intracavernosal injections.
STRENGTHS & LIMITATIONS
To our knowledge, this is the largest series of priapism encounters. However, the data are retrospective from a single institution, and there is a lack of long-term follow up.
CONCLUSION
A large proportion of priapism visits at our institution were attributed to recreational use of ICIs. This is a high-risk patient population that may not be aware of the risks of recreational ICIs and the consequences of priapism. Further effort should be made to increase public and physician awareness of this harmful practice. Zhao H, Berdahl C, Bresee C, et al. Priapism from Recreational Intracavernosal Injections in a High-Risk Metropolitan Community. J Sex Med 2019;16:1650-1654.
Topics: Adult; Emergency Service, Hospital; Erectile Dysfunction; Humans; Illicit Drugs; Injections; Los Angeles; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Priapism; Retrospective Studies; Self Medication; Trazodone; Urban Health
PubMed: 31501058
DOI: 10.1016/j.jsxm.2019.07.024 -
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 -
Archivos Espanoles de Urologia Aug 2022To describe two cases of man with the diagnosis of ischemic priapism after the intake of tamsulosin and to revise the scientific literature. (Review)
Review
OBJECTIVE
To describe two cases of man with the diagnosis of ischemic priapism after the intake of tamsulosin and to revise the scientific literature.
METHODS
We present two cases of men that developed an ischemic priapism after the intake of tamsulosin prescribed for STUI and were treated in our hospital. We described the two cases, from the diagnosis until the surgery that was performed. Also, we review the scientific literature about this topic.
RESULTS
In one hand, a 67 years old man with the previous diagnosis of diabetes mellitus, hypertension and dyslipidemia that take a one single dosis of tamsulosin and developed a priapism of 9 hours of duration. He was diagnosticated of low-flow priapism that was reverted after the use of intracavernosal phenylephrine. On the other hand, a 61 years old man without any medical condition. He developed a priapism after the intake of also one single dosis of tamsulosin and came to the hospital after 48 hours of the beginning of the erection. In this case, the use of intracavernosal phenylephrine wasn´t effective so we decided to performed a distal shunt between cavernosal and spongy body according to the techniques of Winter, Ebbehoj and Al-Ghorab. All of them without results. At the end, we tried a proximal shunt according Quackles technique, also ineffective. The patient declined another surgery for implantation of a pennis prothesis and went home after four days of hospitalization with the disappearance of the pain.
CONCLUSIONS
The tamsulosin is a drug well known by urologist that have a safety profile probed with the years. Nevertheless, it's association with a disease like the priapism forced us to explain to our patients this rare adverse effect.
Topics: Aged; Hospitals; Humans; Male; Middle Aged; Penis; Phenylephrine; Priapism; Tamsulosin
PubMed: 36138510
DOI: 10.56434/j.arch.esp.urol.20227506.86 -
Acta Bio-medica : Atenei Parmensis Jul 2021Priapism is defined as a penile erection that persists four or more hours and is unrelated to sexual stimulation. Priapism resulting from hematologic malignancy is most...
BACKGROUND
Priapism is defined as a penile erection that persists four or more hours and is unrelated to sexual stimulation. Priapism resulting from hematologic malignancy is most likely caused by venous obstruction from microemboli/thrombi and hyperviscosity caused by the increased number of circulating leukocytes in mature and immature forms. In patients with leukemia, 50% of cases of priapism are due to Chronic Myeloid Leukemia (CML). We present a systematic review of priapism in CML. Acquisition of evidence: An extensive literature research was carried out in PubMed, Google Scholar, SCOPUS, and Science Citation Index databases... The search included cases up to 4th August 2020. Synthesis of evidence: A total of 68 articles were found and included in our review, including 3 reviews from three different centers. We found 68 articles (102 patients; figure 1) and several case reports on priapism in CML. Priapism was noticed in some patients at the first presentation of CML. However, it was infrequently reported during the start of treatment, following the stop of medication and post-splenectomy. The mean age at presentation was 27.4 years, and the mean time from onset of priapism to the time to get medical attention (presentation) was 78.2 hours. The mean white blood cell count associated with priapism was 321.29x109/L, and the mean platelet count was 569 x10 9/L. The chronic phase of CML was the most common phase where priapism occurred. Most patients were Asian (>50%). Nearly a quarter of patients (27.4%) developed permanent erectile dysfunction.
CONCLUSIONS
Priapism is a urological emergency requiring urgent multidisciplinary management to prevent erectile dysfunction. Because of the relatively rare occurrence of priapism in CML patients, there is no standard treatment protocol.
Topics: Hematologic Neoplasms; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Priapism
PubMed: 34212918
DOI: 10.23750/abm.v92i3.10796 -
The West Indian Medical Journal Jul 2014Ischaemic priapism is a devastating urological condition that has the potential to cause permanent erectile dysfunction. The disorder has been associated with numerous...
