Cases reported "priapism"

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1/302. priapism: treatment with corpus cavernosum to dorsal vein of penis shunts.

    Deep and superficial dorsal vein to corpus cavernosum shunts successfully relieved priapism lasting 6 and 3 1/2 days in 2 patients. Since the procedures are anatomically sound, require a small surgical field, do not require saphenous vein mobilization and cannot result in a urethrocutaneous fistula further, clinical trials are warranted. If this brief procedure is unsuccessful in relieving priapism corpus cavernosum to saphenous vein or corpus cavernosum to corpus spongiosum shunts can be accomplished without again preparing or positioning the patient. ( info)

2/302. priapism caused by glucose phosphate isomerase deficiency.

    A case of congenital non-spherocytic hemolytic anemia of unknown etiology is described. The patient had priapism and further hematologic evaluation revealed a glucose phosphate isomerase deficiency. This is the first report of priapism secondary to a defect of erythrocyte metabolism. ( info)

3/302. Post-traumatic arterial priapism evaluation with color Doppler ultrasonography: a case report.

    The patient was a 19-year-old man who was examined due to persistent penile erection, which appeared following a blow to the perineal region during work. color Doppler ultrasonography of the corpora cavernosa revealed a cavity in one part of the cavernous artery that suggested a blood leak, and a diagnosis of high flow type priapism due to trauma was made. Bilateral internal pudendal arteriography demonstrated dilation and extravasation in one part of the right cavernous artery, then transarterial embolization was performed superselectively in the right cavernous artery using an autologous clot. However, 2 weeks after treatment, slight penile erection reoccurred. color Doppler ultrasonography revealed reformation of the cavity at the treated lesion, and embolization was again performed using a gelatin sponge. Following embolization, the course proceeded satisfactorily without any relapse. color Doppler ultrasonography, which is non-invasive and can be easily performed, is considered to be an effective means for diagnosis and follow up of arterial high flow priapism. ( info)

4/302. Cerebral edema and priapism in an adolescent with acute lymphoblastic leukemia.

    priapism and increased intracranial pressure are both rare, but recognized, manifestations of leukemia. However, they have never been reported in the same patient. We report a 15-year-old male with acute lymphoblastic leukemia who presented with hyperleukocytosis, priapism, and increased intracranial pressure. central nervous system leukostasis and cerebral edema may have been detected earlier, had his history of priapism been known. Management of hyperleukocytosis complicated by priapism and increased intracranial pressure is discussed. ( info)

5/302. diagnosis and treatment of priapism: experience with 5 cases.

    OBJECTIVES: priapism is a rare disease, but needs early intervention and appropriate management. We present 5 cases, 2 of nonischemic high-flow priapism and 3 of ischemic low-flow priapism. methods: Focusing on the differential diagnosis of priapism between the nonischemic high-flow type and the ischemic low-flow type, we reviewed the medical records of 5 patients. RESULTS: Of the examinations carried out, cavernosography, blood gas analysis of cavernosal blood, color Doppler ultrasound, and internal pudendal arteriography were useful in differentiating the type of priapism. Complete detumescence of the penis in 2 cases of high-flow priapism and 3 cases of low-flow priapism was achieved by selective embolization with gelform and by glandular-cavernosal shunting, respectively. No recurrence was observed in any patient, and postoperative erectile function was preserved in 4 patients and is unknown in 1. CONCLUSIONS: These results indicate that angiographic studies provide the most reliable information for the differentiation of the type of priapism. However, color flow Doppler ultrasound and cavernosal blood gas determination can obviate the need for angiographic studies and are noninvasive. Although conservative treatment or even expectant management may be feasible with high-flow priapism, aggressive treatment should be carried out for low-flow priapism immediately after initial treatment fails to achieve detumescence of the penis. Selective embolization of the internal pudendal artery may be the treatment of choice for patients with high-flow priapism. ( info)

6/302. Prolonged nocturnal penile tumescence caused by epinastine.

    PURPOSE: We report a case of prolonged nocturnal penile tumescence (NPT) caused by the antiallergic agent epinastine. methods/RESULTS: We measured NPT using Rigiscan-Plus (DacoMed, Minneapolis, MN, USA) with or without the patient having taken epinastine. CONCLUSIONS: Considering its pharmacological effects on cyclic nucleotides, epinastine may have an effect on erectile function. ( info)

7/302. cocaine associated priapism.

