RESUMEN
BACKGROUND: This study aimed to evaluate the histopathological and biochemical effects of ketamine on penile tissues following ischemia-reperfusion injury induced by priapism. METHODS: Twenty-four male rats were randomized into three groups. Group 1 served as the control group. Group 2 underwent the priapism model to induce ischemia-reperfusion injury. Group 3, the treatment group, experienced a similar ischemia-reperfusion model as Group 2; additionally, 50 mg/kg of ketamine was administered intraperitoneally just before reperfusion. Blood biochemical analyses and penile histopathological evaluations were performed. RESULTS: In Group 3, significant improvements were observed in all histopathological scores, including desquamation, edema, inflammation, and vasocongestion compared to Group 2 (p<0.001). Blood biochemical analyses showed that the malondialdehyde (MDA) levels were recorded as 10 in Group 2, with a significant decrease in Group 3 (p=0.013). Similarly, proinflammatory cytokine levels, including interleukin-1 beta (IL-1ß), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), were found to be suppressed in Group 3 compared to Group 2 (p=0.003, p=0.022, and p=0.028, respectively). Antioxidant enzyme activities, such as glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), were higher in Group 3 compared to Group 2 (p=0.016 and p=0.024, respec-tively). CONCLUSION: Ketamine is an effective anesthetic agent in alleviating the effects of penile ischemia-reperfusion injury.
Asunto(s)
Modelos Animales de Enfermedad , Ketamina , Malondialdehído , Pene , Priapismo , Daño por Reperfusión , Animales , Ketamina/administración & dosificación , Ketamina/farmacología , Ketamina/uso terapéutico , Masculino , Priapismo/tratamiento farmacológico , Priapismo/etiología , Ratas , Pene/efectos de los fármacos , Pene/irrigación sanguínea , Pene/patología , Daño por Reperfusión/tratamiento farmacológico , Daño por Reperfusión/metabolismo , Malondialdehído/metabolismo , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/metabolismo , Distribución Aleatoria , Anestésicos Disociativos/administración & dosificación , Interleucina-1beta/metabolismo , Interleucina-1beta/sangreRESUMEN
A 29-year-old man developed priapism following the (re)administration of zuclopentixol. In the previous days, a significant amount of alcohol was consumed, presumably in combination with amphetamine and cannabis. Priapism is a rare but serious side effect of various psychoactive medications and recreational drugs, leading to permanent loss of erectile function if not treated in time. In this case the side effect was discovered in a late stage, at which curative treatment was no longer viable. A clear guideline for choosing an alternative antipsychotic agent is currently lacking, but an antipsychotic with low alfa-adrenergic affinity seems preferable. To prevent erectile disfunction following priapism, awareness of its severity is essential, for both doctor and patient.
Asunto(s)
Antipsicóticos , Priapismo , Masculino , Humanos , Adulto , Priapismo/inducido químicamente , Priapismo/tratamiento farmacológico , Antipsicóticos/efectos adversos , ClopentixolRESUMEN
Patients with sickle cell disease (SCD) display priapism, a prolonged penile erection in the absence of sexual arousal. The current pharmacological treatments for SCD-associated priapism are limited and focused on acute interventions rather than prevention. Thus, there is an urgent need for new drug targets and preventive pharmacological therapies for this condition. This review focuses on the molecular mechanisms linked to the dysfunction of the NO-cyclic guanosine monophosphate (cGMP)-phosphodiesterase type 5 (PDE5) pathway implicated in SCD-associated priapism. In murine models of SCD, reduced nitric oxide (NO)-cGMP bioavailability in the corpus cavernosum is associated with elevated plasma hemoglobin levels, increased reactive oxygen species levels that inactive NO, and testosterone deficiency that leads to endothelial nitric oxide synthase downregulation. We discuss the consequences of the reduced cGMP-dependent PDE5 activity in response to these molecular changes, highlighting it as the primary pathophysiological mechanism leading to excessive corpus cavernosum relaxation, culminating in priapism. We also further discuss the impact of intravascular hemolysis on therapeutic approaches, present current pharmacological strategies targeting the NO-cGMP-PDE5 pathway in the penis, and identify potential pharmacological targets for future priapism therapies. In men with SCD and priapism, PDE5 inhibitor therapy and testosterone replacement have shown promising results. Recent preclinical research reported the beneficial effect of treatment with haptoglobin and NO donors. SIGNIFICANCE STATEMENT: This review discusses the molecular changes that reduce NO-cGMP bioavailability in the penis in SCD and highlights pharmacological targets and therapeutic strategies for the treatment of priapism, including PDE5 inhibitors, hormonal modulators, NO donors, hydroxyurea, soluble guanylate cyclase stimulators, haptoglobin, hemopexin, and antioxidants.
