Cases reported "Priapism"

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21/302. Posttraumatic high-flow priapism: treatment with selective embolisation.

    priapism is an uncommon problem in childhood. Most of the reported cases are in boys with sickle-cell disease or leukaemia. It occurs as a result of venous outflow obstruction, resulting in engorgement of the corpora cavernosa, and is termed "low-flow" priapism. In a small group of children priapism is due to uncontrolled arterial inflow, usually as a result of direct trauma. The authors report a case of posttraumatic arterial priapism in a child, successfully treated with selective embolisation of the internal pudendal artery. Recognition of this distinct entity is important, as it carries a good prognosis when appropriately treated. ( info)

22/302. Megalophallus as a sequela of priapism in sickle cell anemia: use of blood oxygen level-dependent magnetic resonance imaging.

    priapism is a common complication of sickle cell anemia. We report a little known sequela of priapism: painless megalophallus, with significant penile enlargement. The patient had had an intense episode of priapism 9 years previously and his penis remained enlarged. blood oxygen level-dependent magnetic resonance imaging revealed enlarged, hypoxic corpora cavernosa. Megalophallus probably resulted from permanent loss of elasticity of the tunica albuginea due to severe engorgement during the episode of priapism. This sequela needs to be recognized by physicians because no intervention is necessary and sexual function seems to remain intact. ( info)

23/302. priapism of ambiguous classification in a sickle cell patient.

    We report a case of recurrent priapism in a sickle cell patient who had undergone physiological transformation from a low-flow state to a mixed high-flow/low-flow picture. An oral alpha-adrenergic agonist/histamine-1 antagonist combination maintained a balance of potency without stutter in the latter state, whereas an oral alpha-adrenergic agonist in the early part of his course did not prevent priapic progression. Concomitant use of a non-steroidal anti-androgenic agent rendered him impotent despite good libido. Other etiologies should be considered in the setting of recurrent priapism and failed standard therapies; duplex ultrasound is useful in order to delineate the hemodynamics. This case supports contentions that priapism is a spectrum phenomenon, and raises questions regarding the mechanism by which alpha-adrenergic agents prevent priapic progression. ( info)

24/302. Refractory priapism of unknown etiology in a pediatric patient.

    priapism is a urologic emergency that can occur in any age group and every patient should receive prompt urologic consultation. Management of priapism is based on the recognition of underlying pathophysiology; ready differentiation between high-flow and low-flow priapism; reversal of any potential precipitating factors; the use of corporal aspiration irrigation combined with intracavernosal alpha adrenergic therapy; and when necessary, a shunting procedure. Delay in recognition or treatment can be crucial as the incidence of long-term complication rises substantially with the duration of the priapism. ( info)

25/302. priapism: ecstasy related?

    priapism, an uncommon urological emergency, is commonly drug-induced. We present a previously unreported case of a young man with priapism probably related to Ecstasy. ( info)

26/302. Selective arterial embolization for post-traumatic high flow priapism.

    We report on a 23 year old patient with high flow priapism following blunt perineal trauma in which arterial-cavernosal fistula was missed by penile Doppler ultrasonography but was successfully localized by arteriography and embolized using Gelfoam pledgets. Detumescence was complete in 2 days and sexual function returned to the premorbid state after 4 weeks. The diagnosis, pathophysiology, and treatment of high flow priapism and review of the literature are discussed. ( info)

27/302. Post-traumatic, high-flow priapism treated with selective cavernous artery embolization and intracavernous streptokinase irrigation: a case report.

    A 54-year-old man developed priapism shortly after a blunt perineal trauma. An arteriocavernous fistula caused the high-flow priapism, and was detected on both color Doppler sonography and selective phaloarteriography. Selective embolization of the left cavernous artery with Gelfoam was performed to seal the fistula, resulting in immediate detumescence. However, the penis remained firm despite returning to almost normal size. No fistula was detected by subsequent color Doppler sonography and phaloarteriography examination. Intracavernous irrigation with 200,000 U streptokinase was applied to treat residual firmness 2 weeks after embolization. Successful sexual intercourse was reported 3 months later. The combination of selective cavernous artery embolization and intracavernous streptokinase irrigation was effective for the treatment of the high-flow priapism in this case. ( info)

28/302. Management of partial segmental priapism.

    We report the cases of 2 patients with partial segmental priapism. The patients presented with pain, a perineal mass, and proximal segmental corporal thrombosis. Treatment consisted of a proximal corpus cavernosal-spongiosum shunt. Diagnostic considerations, literature review, and treatment options are discussed. ( info)

29/302. Bilateral superselective arterial microcoil embolisation in delayed post-traumatic high flow priapism.

    High flow arteriogenic priapism is uncommon and usually occurs after trauma to the genitoperineal area. The onset of prolonged erection can be delayed and is often relatively pain free. Arteriography in this case illustrated the causative bilateral arteriocavernosal fistulae and pseudoaneurysms. Treatment consisted of staged bilateral superselective metallic microcoil embolisations, resulting in prompt detumescence. There were no complications. The patient had normal erectile function six months later. Recent concerns about erectile dysfunction with the bilateral use of permanent metallic coils appear to be unfounded. ( info)

30/302. Malignant priapism associated with metastatic urethral carcinoma.

    We present a 40-year-old man with malignant priapism secondary to urethral squamous cell carcinoma. magnetic resonance imaging revealed the tumor originating from the bulbous urethra, extending into the penile urethra and corpora spongiosa and cavernosa. A penile biopsy confirmed poorly differentiated squamous cell carcinoma of the urethra. Despite administration of systemic chemotherapy, the prognosis of the patient has worsened due to the extensive metastatic disease. ( info)
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