    PURPOSE: cocaine abuse is an ongoing epidemic in the united states. priapism associated with cocaine use has been reported only twice in the urological literature. To our knowledge we report the first series of priapism associated with cocaine use and the first case associated with the use of this drug in its solid form, known as crack. MATERIALS AND methods: We retrospectively reviewed the presentation of 3 patients to our emergency department within the last year. Each patient presented with priapism and no identifiable predisposition other than the use of cocaine within 24 hours, as evident on positive urine toxicology. RESULTS: Each patient delayed seeking treatment, which added to the complexity of therapy. Intracavernosal aspiration and irrigations failed in all 3 cases. Cavernous spongiosal shunting failed in the first 2 cases. Cases 2 and 3 were complicated by the high flow variant of priapism. Case 1 ultimately required partial penectomy for infected, gangrenous, distal penile tissue. CONCLUSIONS: It appears that cocaine can be a cause of refractory priapism and treatment can be challenging. We suggest that urine toxicology screening be considered in such cases. The identification of underlying cocaine abuse is important in preventing priapism recurrence in these patients. ( info)

8/302. priapism induced by chlorpromazine.

    priapism is a pathologically prolonged and painful penile erection, usually unassociated with sexual desire or intercourse. Causes include certain oral medications, although the mechanism for drug-induced priapism is unknown. We describe two cases of priapism attributed to chlorpromazine who have presented within the past two years. ( info)

9/302. Complete resolution of post-traumatic high-flow priapism with conservative treatment.

    The most frequent cause of high-flow priapism is penile or perineal closed trauma with laceration of the cavernous artery and the formation of an arterial-lacunar fistula. We present the case of a high-flow priapism due to closed perineal trauma and damage to the left cavernous artery which completely resolved following conservative treatment. The case was documented by duplex Doppler ultrasound and selective pudendal arteriogram before and after resolution. ( info)

10/302. Arterial embolization in the treatment of post-traumatic priapism.

    priapism is a prolonged penile erection not associated with sexual arousal. Two types of priapism have been described: the more common one is the "veno-occlusive" priapism and can be frequently observed as the consequence of an intracavernosal injection of vaso-active drugs for the treatment of erectile dysfunction. The less common type of priapism is known as "high flow" priapism and usually follows perineal or direct penile trauma. The clinical presentation in case of high flow priapism is quite typical: hystory of recent penile or perineal trauma followed, by the onset of a painless, incomplete and constant erection of the penis. A color-flow Doppler sonogram should be performed as first diagnostic step: this examination allows to identify the presence of patent cavernous arteries and prominent venous drainage with focal area of high flow turbulence along the pathway of one or both the cavernous arteries. An arterial blood sample taken from the corpora will confirm the diagnosis. At first, conservative therapeutical attempts can be suggested, with mechanical external compression of the perineum, the use of ice packs, corporeal aspiration and irrigation with saline. Besides, intracorporeal administration of alpha-agonists and methylene blue should be performed. Unfortunately, these conservative measures often result unsuccessful, and more invasive approaches must be considered. The radiological superselective transcatheter embolization of the proximal artery supplying arterial-lacunar fistula should be the present treatment of choice in these cases of high-flow priapism refractory to conservative and medical treatments. The first successful management of high flow priapism by selective arterial embolization was reported by Wear and coworkers in 1977. Autologous clots and gelatine sponge have been extensively used and become very popular as the embolic agent. More recently, platinum microcoils have been proposed with the aim to achieve more precise and selective embolization. In our single-case-experience on the treatment of high flow priapism by arterial embolization, we used the recently introduced tungsten microcoils. At the time of the follow-up, 2 months later, patient reported satisfactory intercourse with an approximately 75% of penile rigidity. By comparison with microsurgical ligature of the damaged vessel, selective embolization is, at least theoretically, a less invasive procedure, particularly with reference to the trauma caused to the erectile tissue. High-flow priapism is a fairly rare urological pathology which does not require immediate and emergency treatment (as is the case, instead, with venous-occlusive priapism), since the risk of post-ischaemic fibrosis is excluded thanks to the fact that oxygen is supplied to the cavernous tissue. Once the diagnosis has been established with certainty, therefore, the specialist has the necessary time at disposal to arrange for the most appropriate therapeutic steps. When, as is frequently the case, conservative measures prove ineffective, the current treatment of choice for cases of fistula of the cavernous artery would appear to be superselective embolization of the artery, provided same can be performed at specialized centres and by experienced personnel. ( info)
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