Asunto(s)
Anemia de Células Falciformes , Fosfodiesterasas de Nucleótidos Cíclicos Tipo 5 , Óxido Nítrico , Priapismo , Priapismo/etiología , Priapismo/tratamiento farmacológico , Priapismo/metabolismo , Anemia de Células Falciformes/tratamiento farmacológico , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/metabolismo , Humanos , Óxido Nítrico/metabolismo , Masculino , Animales , Fosfodiesterasas de Nucleótidos Cíclicos Tipo 5/metabolismo , GMP Cíclico/metabolismo , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Inhibidores de Fosfodiesterasa 5/farmacologíaRESUMEN
PURPOSE: To explore the differences of priapism events among a diverse cohort taking erectogenic medicines (i.e., phosphodiesterase type 5 inhibitors [PDE5i] and intracavernousal drugs). METHODS: We queried the World Health Organization global database of individual case safety reports (VigiBase) for records of the adverse drug reactions (ADR) with sildenafil, tadalafil, avanafil, vardenafil, papaverine, and alprostadil. Disproportionality analyses (case/non-case approach) were performed to assess the reporting odds ratio (ROR) of priapism reporting in PDE5i consumers compared to intracavernousal drug recipients. RESULTS: From a total of 133 819 ADR events for erectogenic medications, 632 were priapism (PDE5is: n = 550, 0.41%; intracavernousal drugs: n = 82, 9.92%). Priapism disproportionality signals from intracavernousal drugs were 25 times stronger than PDE5is (ROR = 34.7; confidence interval [CI] 95%: 27.12-43.94 vs. ROR = 1.38; 95% CI: 1.24-1.54). For all PDE5i agents, the 12-17 years age group had the highest ROR (9.49, 95% CI: 3.76-19.93) followed by 2-11 years (4.31, 95% CI: 1.57-9.4). Disproportionality signals for consumers under 18 for both all PDE5is as a whole (ROR = 4.57, 95% CI: 2.48-7.73) and sildenafil (ROR = 4.89, 95% CI: 2.51-8.62) were stronger than individuals 18 or older (ROR = 1.06, 95% CI: 0.93-1.21 and ROR = 1.08, 95% CI: 0.91-1.26, respectively). CONCLUSIONS: PDE5i use shows disproportionate priapism signals which are higher in young patients.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Disfunción Eréctil , Priapismo , Masculino , Humanos , Preescolar , Niño , Inhibidores de Fosfodiesterasa 5/efectos adversos , Citrato de Sildenafil/efectos adversos , Priapismo/inducido químicamente , Priapismo/epidemiología , Priapismo/tratamiento farmacológico , Disfunción Eréctil/inducido químicamente , Disfunción Eréctil/tratamiento farmacológico , Disfunción Eréctil/epidemiología , Tadalafilo/efectos adversosRESUMEN
BACKGROUND: Phosphodiesterase type 5 (PDE5) inhibitor labeling states that these agents should not be used in conjunction with other erectogenic medications for fear of priapism occurring. AIM: We explored the risk of priapism and prolonged erections in men in our post-radical prostatectomy (RP) penile injection program who were using regular PDE5 inhibitor and intracavernosal injections (ICIs) as part of their rehabilitation program. METHODS: The study cohort included men on penile injection therapy who (1) were taking tadalafil 5 mg daily or taking sildenafil 25 mg on noninjection days, (2) had an RP, (3) were using their respective PDE5 inhibitor regularly at the time of penile injection training, and (4) complied with the program instructions regarding penile injection use. Demographics, comorbidity details, PDE5 inhibitor dose and utilization, and injection dose and utilization data were collected. All patients underwent in-office injection training and used trimix (papaverine/phentolamine/prostaglandin E1) as the intracavernosal medication. OUTCOMES: Priapism was defined as a patient self-reported penetration hardness erection ≥4 hours in duration, while prolonged erection was defined as a penetration hardness erection lasting ≥2 hours. RESULTS: A total of 112 tadalafil users and 364 sildenafil users were compared. Mean age and duration post-RP were 62 ± 14 years and 5.2 ± 12 months, respectively, and there was no difference between tadalafil and sildenafil groups. The mean trimix