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Academic Emergency Medicine : Official... Aug 1996Priapism is a urologic emergency. All patients should receive prompt urologic consultation. Management is based on prompt recognition, differentiation between low- and... (Review)
Review
Priapism is a urologic emergency. All patients should receive prompt urologic consultation. Management is based on prompt recognition, differentiation between low- and high-flow priapism, reversal of any potential precipitating factors, and the use of corporal aspiration/irrigation combined with intracavernosal alpha-agonist injection therapy. It cannot be over-emphasized that severely prolonged erections are associated with the development of irreversible problems with erectile function and, therefore, immediate and aggressive management is mandatory.
Topics: Algorithms; Emergencies; Humans; Male; Penis; Priapism
PubMed: 8853679
DOI: 10.1111/j.1553-2712.1996.tb03520.x -
Cases Journal Dec 2008A 32 year-old African-American man presented to our institution after attempting suicide via ingestion with quetiapine. He had reported a history of several days of...
BACKGROUND
A 32 year-old African-American man presented to our institution after attempting suicide via ingestion with quetiapine. He had reported a history of several days of substance abuse with alcohol, cocaine and marijuana related to a partying binge. Following this, his partner removed him from his residence resulting in a suicide attempt. During hospitalization the patient developed priapism, a condition he had not experienced before.
CASE PRESENTATION
Given this was his first time with priapism, an extensive work-up revealed the patient had previously undiagnosed sickle cell trait, which we postulate to have been a significant factor in his development of acute priapism. Sickle cell trait is considered to be a generally benign condition except for a few rare complications under more demanding physical conditions. However, upon reviewing the literature on the association of sickle cell trait with priapism, we believe this may not be the case. Case reports and small series that appeared in the 1960s and 1970s indicated an association between priapism and sickle trait. Little has been reported recently, and the general teaching regarding sickle cell trait does not include this information. However, one case was reported with the use of phosphodiesterase-5 (PDE-5) inhibitors and the development of priapism in a patient with sickle cell trait. These medications are now first line treatment in erectile dysfunction. They act by enhancing nitric oxide (NO) production leading to relaxation of smooth muscle in the corpora cavernosa and penile arteries.
CONCLUSION
Priapism was not reported in the initial studies of these medications. Further review of the literature indicates this may be a complex relationship. Interestingly, PDE5 inhibitors also have been postulated to be protective in sickle cell disease and perhaps also sickle cell trait because priapism might be caused by reduced NO availability. In this article, we examine the evidence linking sickle cell trait to priapism, explore the implications of PDE5 use, particularly in the setting of sickle cell trait, and propose that teaching about sickle cell trait include a discussion of priapism risk.
PubMed: 19116025
DOI: 10.1186/1757-1626-1-429 -
BMJ Case Reports Aug 2013With only 34 prior cases in world literature, partial priapism (PP), also called partial segmental thrombosis of the corpus cavernosum, is a rare urological condition.... (Review)
Review
With only 34 prior cases in world literature, partial priapism (PP), also called partial segmental thrombosis of the corpus cavernosum, is a rare urological condition. The aetiology and treatment of PP is still unclear, but bicycle riding, trauma, drug usage, sexual intercourse, haematological diseases and α-blockers have been associated with PP. In this case report and world literature review, we describe the case of a 50-year-old man suffering from PP after ingesting 100 mg of sildenafil. The patient was treated with a surgical incision for corpus cavernosum and clot evacuation, as a conservative treatment of PP was not feasible due to severe pain and unresponsiveness to analgesics.
Topics: Humans; Male; Middle Aged; Penile Diseases; Phosphodiesterase 5 Inhibitors; Piperazines; Priapism; Purines; Sildenafil Citrate; Sulfones; Thrombosis
PubMed: 23933863
DOI: 10.1136/bcr-2013-200031 -
The Journal of Sexual Medicine Dec 2019Priapism is the persistent and painful erection of the penis and is a common sickle cell disease (SCD) complication. (Comparative Study)
Comparative Study
INTRODUCTION
Priapism is the persistent and painful erection of the penis and is a common sickle cell disease (SCD) complication.
AIM
The goal of this study was to characterize clinical and genetic factors associated with priapism within a large multi-center SCD cohort in Brazil.
METHODS
Cases with priapism were compared to SCD type-matched controls within defined age strata to identify clinical outcomes associated with priapism. Whole blood single nucleotide polymorphism genotyping was performed using a customized array, and a genome-wide association study (GWAS) was conducted to identify single nucleotide polymorphisms associated with priapism.
MAIN OUTCOME MEASURE
Of the 1,314 male patients in the cohort, 188 experienced priapism (14.3%).
