-
Cureus Feb 2024Priapism, characterized by prolonged and painful penile erection, is a rare urological emergency with diverse etiologies. We present a case of refractory ischemic...
Priapism, characterized by prolonged and painful penile erection, is a rare urological emergency with diverse etiologies. We present a case of refractory ischemic priapism following hemodialysis in a 57-year-old male with a history of type II diabetes mellitus, hypertension, and end-stage renal disease. Despite standard conservative management, the patient's condition persisted, necessitating penile distal shunting through an intracorporeal dilatation plus Al-Ghorab corporoglandular shunt. Blood gas analysis of corpus cavernosum blood revealed severe acidosis and hypoxemia, emphasizing the systemic impact of ischemic priapism. The patient's history of erythropoietin injections and the administration of heparin during dialysis emerged as potential contributors to priapism. We discuss the complex interplay between erythropoietin, coagulation cascade, and heparin in the context of priapism development. The case underscores the need for further research to understand the specific mechanisms contributing to priapism in patients undergoing hemodialysis.
PubMed: 38496140
DOI: 10.7759/cureus.54185 -
Therapeutic Advances in... 2022Priapism is a rare pathological condition defined as painful and persistent penile erection that is unrelated to sexual stimulation. It can be classified as ischaemic or...
Priapism is a rare pathological condition defined as painful and persistent penile erection that is unrelated to sexual stimulation. It can be classified as ischaemic or non-ischaemic. Many causes have been attributed to ischaemic priapism, including the use of some medications such as antipsychotics. The mechanism of priapism associated with antipsychotics is thought to be related to alpha-adrenergic blockage that is mediated by the alpha receptors in the corpora cavernosa of the penis. In this paper, we describe a case of a patient who suffered from Risperidone-induced priapism, and how this adverse effect was resolved by switching to olanzapine followed by olanzapine pamoate. A literature search on PubMed/Medline up to 2011 was conducted by some doctors from London and found 30 cases of priapism associated with risperidone. Based on this work, we searched PubMed through 2021, using the keywords 'priapism' and 'risperidone' and found a total of 43 cases of priapism involving risperidone. Priapism is not correlated with the dosage of this psychotropic drug, and has also occasionally occurred when risperidone has been used in conjunction with another drug. The question of choosing a replacement antipsychotic after the first one has induced priapism, remains problematic. It would be preferable to switch to a drug with less marked alpha1-blocking properties, but no consensus has been reached as to the best choice of medication. Finally, any prescription of an antipsychotic treatment must be preceded by a careful interrogation in search of risk factors for priapism, and the patient should be made aware of the possible occurrence of this side effect and the need to then seek urgent medical advice.
PubMed: 36051502
DOI: 10.1177/20451253221113246 -
Sexual Medicine Dec 2021Clitoral priapism due to venous outflow obstruction is a rare event and medical emergency. Androgen-induced clitoromegaly in transgender men has not been previously...
INTRODUCTION
Clitoral priapism due to venous outflow obstruction is a rare event and medical emergency. Androgen-induced clitoromegaly in transgender men has not been previously identified as a risk factor.
AIMS
Advance current knowledge on identification and treatment of clitoral priapism in the transgender male.
METHODS
A 32 year-old presurgical transgender male underwent gender-affirming laparoscopic total hysterectomy and bilateral salpingo-oöphorectomy without incident. Seven days postop, he developed progressive and painful clitoral engorgement that was persistent. Examination and imaging were consistent with clitoral priapism.
RESULTS
Clitoral priapism was treated with adrenergic drugs (imipramine and pseudoephedrine) with rapid resolution of symptoms.
CONCLUSION
Clitoral priapism is a rare phenomenon usually associated with use of a psychotropic medication. Whether clitoromegaly secondary to androgen administration in transgender men is a risk factor for this rare medical emergency is unknown. Prompt recognition and treatment is paramount. Kusko RE, Singhal E, Kauffman RP. Clitoral Priapism in a Transgender Male. Sex Med 2021;9:100431.
PubMed: 34601429
DOI: 10.1016/j.esxm.2021.100431 -
Journal of Endourology Case Reports 2020Tamsulosin in a widely used drug in urology practice in treating lower urinary tract symptoms of benign prostatic hyperplasia, distal ureteral stones, and ureteral...