dose was tadalafil 24 ± 24 units and sildenafil 31 ± 37 units (P < .05). Priapism occurred in 2 (1.7%) of 112 tadalafil users and 5 (1.4%) of 364 sildenafil users (P = .47). Excluding those men experiencing priapism on any occasion, those with any reported penetration hardness erection lasting ≥2 hours were 7 (6.3%) of 112 tadalafil users and 12 (3.3%) of 364 sildenafil users (P < .01). A total of 53% of these prolonged erections occurred within the first 6 injections at home (no difference between tadalafil and sildenafil groups). CLINICAL IMPLICATIONS: We emphasize the need for continued monitoring and education on proper injection techniques to minimize the risk of adverse events in ICI and PDE5 inhibitor combination therapy. STRENGTHS & LIMITATIONS: This study has a relatively large patient population with a considerable follow-up time. Additionally, the rigorous training, education, and monitoring of the participants, as well as the use of formal definitions for priapism and prolonged erections, enhances the accuracy and reliability of the results. However, there are some limitations, such as social desirability, confounding factors, and recall bias. CONCLUSION: There is no significant difference in the incidence of priapism in an ICI program in which men combine ICI with tadalafil or sildenafil. However, tadalafil patients had a higher rate of prolonged erections, which was found to occur mostly early during the titration phase.
Asunto(s)
Disfunción Eréctil , Priapismo , Masculino , Humanos , Persona de Mediana Edad , Anciano , Inhibidores de Fosfodiesterasa 5/efectos adversos , Citrato de Sildenafil/efectos adversos , Tadalafilo/efectos adversos , Disfunción Eréctil/tratamiento farmacológico , Disfunción Eréctil/etiología , Disfunción Eréctil/cirugía , Priapismo/tratamiento farmacológico , Priapismo/etiología , Priapismo/cirugía , Reproducibilidad de los Resultados , Piperazinas , Purinas/efectos adversos , Erección Peniana/fisiología , Prostatectomía/efectos adversos , Prostatectomía/métodosRESUMEN
Priapism, an unwanted, painful, prolonged erection that is unrelated to sexual stimulation, is a common complication of sickle cell disease (SCD). Priapic events in SCD are stuttering, meaning they occur repeatedly with intervening periods of detumescence. Without health care intervention, repeated episodes can lead to erectile dysfunction. There are limited treatment options for SCD-related priapism and no approved targeted therapies. Crizanlizumab is a monoclonal antibody that binds to P-selectin and is used to reduce the frequency of vaso-occlusive crises in patients with SCD. Here, we report the cases of 3 patients with SCD-related priapism who were treated with crizanlizumab. All patients were African American men who experienced numerous priapic episodes that interfered with their daily lives. Upon treatment with crizanlizumab, priapic events were reduced in all 3 patients. These successful cases suggest a potential role for crizanlizumab in the prevention of SCD-related priapism.
Asunto(s)
Anemia de Células Falciformes , Priapismo , Masculino , Humanos , Priapismo/tratamiento farmacológico , Priapismo/etiología , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/tratamiento farmacológico , Anticuerpos Monoclonales Humanizados/uso terapéuticoRESUMEN
Priapism is a prolonged erection lasting more than four hours. In most cases, it is a surgical emergency. Trazodone is one of the molecules that can cause priapism. This constitutes a real challenge in the management of these patients, who are often young, to avoid too bad impact on erectile function. We report the case of a 34-year-old man.
Le priapisme est une érection prolongée de plus de quatre heures. Il constitue, dans la majorité des cas, une urgence chirurgicale. La trazodone fait partie des molécules pouvant entraîner un priapisme. Ceci constitue un vrai challenge dans la prise en charge de ces patients, souvent jeunes, pour éviter un impact trop important sur la fonction érectile. Nous rapportons le cas d'un homme de 34 ans.