RESULTS
Priapism was more common among older patients (P = .006) and more severe SCD genotypes such as homozygous SS (P < .0001). In the genotype- and age-matched analyses, associations with priapism were found for pulmonary hypertension (P = .05) and avascular necrosis (P = .01). The GWAS suggested replication of a previously reported candidate gene association of priapism for the gene transforming growth factor beta receptor 3 (TGFBR3) (P = 2 × 10).
CLINICAL IMPLICATIONS
Older patients with more severe genotypes are at higher risk of priapism, and there is a lack of consensus on standard treatment strategies for priapism in SCD.
STRENGTHS & LIMITATIONS
This study characterizes SCD patients with any history of priapism from a large multi-center cohort. Replication of the GWAS in an independent cohort is required to validate the results.
CONCLUSION
These findings extend the understanding of risk factors associated with priapism in SCD and identify genetic markers to be investigated in future studies to further elucidate priapism pathophysiology. Ozahata M, Page GP, Guo Y, et al. Clinical and Genetic Predictors of Priapism in Sickle Cell Disease: Results from the Recipient Epidemiology and Donor Evaluation Study III Brazil Cohort Study. J Sex Med 2019;16:1988-1999.
Topics: Adult; Anemia, Sickle Cell; Brazil; Cohort Studies; Genome-Wide Association Study; Genotype; Humans; Male; Middle Aged; Penile Erection; Penis; Polymorphism, Single Nucleotide; Priapism; Risk Factors
PubMed: 31668730
DOI: 10.1016/j.jsxm.2019.09.012 -
Revista Brasileira de Enfermagem 2018To identify self-care demands of men with sickle cell disease and priapism and describe self-care measures in light of Orem's Self-Care Theory.
OBJECTIVE
To identify self-care demands of men with sickle cell disease and priapism and describe self-care measures in light of Orem's Self-Care Theory.
METHOD
This is a descriptive exploratory study with qualitative approach conducted with nine men with a history of sickle cell disease and priapism. Data were analyzed using Orem's Self-Care Theory.
RESULTS
Some demands were identified: from universal self-care - difficulty in social interaction and solitude, changes in self-image, self-esteem and sexual activity; from development - the experience with priapism and little knowledge about the pathophysiology of the disease; regarding health deviations - pain crises.
CONCLUSION
Orem's theory allowed to identify self-care demands, which are essential for the nursing care provided for men with priapism. Nursing has an essential role in the measures for the different demands presented.
Topics: Adult; Anemia, Sickle Cell; Humans; Male; Nursing Theory; Priapism; Qualitative Research; Self Care
PubMed: 30304171
DOI: 10.1590/0034-7167-2017-0464 -
Blood Jun 2015Priapism is a disorder of persistent penile erection unrelated to sexual interest or desire. This pathologic condition, specifically the ischemic variant, is often...
Priapism is a disorder of persistent penile erection unrelated to sexual interest or desire. This pathologic condition, specifically the ischemic variant, is often associated with devastating complications, notably erectile dysfunction. Because priapism demonstrates high prevalence in patients with hematologic disorders, most commonly sickle cell disease (SCD), there is significant concern for its sequelae in this affected population. Thus, timely diagnosis and management are critical for the prevention or at least reduction of cavernosal tissue ischemia and potential damage consequent to each episode. Current guidelines and management strategies focus primarily on reactive treatments. However, an increasing understanding of the molecular pathophysiology of SCD-associated priapism has led to the identification of new potential therapeutic targets. Future agents are being developed and explored for use in the prevention of priapism.
Topics: Anemia, Sickle Cell; Humans; Ischemia; Male; Penis; Priapism
PubMed: 25810489
DOI: 10.1182/blood-2014-09-551887 -
World Neurosurgery Jan 2018Since ancient times, physicians of antiquity noted the occurrence of priapism in some spinal cord injuries. Although priests saw it as a consequence of curses and... (Review)
Review
Since ancient times, physicians of antiquity noted the occurrence of priapism in some spinal cord injuries. Although priests saw it as a consequence of curses and witchcraft, after clinical observations of the Middle Ages and Renaissance, the first medical hypotheses emerged in the 17th-19th centuries completed and argued by neuroscience and neurology developed in the European laboratories and hospitals. This study aims to present a short overview of the history of clinical observations of posttraumatic male priapism after spinal cord injuries since antiquity until the beginning of the 20th century.
Topics: Europe; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; History, Medieval; Humans; Male; Priapism; Spinal Cord Injuries
PubMed: 29054772
DOI: 10.1016/j.wneu.2017.10.041 -
Journal of Education & Teaching in... Jan 2021This low-cost priapism reduction task trainer is designed to instruct emergency medicine (EM) resident physicians.
AUDIENCE
This low-cost priapism reduction task trainer is designed to instruct emergency medicine (EM) resident physicians.
