Priapism

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.

Priapism, whether of the arterial or veno-occlusive type, mainly affects the cavernous bodies, leaving the low-pressure system in glans and corpus spongiosum soft without urethral compression. In the present 2 case reports, the pathologically increased pressure primarily affected the corpus spongiosum. One had arterial priapism following penile revascularization and the other veno-occlusive priapism due to thrombosis of the internal pelvic veins. Both had ulcerations of the glans and urinary retention requiring suprapubic catheterization. Arteriography revealed the disease mechanism in both, and led to embolization in 1.

We present the fourth reported case of tamsulosin induced priapism in an elderly gentleman with diabetes and hypertension in whom penile blood gas analysis revealed IP. Intracavernous phenylephrine injection relieved IP. Subsequent cardiac monitoring revealed ST segment depression and positive troponins confirming a diagnosis of NSTEMI which was managed by PCI and medical therapy.

A patient with high-flow priapism was treated by transcatheter embolization of a posttraumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate (NBCA), resulting in complete detumescence. Erectile function has been preserved during a 3-month follow-up. Only two patients with NBCA embolization for high-flow priapism have been reported previously.

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OBJECTIVESTo verify the effect on erectile tissue of mice of two neuropeptides extracted from the poison of a spider, Phoneutria nigriventer, (Tx2-5 and -6, termed ‘eretina’) after direct injection into the corpus cavernosum, to assess the minimum dosage necessary for effect, the time for initiation of action, the local duration of the erection, histological effects and the presence of local and systemic side-effects.To verify the effect on erectile tissue of mice of two neuropeptides extracted from the poison of a spider, Phoneutria nigriventer, (Tx2-5 and -6, termed ‘eretina’) after direct injection into the corpus cavernosum, to assess the minimum dosage necessary for effect, the time for initiation of action, the local duration of the erection, histological effects and the presence of local and systemic side-effects.MATERIALS AND METHODSWhen applied intraperitoneally, eretina promotes the relaxation of cavernous smooth muscle, thus causing penile erection. Thirty-five mice were divided in two groups; 10 control mice were injected 20 µL of saline solution, and in the treated group, 25 mice were divided into groups of five and each subgroup received eretina in decreasing doses (0.024, 0.012, 0.006, 0.003 and 0.0015 µg/kg) until the minimum dose that produced an erection was determined. After treatment all mice were monitored to determine the response and any collateral effects.When applied intraperitoneally, eretina promotes the relaxation of cavernous smooth muscle, thus causing penile erection. Thirty-five mice were divided in two groups; 10 control mice were injected 20 µL of saline solution, and in the treated group, 25 mice were divided into groups of five and each subgroup received eretina in decreasing doses (0.024, 0.012, 0.006, 0.003 and 0.0015 µg/kg) until the minimum dose that produced an erection was determined. After treatment all mice were monitored to determine the response and any collateral effects.RESULTSThe minimum dose producing an erection was 0.006 µg/kg, the five mice in this group having evidence of an erection at 35–45 min after injection. The histology of the cavernosum of mice treated with eretina showed dilatation and congestion of the vascular spaces with more blood than in controls. With the minimum dose there were no local or systemic collateral effects and the erection was lost after 120–140 min.The minimum dose producing an erection was 0.006 µg/kg, the five mice in this group having evidence of an erection at 35–45 min after injection. The histology of the cavernosum of mice treated with eretina showed dilatation and congestion of the vascular spaces with more blood than in controls. With the minimum dose there were no local or systemic collateral effects and the erection was lost after 120–140 min.CONCLUSIONThe minimum dose of eretina producing an erection in mice was determined, and the agent was safe for this use as it did not produce any collateral toxic effects. These studies indicate a possible means of determining the mechanism of action of eretina.The minimum dose of eretina producing an erection in mice was determined, and the agent was safe for this use as it did not produce any collateral toxic effects. These studies indicate a possible means of determining the mechanism of action of eretina.

We present the case of a 22 year old man who developed a permanent penile erection after a blunt perineal trauma. Conservative treatment in terms of cooling, compression and puncture of the cavernosal corpora with blood aspiration failed to resolve the priapism. Angiography confirmed the diagnosis of high-flow priapism caused by an arteriovenous fistula. Interventional coil embolization of the fistula was effective meaning that complete detumescence was achieved and erectile function was preserved.