Ischaemic priapism is a devastating urological condition that has the potential to cause permanent erectile dysfunction. The disorder has been associated with numerous medical conditions and the use of pharmacotherapeutic agents. The aetiology is idiopathic in a number of cases. There are two prior case reports of the association of ischaemic priapism and glucose-6-phosphate dehydrogenase (G6PD) deficiency. We report on a third case of priapism associated with G6PD deficiency and review recently described molecular mechanisms of increased oxidative stress in the pathophysiology of ischaemic priapism. The case report of a 32-year old Afro-Caribbean male with his first episode of major ischaemic priapism is described. Screening for common causes of ischaemic priapism, including sickle cell disease was negative. Glucose-6-phosphate dehydrogenase deficiency was discovered on evaluation for priapism. Penile aspiration was performed and erectile function was good post treatment.Glucose-6-phosphate dehydrogenase deficiency is a cause for ischaemic priapism and should be a part of the screening process in idiopathic causes of the disorder. Increased oxidative stress occurs in G6PD deficiency and may lead to priapism.
PubMed: 25803385
DOI: 10.7727/wimj.2013.294 -
Andrology Jul 2017In patients with sickle cell anemia, the sickling of red blood cells is known to cause end-organ damage by infarction. In some men who are affected by sickle cell... (Review)
Review
In patients with sickle cell anemia, the sickling of red blood cells is known to cause end-organ damage by infarction. In some men who are affected by sickle cell anemia, the obstruction of venous outflow of the penis causes priapism, which could lead to erectile dysfunction. There is also evidence that the disease is linked to other reproductive issues in men-specifically delayed puberty, low testosterone, and sperm abnormalities-although the causes of these problems are less clear. Treatment of sickle cell anemia can have effects on the reproductive system as well. This review summarizes the findings from various publications pertaining to reproductive endocrinology, along with their conclusions and discrepancies.
Topics: Adolescent; Adult; Anemia, Sickle Cell; Antisickling Agents; Child; Child Development; Child, Preschool; Erectile Dysfunction; Female; Hormones; Humans; Hypogonadism; Infertility, Male; Male; Penile Erection; Pregnancy; Pregnancy Rate; Priapism; Puberty; Reproduction; Risk Factors; Semen Analysis; Testis
PubMed: 28662541
DOI: 10.1111/andr.12370 -
Medical Principles and Practice :... 2014To evaluate the relationship between the occurrence of priapism and important steady-state clinical and laboratory parameters in homozygous sickle cell disease (SCD).
OBJECTIVE
To evaluate the relationship between the occurrence of priapism and important steady-state clinical and laboratory parameters in homozygous sickle cell disease (SCD).
SUBJECTS AND METHODS
Steady-state clinical and laboratory data were obtained from the medical records of 126 male patients seen in the clinic over a 7-year period. Estimated prevalence rates, correlation coefficients and independent t tests were calculated to assess the relationship between priapism and several important clinical and laboratory indices. Patient data on age, haemoglobin concentrations, the frequency of crises per annum, leucocyte counts, platelet counts, serum bilirubin and aspartate transaminase were evaluated.
RESULTS
The prevalence of priapism was determined to be 21.4%, and 22.2% of those affected had erectile dysfunction. There was a significant positive correlation between priapism and older age (p = 0.049) and lower leucocyte counts (p = 0.008). There was no significant relationship with other clinical or laboratory indices.
CONCLUSION
About 1 in 4 of all homozygous older SCD patients had priapism, and an approximately similar ratio developed erectile dysfunction; they also had lower steady-state leucocyte counts. Other clinical and laboratory indicators of disease severity in SCD did not positively correlate with the occurrence of priapism, and this may imply an alternative pathogenetic mechanism.
Topics: Adult; Age Factors; Anemia, Sickle Cell; Aspartate Aminotransferases; Bilirubin; Blood Platelets; Female; Hematologic Tests; Hemoglobins; Humans; Leukocytes; Male; Nigeria; Priapism
PubMed: 24685837
DOI: 10.1159/000360608 -
European Review For Medical and... 2014Priapism is a persistent and often painful penile erection in the absence of sexual stimulation. It can cause progressive fibrosis, edema and drying of the erectile...
OBJECTIVE
Priapism is a persistent and often painful penile erection in the absence of sexual stimulation. It can cause progressive fibrosis, edema and drying of the erectile tissue and then it can lead to erectile dysfunction. Previous studies suggested that, neuronal nitric oxide levels increased during the priapism. High NO levels can result in the formation of reactive oxygen species (ROS) leading to oxidative stress in tissue and reproductive system. The aim of this study was to evaluate oxidative and nitrosative effects caused by priapism in cavernosal tissue and serum, and determinate beneficial effects of lycopene on ischemic priapism.