INTRODUCTION
Priapism is a true urologic emergency that EM physicians must be able to diagnose and treat in order to prevent significant tissue damage and loss of erectile function. Given the nature of the condition, priapism treatment is often both physically invasive and psychologically upsetting. Simulation allows learners to practice invasive or rare procedures in a safe and educational environment. At present, there are few inexpensive and easily created task trainers for priapism reduction. Our goal was to create an inexpensive, reusable task trainer that allows learners to practice the skills needed for priapism reduction.
EDUCATIONAL OBJECTIVES
By the end of this educational session, learners should be able to 1) Verbalize the difference between low-flow and high-flow priapism 2) Describe the landmarks for a penile ring block and cavernosal aspiration/injection 3) Demonstrate the appropriate technique for performing a penile ring block, cavernosal aspiration, and cavernosal injection.
EDUCATIONAL METHODS
Using inexpensive and commonly found materials, we were able to successfully create a partial task trainer for teaching priapism reduction techniques including administering local anesthesia, medication injection, and realistic cavernosal aspiration with simulated blood return. As part of a standard EM residency didactics curriculum, this task trainer has been used to teach post graduate year (PGY) 1-4 resident learners. After an introductory didactic session, participants were given the opportunity for hands-on skills-based practice using the simulated task trainer.
RESEARCH METHODS
Learners were asked to complete a post-session survey to assess the educational value of the station and the task trainer.
RESULTS
We were able to successfully create a low cost, easy to build partial task trainer for priapism reduction that allowed learners to perform local anesthesia, medication injections, and corporal aspiration. Twenty-five residents (ten PGY-1, five PGY-2, five PGY-3, five PGY-4) participated in a single didactic session and completed a post-session survey. The majority (68%, N=17) of participants had never previously treated a patient with priapism. On average, participants rated their comfort managing a patient with priapism before the session to be 1.76 on a 5-point Likert-scale (where 1=not at all comfortable and 5=extremely comfortable). Following the session, participants' comfort increased to 3.76 on the same scale. Participants rated the usefulness of the priapism model for teaching priapism reduction techniques to be 4.64 on a 5- point scale (where 1=not at all useful and 5=extremely useful).
DISCUSSION
Using inexpensive and commonly found materials, we were able to successfully create a partial task trainer for teaching priapism reduction techniques including local anesthesia, medication injection, and cavernosal aspiration. Learners reported that the educational session greatly increased their confidence in caring for patients presenting with priapism. Additionally, they found the priapism model to be extremely helpful for teaching reduction techniques. Our model was successful in teaching a procedure that providers may encounter in clinical practice yet most resident learners had not yet had the opportunity to perform in training.
TOPICS
Penile anesthesia, priapism reduction, urologic emergencies.
PubMed: 37465537
DOI: 10.21980/J8K64F -
Urologia Internationalis 1986A case report of a 27-year-old male with segmental priapism of the left proximal corpus cavernosum is presented. Treatment consisted in evacuation and irrigation of the...
A case report of a 27-year-old male with segmental priapism of the left proximal corpus cavernosum is presented. Treatment consisted in evacuation and irrigation of the corpus.
Topics: Adult; Diagnosis, Differential; Drainage; Humans; Male; Perineum; Priapism; Therapeutic Irrigation
PubMed: 3727193
DOI: 10.1159/000281187 -
Translational Andrology and Urology Oct 2023Malignant priapism, a rare disease with only about 500 reported cases to date, consists of persistent erection secondary to invasion or metastasis of a primary neoplasm....
BACKGROUND
Malignant priapism, a rare disease with only about 500 reported cases to date, consists of persistent erection secondary to invasion or metastasis of a primary neoplasm. While treatment guidelines for priapism in non-malignant cases have been established, there is currently no guideline for treating malignant priapism. Herein, we describe three cases of malignant priapism and suggest a step-by-step approach for clinical management.
CASE DESCRIPTION
This study reports three cases of malignant priapism resulting from advanced genitourinary cancers. All patients experienced a sub-acute progression of penile pain and ultimately underwent palliative penectomy, resulting in sustained symptom relief.
CONCLUSIONS
Treatment of malignant priapism needs to be individualized to the needs of the patient. No matter the primary or secondary nature of the disease, current data suggest that malignant priapism is associated with poor outcomes and emphasis should be put on palliative care. Similar to previous cases, our cases died shortly after the diagnosis of malignant priapism. Conventional procedures such as shunting may not necessarily provide symptom relief in these patients. Although new radiation techniques have shown favorable outcomes, penectomy should be considered the last resort in clinical management. Revisions to the existing management guidelines for priapism are necessary to address its occurrence in malignant contexts.
PubMed: 37969781
DOI: 10.21037/tau-23-327