A 7-year-old intact male Boxer was referred to our services at the Veterinary Teaching Hospital of the University of Trás-os-Montes and Alto Douro, suffering from a persistently erect penis (including the bulbus glandis) that had been exposed for several days. Radiographic and ultrasonographic examinations detected a 5.0 × 3.5 cm mass located dorso-laterally to the urinary bladder. The microbial culture of the mass revealed Staphylococcus spp. At that time, we suspected the involvement of an abscess in the origin of the priapism. Medical and surgical treatments were promptly instituted, which allowed for penile withdrawal into the prepuce; however, the resolution of the penile erection was not accomplished in the following days and penile amputation was required. Histological evaluation of the excised penis revealed extensive infarction of the erectile tissue of the pars longa and bulbus glandis, and also of the blood vessels of the penis. Following penile amputation and antimicrobial therapy, the animal fully recovered. Ultimately, the animal died as a consequence of gastric torsion. At necropsy, some lesions compatible with a previous perforation of the intestinal wall were recorded. The data gathered from the anamnesis, the physical and imaging examinations, along with the post-mortem findings, allowed us to conclude that in this clinical case the primary cause of priapism was a perineal abscess due to bowel perforation.

Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of priapism is a matter of urgency requiring identification of underlying hemodynamics. To define the types of priapism, address its pathogenesis and epidemiology, and develop an evidence-based guideline for effective management. Six experts from four countries developed a consensus document on priapism; this document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. This report focuses on guidelines written over the past decade and reviews the priapism literature from 2003 to 2009. Although the literature is predominantly case series, recent reports have more detailed methodology including duration of priapism, etiology of priapism, and erectile function outcomes. Consensus recommendations were based on evidence-based literature, best medical practices, and bench research. Basic science supporting current concepts in the pathophysiology of priapism, and clinical research supporting the most effective treatment strategies are summarized in this review. Prompt diagnosis and appropriate management of priapism are necessary to spare patients ineffective interventions and maximize erectile function outcomes. Future research is needed to understand corporal smooth muscle pathology associated with genetic and acquired conditions resulting in ischemic priapism. Better understanding of molecular mechanisms involved in the pathogenesis of stuttering ischemic priapism will offer new avenues for medical intervention. Documenting erectile function outcomes based on duration of ischemic priapism, time to interventions, and types of interventions is needed to establish evidence-based guidance. In contrast, pathogenesis of nonischemic priapism is understood, and largely attributable to trauma. Better documentation of onset of high-flow priapism in relation to time of injury, and response to conservative management vs. angiogroaphic or surgical interventions is needed to establish evidence-based guidance.

The aim of our work is to evaluate the efficacy of intracavernous sodium nitroprusside (SNP) in management of erectile dysfunction (ED) in a clinical comparative study with papaverine/phentolamine in ED patients. The study included 40 patients with ED divided into two groups. Group I include 20 patients receiving intracavernous (30 mg papaverine + 1 mg phentolamine) followed 1 week later by intracavernous 300 microg SNP. Group II included 20 patients receiving the same regimen of group I but with intracavernous SNP first followed by papaverine/phentolamine 1 week later. All patients were assessed clinically for their response and any developing complications. The numbers of good and poor responders were not statistically significant (P > 0.05) among the two groups. The mean erectile duration of SNP was similar to bimix (P > 0.05). No side-effects whether local or systemic occurred with SNP while priapism and local penile pain were recorded with bimix solution. Intracavernous pharmacotherapy is still a reliable method both for diagnosis and for treatment of ED. While preliminary results of our study show a potential of SNP to be an effective and safe intracavernous agent, long-term self-injection clinical trials are needed before large-scale usage is recommended.

Sickle cell disease is a very common entity in central India, especially in Maharashtra. Patients usually present with recurrent haemolytic and/or vaso-occlusive crises. Although unusual, Priapism i.e. spontaneous painful erection of penis can be a debilitating manifestation of crisis. Especially when it occurs in prepubertal males it can lead to impotence in later life. It is also one of the least discussed complications of sickle cell disease. Here we present a case of sickle cell disease with recurrent priapism in a young boy of 16 years of age. He failed to respond to standard line of treatment. When all modalities failed he was given Tablet Gabapentin after which his priapism was totally relieved. We would like to recommend the use of Gabapentin in such cases of recurrent priapism.

Priapism is an emergency condition resulting from prolonged sexual desire, trauma, tumor infiltration or hematological disorders like sickle cell anemia or leukemia. Rarely may it be drug induced. Here we report a rare case of priapism following intake of terazocin and tamsulosin simultaneously in a 32 year old patient.