Successful Management of Recurrent High-Flow Priapism Treated with Selective Arterial Embolization: A Case Report.

Introduction: High-flow priapism is rare, uncontrolled arterial inflow, preceded by penile or perineal trauma and arterial-lacunar fistula. There are several ways to treat high-flow priapism, i.e., conservative management, the use of ice packs, mechanical decompression, surgery, and super-selective arterial embolization. Embolization is currently widely accepted in patients who fail from conservative management. This study aimed to report the use of Gelfoam and microcoil embolization in recurrent high-flow priapism compared to PVA embolization. Case Study: A 36-year-old man complained of prolonged erection. The erection occurred three days before admission while waking up in the morning, not accompanied by either sexual stimulation or pain. There was a history of fall four days ago in the afternoon, with the patient's groin hitting a rocky ground. Physical examination revealed an erect penis, which felt warm, with an EHS of 4. Blood gas analysis of the corpus cavernosum showed bright red blood with a pH of 7.47, pCO2 of 23.6, pO2 of 145, HCO3 of 17.3, BE of -6, and SaO2 of 99%. Doppler ultrasound examination of the penis showed high-flow priapism. Embolization with PVA was performed, and there were decreased complaints. A few hours later, the erection occurred. Reevaluation was then performed and continued with embolization using Gelfoam and microcoil. There were immediate successful results (EHS of 3) accompanied by a decrease in symptoms. Long-term follow-up has shown a return to normal erectile function six months following the injury. Conclusion: Priapism may happen due to various etiologies. Differentiating high-flow and low-flow is paramount during the acute phase because of different treatment strategies. Conservative management may be applied to high-flow priapism. If conservative management fails, embolization may be attempted. The choice of embolization agent must be taken into account.

The Effect of Covid-19 Severity on Lower Urinary Tract Symptoms Manifestations.

Background: The dominant symptoms in the patient with COVID-19 are symptoms of the respiratory organ system such as cough, rhinorrhea, dan shortness of breathing. Nonetheless, some reports found involvement of another organ system, including the gastrointestinal system, cardiovascular system, central nervous system, urinary system, such as lower urinary tract symptoms. Hematuria related to infection of COVID-19 virus on adult and kids were reported. Urinary frequency related to infection of the covid-19 virus was also reported. However, the association between covid-19 infection and lower urinary symptoms was still unknown. Objective: This study aims to identify the effect of covid-19 infection on lower urinary tract symptoms manifestation on the patient with COVID-19 treated in Field Hospital. Methods: The design of this study is cross-sectional. After inclusion and exclusion criteria, the male and female patients were then asked based on question points from the International Prostate Score and latest condition related covid-19. In addition, we statistically analyzed the association and the effect between these two variables. Results: Six hundred and six COVID-19 confirmed patients were included in this study. The most frequent complaints of lower urinary tract symptoms were frequency. The severity of the covid-19 correlates with the lower urinary tracts symptoms score. Conclusion: The most common lower urinary tract symptoms are frequency, urgency, and nocturia. These lower urinary tract symptoms may increase in severity with the severity of the infection from COVID-19. The severity of COVID-19 has a significant effect on the increase in lower urinary tract symptoms.