MATERIALS AND METHODS
32 rats were randomly divided into four groups and the first group being as the control. In the second group, experimental ischemic priapism was formed for an hour and then 1hour reperfusion was provided. In the third group, lycopene was intraperitoneally given at the dose of 10 mg/kg. In the fourth group, lycopene were administered to rats with experimental priapism.
RESULTS
Priapism caused a significant increase in TBARS (thiobarbituric acid reactive substances) and NO levels and a significant decrease in the levels of GSH, CAT, GPx and SOD in serum and cavernosal tissue of rats. However, lycopene significantly increased GSH, CAT, GPx and SOD levels but decreased formation of TBARS production and NO in rats with priapism.
CONCLUSIONS
Our findings indicated that ischemic priapism lead to significant oxidative and nitrosative damage in cavernosal tissue and serum samples of rats. However lycopene treatment eliminates these negative effects induced by priapism. For this reason, we suggested that lycopene may be used in the treatment of priapism.
Topics: Animals; Carotenoids; Disease Models, Animal; Lycopene; Male; Nitric Oxide; Oxidative Stress; Priapism; Random Allocation; Rats; Rats, Sprague-Dawley; Reactive Oxygen Species; Thiobarbituric Acid Reactive Substances
PubMed: 25487946
DOI: No ID Found -
Balkan Medical Journal Jan 2017Priapism is a potentially painful and prolonged erection that occurs in the absence of any stimulation. Olanzapine has been reported to induce priapism in several adult...
BACKGROUND
Priapism is a potentially painful and prolonged erection that occurs in the absence of any stimulation. Olanzapine has been reported to induce priapism in several adult cases with schizophrenia and/or mood disorders but very rarely reported in children.
CASE REPORT
9-year-old male with Asperger's Syndrome (AS) referred to our clinic with the complaints of inattention, hyperactivity and impulsivity. He was diagnosed with attention deficit hyperactivity disorder (ADHD) and given methylphenidate treatment which ameliorated his ADHD symptoms. He started to have severe loss of appetite after methylphenidate treatment so olanzapine 2.5 mg/day was added to cope with severe inappetence. However he experienced priapism after olanzapine and priapism resolved after ceasing the drug. His mother restarted olanzapine because he benefited from olanzapine. But the same episodes occurred soon after olanzapine again and his mother had to stop the medication.
CONCLUSION
Because atypical antipsychotics are now widely used in children, unusual side effects such as priapism should be taken into consideration for the differential diagnosis.
Topics: Antipsychotic Agents; Asperger Syndrome; Attention Deficit Disorder with Hyperactivity; Benzodiazepines; Child; Humans; Male; Olanzapine; Priapism
PubMed: 28251031
DOI: 10.4274/balkanmedj.2015.1300 -
European Review For Medical and... Dec 2015We aimed to identify the oxidative stress effects of the ischemic priapism on cavernosal tissues and to assess the biochemical and histopathological effects of curcumin...
OBJECTIVE
We aimed to identify the oxidative stress effects of the ischemic priapism on cavernosal tissues and to assess the biochemical and histopathological effects of curcumin in rats.
MATERIALS AND METHODS
26 adult male Sprague Dawley rats were randomly divided into three groups. Group 1 (Control, n = 8): only penectomy was performed and 3 ml blood samples were obtained from the vena cava inferior (VCI). Group 2 (ischemia-reperfusion group; n= 8): penectomy was performed after 1 hour ischemic priapism + 30 min reperfusion and 3 ml blood samples were obtained from the VCI. Group III (IR + CURC group, n = 10): 200 mg/kg/day curcumin per orally before surgery for 7 days + penectomy after 1 hour ischemic priapism + 30 min reperfusion and 3 ml blood samples from the VCI. Total oxidant status (TAS), total antioxidant status (TAS) and paraoxonase (PON1) levels were measured. Tissue samples were investigated and scored histopathologically in terms of bleeding, edema and necrosis.
RESULTS
TOS levels were higher (p = 0.002), and TAS levels were lower (p = 0.001) in the IR group compared to the control group. As a result of curcumin treatment, TAS levels were increased (p = 0.003), and TOS levels were decreased (p = 0.004) in the IR + CURC group compared to the IR group. In the treatment group (IR + CURC) TAS and TOS levels were similar to levels in the control group. PON1 levels were increased with ischemia-reperfusion (p = 0.21) and decreased with curcumin treatment (p = 0.53), however these changes were not statistically significant. There was no significant difference in the effects of curcumin on histopathological changes.
CONCLUSIONS
This study showed that curcumin has preventive effects on oxidative stress parameters against ischemia-reperfusion injury.
Topics: Animals; Antioxidants; Aryldialkylphosphatase; Curcumin; Male; Oxidative Stress; Penis; Priapism; Rats; Rats, Sprague-Dawley; Reperfusion Injury
PubMed: 26698266
DOI: No ID Found