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A case of priapism with ruptured intracranial aneurysm.

A man of 35 years, who had had three attacks of subarachnoid hemorrhage in the previous 3 years, was admitted to hospital with complaints of headache and priapism. There had been intermittent priapism with abnormal acceleration of sexual desire since the first attack, and erection of the penis had persisted with intolerable pain after the last attack of subarachnoid hemorrhage. A carotid angiogram revealed an aneurysm at the junction of the left internal carotid and posterior communicating arteries. Clipping of the aneurysmal neck was successfully performed. However, priapism continued for 22 days after the operation and resulted in sexual impotence. The neurological problems of priapism are discussed with special reference to a hypothalamic lesion caused by the ruptured intracranial aneurysm in this report.

Adult

Cavernospongiosum shunt in management of priapism: is it a reliable method?

The efficiency of cavernospongiosum shunt in the management of priapism was evaluated in 10 patients. Technical details such as the "Z" perineal incision and the opening followed by closure of the contralateral corpus cavernosum, at the time of corpora evacuation, can improve the local exposure and permits a more complete drainage of the corpus cavernosum, but did not improve our results when they were compared with other techniques for treatment of priapism. Penile flaccidity and preservation of sexual potency occurred in 6 (60%) and 5 (50%) patients, respectively, and no surgical complications were observed. Immediate penile flaccidity and regaining of physiologic erection were, however, not complete even in the successfully treated patients. The cavernospongiosum shunt does not seem to represent the definitive form of treating priapism. New knowledge about mechanisms involved in priapism has to be obtained, in order to improve the approach and the prognosis of this disabling condition.

Adolescent

Priapism: evolution of management in 48 patients in a 22-year series.

The choice of an effective method to treat priapism is challenging because precise causes in the majority of patients have not been well defined. A review of 48 patients treated during a 22-year period shows evolution of a regimen of management that has yielded a high percentage of success. Idiopathic priapism and sickle cell disease accounted for 81 per cent of the subjects. An evaluation should include a medication history, a search for specific diseases, as well as a thorough physical examination to detect possible etiologic factors. The explanation for the frequent association of fever deserves further investigation. Initial therapy consisting of aspiration and irrigation, and intermittent pneumatic cuff compression should be undertaken for a trial period of 12 to 36 hours, repeating the aspiration 2 or 3 times if necessary. The failure of priapism to resolve after such treatment is an indication for a shunt operation. Patients with known etiology should be treated specifically for the primary disease and usually more conservatively for priapism. Resolution occurred in all patients and approximately 50 per cent regained sexual potency.

Adolescent

[Priapism--pathogenesis and therapy].

Priapism can occur when pathologic stimuli (e.g. lesions of the cervical spinal cord) cause prolonged erection, and when normal stimuli under pathologic circumstances (e.g. sickle cell disease, leukemia) produce prolonged erection. As any priapism eventually leads to permanent impotentia coeundi, immediate therapy is absolutely indicated. All unspecific procedures are useless and merely waste time. The priapism in connection with hematologic diseases must be countered by conservative specific therapy (sickle cell disease by blood transfusions; leukemias by cytostatic drugs). All other forms of priapism must be treated by surgery as soon as possible. The operation of choice today perineal bilateral shunt between the corpus cavernosum and the corpus spongiosum

Anemia, Sickle Cell

[Priapism--clinical aspects and treatment].

After references to definition, anatomic and physiologic foundations the author deals with the pathology of priapism. A clinical systematization of the diseases occurring together with priapism according to causal points of view is no more worth being advocated. It is completely unclarified to which extent the disease actually participates in priapism. After the description of the possibilities of a conservative medical treatment to the heparin and fibrinolysis therapy it is referred to the importance of the continuous drainage of the corpora cavernosa after Grayhack and Quackels. It is reported on two patients operated according to Grayhack. Results of surgical therapy reported in publications of the last time refer to an essential improvement of the prognosis of priapism.

Adult

Factors predisposing to priapism in haemodialysis patients.

Clinical data and therapy of all male home dialysis patients of two centres were compared in order to establish predisposing factors to priapism. One centre (Frankfurt) had nine priapisms in 96 patients, whereas the other centre (Montpellier) had none in 59 patients. The only difference found were higher haematocrits in Frankfurt than in Montpellier. The highest haematocrits were found in the priapism patients. Further evaluation of the Frankfurt data showed that androgen therapy, high haematocrits and hypovolemia increase the risk of dialysis priapism. It is recommended to withdraw androgen therapy when the haematocrit is consistantly above 25%.