Asunto(s)
Priapismo , Trazodona , Masculino , Humanos , Adulto , Priapismo/inducido químicamente , Priapismo/tratamiento farmacológico , Pene/cirugía , Trazodona/efectos adversos , Erección PenianaRESUMEN
PURPOSE: The following case report discusses probable clitoral priapism secondary to duloxetine and pregabalin. While this is a rare adverse effect, it is possible given the mechanism of action and potentiating effects of the combined therapy. This adverse drug reaction was reported to MedWatch and shows that additional research into the physiology of clitoral erection is warranted given the scarcity of information on how drugs influence this reaction. SUMMARY: A 53-year-old African American female with uncontrolled anxiety was started on duloxetine. Pregabalin was added 1 month later due to continued feelings of anxiety. Three weeks later, the patient reported symptoms of clitoral pain, as well as a swollen, tender, and erect clitoris. These adverse effects remained for 4 days, prompting the patient to present to the emergency department where a physical exam was completed with no significant finding except as noted above. Pregabalin was immediately discontinued by the attending physician based on the probability that the swelling was likely drug-induced clitoral priapism. During follow-up, the patient continued to note clitoral erection and pain. The psychiatric pharmacist tapered off duloxetine over 2 weeks with resolution of symptoms. In an examination of the mechanism of action of both drugs, pregabalin can amplify duloxetine's inhibitory effects on voltage-dependent calcium channels. It is likely this mechanism that causes smooth muscle relaxation and led to clitoral priapism. CONCLUSION: This case suggests that pharmacological agents affecting vasoconstriction through serotonergic receptors or calcium-dependent channels can also influence clitoral erection.
Asunto(s)
Clítoris , Priapismo , Masculino , Femenino , Humanos , Persona de Mediana Edad , Pregabalina/efectos adversos , Clítoris/fisiología , Clorhidrato de Duloxetina/efectos adversos , Priapismo/inducido químicamente , Priapismo/complicaciones , Priapismo/tratamiento farmacológico , Dolor/tratamiento farmacológico , Probabilidad , Analgésicos/uso terapéuticoRESUMEN
Lamotrigine is an antiepileptic drug that can be used to control many types of seizures as a single-agent or an add-on therapy in patients over 2 years of age. In addition to common adverse reactions, this current case report describes a paediatric male patient with a rare side-effect of persistent penile erectile due to lamotrigine. Previous studies have shown that it can improve sexual function in adult male patients. This patient suffered from refractory epilepsy and pneumonia. He had taken a variety of antiepileptic drugs for a long time and developed priapism after the dosage of lamotrigine had been increased. The priapism improved after drug withdrawal and sedation. Further research is needed to elucidate the mechanism of this rare side-effect.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Epilepsia , Priapismo , Adulto , Humanos , Masculino , Niño , Lamotrigina/efectos adversos , Anticonvulsivantes/efectos adversos , Priapismo/inducido químicamente , Priapismo/tratamiento farmacológico , Epilepsia/tratamiento farmacológico , Triazinas/efectos adversosRESUMEN
INTRODUCTION: Priapism is defined as a prolonged penile erection in absence of sexual arousal, leading also to serious sexual and urological problems such as erectile dysfunction and penile fibrosis. Amongst many different etiologies, priapism may be caused by a wide range of antipsychotic medications, mainly due to the α1-adrenergic receptor antagonism. On the other hand, only a couple of cases of opioid compounds have been linked to the onset of priapism, with evidence coming only from methadone and buprenorphine. Here we describe the case of a patient treated with antipsychotics who developed priapism four times following rapid discontinuation of buprenorphine/naloxone (Suboxone®). CASE PRESENTATION: S.C. is a 30-year-old Caucasian man suffering from chronic buprenorphine/naloxone (Suboxone®) abuse, borderline personality disorder, antisocial traits, and multiple suicide attempts. During the acute and the first part of post-acute Suboxone® withdrawal, four episodes of priapism developed while he was treated with clotiapine, clozapine, and chlorpromazine. However, after the last episode of priapism, despite he was either on haloperidol or zuclopenthixol and chlorpromazine, no other urological event occurred during the following 6 months of observation. CONCLUSIONS: As opioids may have dampened the patient's sexual function due to chronic consumption, a rapid drug suspension coupled with an antipsychotic therapy might have created the conditions to facilitate the occurrence of close clustered priapism events.