Tamsulosin in a widely used drug in urology practice in treating lower urinary tract symptoms of benign prostatic hyperplasia, distal ureteral stones, and ureteral stent-related symptoms. Ischemic priapism is a rare but serious adverse effect of tamsulosin. We report two cases of tamsulosin-induced priapism and reviewed available literature citing priapism as a complication of tamsulosin. We also reviewed the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database to identify reported cases of tamsulosin-induced priapism. First patient was a 61-year-old African American male with paraplegia of 30-year duration. He developed priapism after taking first dose of tamsulosin for lower urinary tract symptoms. He presented with 18 hours of painful erection and was treated with aspiration and irrigation, followed by phenylephrine injection. The patient maintained potency after treatment. The second patient was a 24-year-old male who received tamsulosin in the emergency department as medical expulsive therapy for 11 mm distal ureteral stone. Since he had intractable pain, he underwent emergency primary ureteroscopy with laser lithotripsy as definitive treatment of his ureteral calculus. He developed intraoperative priapism that subsided postoperatively. However, he was discharged with tamsulosin to reduce stent-related urinary symptoms. He returned back to the emergency department after 3 days with persistent priapism for 3 days and needed penoscrotal corporeal decompression to treat his priapism. At 6 weeks follow-up visit, the patient has lost his potency. Although there were only 4 case reports on review of the literature, we were able to identify 46 cases reported in the U.S. FAERS database. Priapism can be an adverse reaction to tamsulosin. Providers and patients should be aware about this complication to ensure early seeking of management to avoid devastating outcomes, particularly in young patients when tamsulosin is given as medical expulsive therapy for ureteral stone and stent-related symptoms.
PubMed: 33102720
DOI: 10.1089/cren.2019.0157 -
British Journal of Haematology Jul 2012Priapism is a rare presenting feature of chronic myeloid leukaemia (CML). It is a urological emergency requiring urgent treatment to prevent long-term complications, in... (Review)
Review
Priapism is a rare presenting feature of chronic myeloid leukaemia (CML). It is a urological emergency requiring urgent treatment to prevent long-term complications, in particular erectile dysfunction. In males with CML, ischaemic priapism is believed to result from hyperleucocytosis and associated leucostasis or hyperviscosity, and is seen in patients presenting with a high white cell count. Increasingly, a combined modality approach is being used to treat CML patients presenting with priapism. This includes systemic therapy with chemotherapy (hydroxycarbamide or tyrosine kinase inhibitors) and therapeutic leukapheresis to reduce the white cell count as well as local intracavernous therapy. This review will examine the literature and discuss the presenting features, investigations and management of priapism in CML.
Topics: Antineoplastic Agents; Humans; Leukapheresis; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Penile Erection; Penis; Priapism
PubMed: 22571386
DOI: 10.1111/j.1365-2141.2012.09151.x -
Postgraduate Medical Journal Nov 1996The act of heterosexual coitus is associated with morbidity due to a variety of conditions as well as with a small risk of sudden death. Awareness of the presentation of... (Review)
Review
The act of heterosexual coitus is associated with morbidity due to a variety of conditions as well as with a small risk of sudden death. Awareness of the presentation of coital emergencies is essential to allow appropriate medical management and sexual counselling.
Topics: Cerebrovascular Disorders; Coitus; Emergencies; Female; Headache; Humans; Male; Penis; Priapism; Rupture
PubMed: 8944205
DOI: 10.1136/pgmj.72.853.653 -
Research and Reports in Urology 2022Ischemic priapism accounts for more than 95% of all priapic episodes. It has to be considered a urological emergency because its time extension may lead to necrosis of... (Review)
Review
Ischemic priapism accounts for more than 95% of all priapic episodes. It has to be considered a urological emergency because its time extension may lead to necrosis of smooth muscle cells of the corpora cavernosa, resulting in a complete erectile dysfunction, penile shortening and loss of girth. In the present systematic review, we perform an up-to-date literature search for patients suffering from refractory ischemic priapism who undergo penile prosthesis implantation with particular interests to the patients characteristics. The conservative management of the priapic episode consists of a sympathomimetic agent in the first istance. Failure or recurrence of priapism following these conservative measures is an indication for surgical management. Shunt procedures between the corpora cavernosa and the neighbouring structures are often used first line; however, in refractory ischemic priapism the success rate is minimal. In such cases (>48 h) an indication of immediate placement of a penile prosthesis could be the best solution.