Adult

Priapism and multiple myeloma. Successful treatment with plasmapheresis.

Priapism was associated with multiple myeloma and hyperviscosity in a sixty-year-old black male. Plasmapheresis treatment of the hyperviscosity corrected his priapism, and chemotherapy for the underlying multiple myeloma prevented the recurrence of priapism after a chronic intermittent history of seventeen years.

Humans

Idiopathic priapism in the newborn.

Priapism in children usually results directly or indirectly from an underlying cause. Secondary priapism is extremely rare in neonates and idiopathic priapism has not been described previously.

Humans

Association of priapism in phenothiazine therapy.

We present 4 patients seen in the last 5 years who had taken thioridazine (Mellaril) prior to development of priapism. One of the 4 patients suffered penile trauma while taking the phenothiazine drug and this is another possible etiologic factor in that case. No underlying urologic or hematologic disorders were present. All patients were treated by corporeal aspiration and corpus cavernosum-corpus spongiosum shunts. The mechanism of phenothiazine=induced priapism is hypothesized as being related to its peripheral adrenergic blockade, perhaps directly blocking the sympathetic impulse for detumescence, although a central nervous system effect must be considered as well. Lastly there exists the possibility of coincidence since phenothiazine treatment is becoming more common and was unrelated to the condition in an additional 6 patients with priapism seen during the same period.

Adult

Etiological aspects and interest of early surgical management of priapism.

12 patients have been treated for priapism between March 1973 and September 1977. Etiologic conditions have been found 9 times, leaving only 3 idiopathic priapisms. Treatment of choice consisted of 8 saphenocavernous shunts, achieving detumescence in 7 cases and preserving sexual potency in 5. The precocity of operation seems of no interest to priapism itself but is mandatory to prevent secondary impotence.

Adult

RBC exchange pheresis for priapism in sickle cell disease.

An intermittent-flow blood cell separator was used to perform a sub-total RBC exchange pheresis with prompt relief or priapism secondary to sickle cell disease. The blood cell separator offers an efficient, practical, safe method of performing exchange transfusion in the adult. Surgical procedures in the treatment of priapism have met with limited success and carry a 50% rate of subsequent impotence. We believe that RBC exchange pheresis offers a superior approach in the treatment of complications of sickle cell crisis, including priapism, and should be instituted in the symptomatic patient before more drastic procedures are undertaken.

Adult

A new approach to the treatment of priapism.

A 26-year-old man with post-traumatic priapism was treated successfully by occlusion of the left internal pudendal artery with an autologous clot. The recovery was marked by the return of entirely normal sexual function. This excellent result suggests that autologous clot injection of the internal pudental artery should be considered as an appropriate form of therapy for the treatment of selected patients with priapism.

Adult

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.

Adolescent

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.

Adolescent

Priapism as a sequela of chlorpromazine therapy.

A patient developed priapism following a single intramuscular injection of chlorpromazine for hiccups. Conservative management was unsuccessful. During surgical intervention on the 15th hospital day, the corpora cavernosa of the turgid penis was irrigated and aspirated with heparinized saline using No14 gauge needles. The patient did well postoperatively. The physiology of the erection and the pathophysiology of priapism are discussed.

Adult

Priapism during filtration leukapheresis.

Priapism has been observed during two out of 3,680 filtration leukapheresis procedures in male donors and has been reported during hemodialysis. Both procedures are associated with enhanced granulocyte adhesion and aggregation presumably due to C5a. During both procedures, heparin is administered and this drug has been shown to cause heparin-dependent anti-platelet antibodies. It is suggested that complement mediated venous leukostasis or immune-induced platelet aggregates might impair the normal blood flow from the penis and result in a state of priapism.

Adult

Priapism: surgical or medical treatment?

Two cases of priapism treated with fibrinolysin (streptokinase) are presented. Comparisons are made between medical and surgical treatment in the literature. It is concluded that fibrinolysin may be useful in some cases of early priapism, but should be chosen only after serious consideration of the circumstance that its use precludes early surgery.

Adrenal Cortex Hormones

[2 cases of priapism treated by cavernous body shunts].

The authors present their personal experience in connection with two cases to priapism, one of which was solved by unilateral saphenocavernous anastomosis in a leukemic patient, and the second one by bilateral caverno-spongious anastomosis in a patient with idiopathic priapism. Both interventions had a good outcome. The emergency character is stressed, of this type of intervention, that should b performed bilaterally and followed by anticoagulant treatment.

Adult