Asunto(s)
Antipsicóticos , Buprenorfina , Clozapina , Priapismo , Adulto , Analgésicos Opioides/efectos adversos , Antipsicóticos/efectos adversos , Trastorno de Personalidad Antisocial , Buprenorfina/efectos adversos , Combinación Buprenorfina y Naloxona/efectos adversos , Clorpromazina/efectos adversos , Clopentixol/efectos adversos , Clozapina/efectos adversos , Haloperidol , Humanos , Masculino , Metadona/efectos adversos , Priapismo/inducido químicamente , Priapismo/tratamiento farmacológico , Receptores AdrenérgicosRESUMEN
OBJECTIVE: To determine the safety and efficacy of hourly, high dose phenylephrine (>1000 µg) for acute ischemic priapism (AIP) through monitoring adverse hemodynamic events amongst risk profiles. METHODS: An IRB-approved retrospective review of patients with AIP from 2010 to 2020. Patients were stratified to a low or high dose phenylephrine group based on cumulative, hourly dose of ≤1000 µg and > 1000 µg respectively and examined for successful resolution of their AIP. The safety profile of phenylephrine for patients at risk for adverse hemodynamic events was examined. RESULTS: A total of 123 patients were identified with a median age of 40 (range: 7-76) years with median time from AIP onset to presentation of 11 (2-168) hours. A total of 97 men received phenylephrine (78.9%) and detumescence was achieved nonoperatively in 62 of these men (63.9%) with a mean priapism duration of 8.7 hours. Those resolving with phenylephrine administration had a mean duration of 8.8 ± 5.6 vs 57.3 ± 37.1 hours without resolution P < .001. Among low and high dose phenylephrine groups (500 and 2000 µg respectively), the median duration of AIP was 10 and 12 hours respectively without a difference in AIP resolution (P > .05). Twenty-one patients (17.1%) were deemed at risk for phenylephrine complication of which 4 (4.1%) had phenylephrine discontinued due to hemodynamic changes. CONCLUSION: Nonoperative resolution of AIP with phenylephrine does not appear to be dose-dependent and hemodynamic changes secondary to phenylephrine administration may be underreported. Future work should utilize standardized risk assessment and periprocedural monitoring for hemodynamic change.
Asunto(s)
Priapismo , Masculino , Humanos , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Priapismo/tratamiento farmacológico , Priapismo/etiología , Fenilefrina , Mejoramiento de la Calidad , Pene/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Children and adult with sickle cell disease (SCD) display priapism associated with low nitric oxide (NO) bioavailability and oxidative stress in penis. AIM: This study aimed to evaluate the effects of hybrid compound RVT-FxMe, derived from resveratrol bearing a NO-donor subunit, on two murine model that display priapism phenotype, SCD transgenic mice and endothelial NO synthase gene-deficient (eNOS-/-) mice. METHODS: Wild-type, SCD, and eNOS-/- mice were treated with RVT-FxMe (25 mg/kg/d, 2 weeks). OUTCOMES: Hematological parameters, concentration-response curves to acetylcholine (ACh) and sodium nitroprusside (SNP), as well as to electrical field stimulation (EFS), were obtained in mice corpus cavernosum strips. RESULTS: Corpus cavernosum relaxations to SNP and EFS were increased in eNOS-/- group, which were normalized by RVT-FxMe treatment. SCD mice exhibited an excessive CC relaxant response induced by ACh, EFS and SNP RVT-FxMe treatment did not change the increased relaxant responses to ACh, EFS and SNP in corpus cavernosum from SCD group. CLINICAL TRANSLATION: Excess of plasma hemoglobin in SCD may interfere in pharmacological activity of NO donors compounds. STRENGTH/LIMITATIONS: While mechanistic data with promising potential is showed, the current study is not without limitations. RVT-FxMe effects in the mid- and long-term warrant complementary studies. CONCLUSION: Treatment with RVT-FxMe reversed the enhanced NO-cGMP-mediated CC relaxations in eNOS-/- mice, but not in SCD mice; it is likely that excess of plasma hemoglobin in SCD mice act to inactivate NO before it reaches soluble guanylyl cyclase, avoiding restoration of NO bioavailability in penis.
Asunto(s)
Anemia de Células Falciformes , Priapismo , Acetilcolina/farmacología , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/tratamiento farmacológico , Animales , Hemoglobinas , Humanos , Masculino , Ratones , Ratones Transgénicos , Óxido Nítrico , Donantes de Óxido Nítrico/farmacología , Nitroprusiato/farmacología , Priapismo/tratamiento farmacológico , Priapismo/etiología , Resveratrol/farmacologíaRESUMEN
Although rare in pediatrics, ischemic priapism carries significant risk of erectile dysfunction if not treated promptly. We report a case of idiopathic ischemic priapism in a male aged 14 years, refractory to traditional therapies, including aspiration/irrigation, phenylephrine injection, and distal shunt. However, the priapism resolved after intracavernosal injections of tissue plasminogen activator (tPA) with preservation of normal erectile function. To our knowledge, this is the first reported case of intracavernosal tPA for treatment of pediatric priapism. tPA may be a useful management option for recalcitrant ischemic priapism in pediatric patients and may prevent devastating outcomes such as lifelong erectile dysfunction.