PubMed: 35059330
DOI: 10.2147/RRU.S278807 -
Investigative and Clinical Urology Jan 2021We examined whether patients are appropriately screened for previous prolonged erections or priapism and counseled about trazodone complications, specifically prolonged...
PURPOSE
We examined whether patients are appropriately screened for previous prolonged erections or priapism and counseled about trazodone complications, specifically prolonged erections and priapism, prior to trazodone treatment.
MATERIALS AND METHODS
We identified patients under the age of 50 on trazodone as of February 27, 2019 at the VA New Jersey Health Care System. Patients were asked about information provided to them prior to medication initiation, occurrence of prolonged erections/priapism, and reporting rate of side effects.
RESULTS
Two hundred and twenty nine out of five hundred and twenty four male patients agreed to participate in the study. Forty three out of two hundred and twenty nine of patients were informed about the side effects of prolonged erections and 37/229 of patients were informed of risk of priapism prior to treatment. Only 17/229 of patients were asked if they had had any episodes of prolonged erection or priapism in the past. Eighteen patients developed prolonged erection while taking trazodone. Only 5/18 patients who had developed prolonged erections informed their physicians.
CONCLUSIONS
Only a fraction of patients were properly screened for previous prolonged erections or priapism and properly informed about the side effects of trazodone. Urologist should better educate trazodone prescribers, such as family medicine and psychiatric colleagues, regarding the side effects of trazodone. It is imperative that prescribing physicians appropriately screen and educate patients prior to trazodone initiation and instruct patients to report any treatment side effects to avoid potential long-term adverse outcomes.
Topics: Adult; Antidepressive Agents, Second-Generation; Directive Counseling; Humans; Male; Mass Screening; Medical History Taking; Middle Aged; Patient Education as Topic; Penile Erection; Priapism; Trazodone
PubMed: 33314808
DOI: 10.4111/icu.20200195 -
Frontiers in Endocrinology 2022Hypogonadism is common in men with sickle cell disease (SCD) with prevalence rates as high as 25%. Testicular failure (primary hypogonadism) is established as the... (Review)
Review
Hypogonadism is common in men with sickle cell disease (SCD) with prevalence rates as high as 25%. Testicular failure (primary hypogonadism) is established as the principal cause for this hormonal abnormality, although secondary hypogonadism and compensated hypogonadism have also been observed. The underlying mechanism for primary hypogonadism was elucidated in a mouse model of SCD, and involves increased NADPH oxidase-derived oxidative stress in the testis, which reduces protein expression of a steroidogenic acute regulatory protein and cholesterol transport to the mitochondria in Leydig cells. In all men including those with SCD, hypogonadism affects physical growth and development, cognition and mental health, sexual function, as well as fertility. However, it is not understood whether declines in physical, psychological, and social domains of health in SCD patients are related to low testosterone, or are consequences of other abnormalities of SCD. Priapism is one of only a few complications of SCD that has been studied in the context of hypogonadism. In this pathologic condition of prolonged penile erection in the absence of sexual excitement or stimulation, hypogonadism exacerbates already impaired endothelial nitric oxide synthase/cGMP/phosphodiesterase-5 molecular signaling in the penis. While exogenous testosterone alleviates priapism, it disadvantageously decreases intratesticular testosterone production. In contrast to treatment with exogenous testosterone, a novel approach is to target the mechanisms of testosterone deficiency in the SCD testis to drive endogenous testosterone production, which potentially decreases further oxidative stress and damage in the testis, and preserves sperm quality. Stimulation of translocator protein within the transduceosome of the testis of SCD mice reverses both hypogonadism and priapism, without affecting intratesticular testosterone production and consequently fertility. Ongoing research is needed to define and develop therapies that restore endogenous testosterone production in a physiologic, mechanism-specific fashion without affecting fertility in SCD men.
Topics: Anemia, Sickle Cell; Animals; Humans; Hypogonadism; Male; Mice; Penis; Priapism; Testosterone
PubMed: 35592776
DOI: 10.3389/fendo.2022.892184 -
Archivos Espanoles de Urologia Oct 2017
Topics: Humans; Male; Priapism
PubMed: 28976351
DOI: No ID Found