Asunto(s)
Disfunción Eréctil , Pediatría , Priapismo , Niño , Humanos , Isquemia/complicaciones , Masculino , Pene , Priapismo/tratamiento farmacológico , Priapismo/etiología , Activador de Tejido Plasminógeno/uso terapéuticoRESUMEN
Background: Priapism refers to prolonged erection unrelated to sexual stimulation, with severe sequelae unless treated. In humans, it is a rare complication associated with epidural or spinal opioid administration. Its pathophysiology is unclear. This is the first report of priapism following neuraxial anesthesia in dog. Case Description: An intrathecal morphine injection (30 mcg/kg) at L5-L6 for postoperative analgesia was given at the end of surgery for removal of cutaneous mastocytomas of the abdomen and left axillary lymphadenectomy. Painless penile erection occurred 2 hours later and lasted 6 hours, before spontaneously resolving 7-8 hours after the injection. No pain or other adverse events (e.g., nausea, urinary retention, and itching) were recorded. Recovery was complete without treatment. Conclusion: Painless, self-resolving priapism is a rare complication associated with intrathecal morphine injection in dogs.
Asunto(s)
Enfermedades de los Perros , Priapismo , Humanos , Masculino , Perros , Animales , Morfina/efectos adversos , Priapismo/inducido químicamente , Priapismo/veterinaria , Priapismo/tratamiento farmacológico , Analgésicos Opioides/efectos adversos , Inyecciones Espinales/efectos adversos , Inyecciones Espinales/veterinaria , Inyecciones/veterinaria , Enfermedades de los Perros/inducido químicamente , Enfermedades de los Perros/tratamiento farmacológicoRESUMEN
Dopamine agonists are generally well tolerated and represent the first-line therapy for prolactinomas. We report a case of a 20-year-old man with a macroprolactinoma who developed recurrent priapism with cabergoline and bromocriptine. Transsphenoidal pituitary adenoma resection was done with normalization of the prolactin level. Priapism is a rare side effect of dopamine agonists that warrants discontinuation of therapy. Patients should be educated about this potential side effect at the time of prescribing the medication.
Asunto(s)
Neoplasias Hipofisarias , Priapismo , Prolactinoma , Adulto , Bromocriptina/uso terapéutico , Cabergolina , Ergolinas/efectos adversos , Humanos , Masculino , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/tratamiento farmacológico , Neoplasias Hipofisarias/cirugía , Priapismo/inducido químicamente , Priapismo/tratamiento farmacológico , Prolactinoma/complicaciones , Prolactinoma/tratamiento farmacológico , Adulto JovenRESUMEN
OBJECTIVES: To examine the current molecular therapeutics in the medical treatment of recurrent ischemic priapism (RIP). To propose a stepwise clinical management paradigm for the treatment of RIP. METHODS: We performed a literature search using the PubMed database for the terms 'recurrent ischemic priapism' and 'stuttering priapism' up until December 2020. We assessed pre-clinical and clinical studies regarding medical management of RIP and molecular pathophysiology. Case series and randomized trials were evaluated by study quality and patient outcomes to determine a potential clinical management scheme. RESULTS: Recent research has fostered an improved understanding of the underlying molecular pathophysiology of RIP that has paved the way forward for developing new therapeutic agents. Medications targeting neurovascular, hormonal and haematological mechanisms associated with RIP show great promise towards remedying this condition. A host of therapeutic agents operating across different mechanistic directions may be implemented according to a clinical management scheme to potentially optimize RIP outcomes. CONCLUSION: RIP remains a medically neglected condition with current management focused on treating the acute condition rather than modulating the course of disease. Continued research into the molecular mechanisms of RIP and standardized clinical pathways can improve the quality of care for patients suffering from this condition.
Asunto(s)
Algoritmos , Anemia de Células Falciformes/tratamiento farmacológico , Isquemia/tratamiento farmacológico , Priapismo/tratamiento farmacológico , Inhibidores de 5-alfa-Reductasa/uso terapéutico , Agonistas de Receptores Adrenérgicos alfa 1/uso terapéutico , Agonistas Adrenérgicos beta/uso terapéutico , Anemia de Células Falciformes/complicaciones , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antifúngicos/uso terapéutico , Antidrepanocíticos/uso terapéutico , Humanos , Hidroxiurea/uso terapéutico , Isquemia/complicaciones , Cetoconazol/uso terapéutico , Masculino , Selectina-P/antagonistas & inhibidores , Erección Peniana/fisiología , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Priapismo/etiología , RecurrenciaRESUMEN
INTRODUCTION: The management of recurrent ischemic priapism is unclear in contemporary practice. Yet, if left untreated, the condition may evolve into an acute ischemic priapism and in some cases result in erectile dysfunction. This report documents the results of successful management of recurrent ischemic priapism using cyproterone acetate in a 30-year-old Saudi man with sickle cell anemia as a comorbidity. CASE PRESENTATION: A 30-year-old Saudi man denoted visited the emergency room with a painful erection which had lasted for more than four hours. The patient has sickle cell anemia and a family history of sickle cell disease. He is married and has two children. His first priapism case occurred when he was 7 years old. At the age of 15, the condition recurred, and the patient's doctor prescribed cyproterone acetate 50 mg twice daily for 5 days. The doctor had told him that whenever he was experiencing priapism, he should adhere to this regimen for 5 days. The doctor could not find any guidelines for the prescription of cyproterone acetate. CONCLUSION: Priapism cases represent a significant challenge in therapeutic management because of the elevated risk of structural damage to the penis. The fact that there lacks a clinically approved standard approach to managing the condition make it difficult for physicians to effectively manage the condition. Management of the condition is further complicated by existence of comorbidities such as sickle cell anemia. This patient's case demonstrates that cyproterone acetate prescription is a great preventative strategy that limits priapism recurrences.
Asunto(s)
Anemia de Células Falciformes , Priapismo , Adulto , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/tratamiento farmacológico , Niño , Comorbilidad , Acetato de Ciproterona/uso terapéutico , Humanos , Masculino , Pene , Priapismo/tratamiento farmacológico , Priapismo/etiologíaRESUMEN
BACKGROUND: Priapism is a urologic emergency consisting of a painful erection lasting greater than 4 hours; antithrombotic therapy (ATT) have recently been recommended as an adjunct in the treatment of ischemic priapism. AIM: To determine the short- and long-term outcomes of periprocedural ATT in the management of acute ischemic priapism. METHODS: A retrospective review of patients seen at the University of California, San Francisco, from 2008 to 2019 was carried out to identify those evaluated for acute priapism. Information regarding duration of priapism, etiology, treatment, periprocedural and postprocedural ATT type and dose, and follow-up data was collected. OUTCOMES: ATT use was the exposure of interest; outcome variables included priapism resolution, repeat episodes, long-term complications, and follow-up. RESULTS: 70 patients with at least 1 detailed record of an acute priapism episode between 2008 and 2019 were identified. Of the 70 patients who underwent management for an acute episode of priapism, 59 (84%) received intracavernous injection of phenylephrine with or without corporal aspiration. Of the 4 patients who received ATT at the same time as intracavernous injection, none had additional priapism episodes. In the 55 patients who did not receive immediate ATT, 22 (40%) required at least 1 shunting procedure. The 9 patients who received ATT concurrently with shunting experienced less recurrence than the 13 patients who did not receive ATT (11% vs 69%, respectively P = .012). There were no significant differences in long-term erectile dysfunction (P = .627), fibrosis (P = .118), genitourinary pain (P = .474), and urinary issues (P = .158) between those who received ATT and those who did not. CLINICAL IMPLICATIONS: Our findings suggest that ATT has a role in preventing priapism recurrence; we observed that long-term repeat priapism episodes are less frequent in those who received periprocedural ATT compared with those who did not and that ATT may especially reduce recurrence in cases when shunting was required STRENGTHS & LIMITATIONS: This is the first study looking at the clinical outcomes of periprocedural ATT in the management of ischemic priapism. It is limited by the fact that it is a single-center study, types of ATT were heterogenous, and the exact timing of priapism management could not be measured for everyone. CONCLUSION: In spite of its limitations, these preliminary findings are promising and warrant further exploration of the use of ATT in the management of ischemic priapism. Ramstein JJ, Lee A, Cohen AJ, et al. Clinical Outcomes of Periprocedural Antithrombotic Therapy in Ischemic Priapism Management. J Sex Med 2020;17:2260-2266.