Effects of priapism lasting 24 hours or longer caused by intracavernosal injection of vasoactive drugs.

Twenty-four patients, treated after > or = 24 h of priapism caused by the injection of vasoactive drugs, were examined. The aetiology of impotence was psychogenic in > 50% of the patients (13/24). Most priapisms that lasted < 36 h could be treated successfully by puncture and alpha-adrenergic drugs without any fibrosis of the corpora cavernosa, and most patients continued to receive vasoactive agents for the treatment of impotence; but this approach was no longer adequate after priapism had lasted > = or 36 h when glandulocavernosal shunts were needed to achieve permanent detumescence. After > 48 h of priapism all the patients developed fibrosis of the corpora cavernosa and none of them was able to continue with the injections of vasoactive drugs. In addition to fibrosis of the penis, one fulminant infection, one case of urethral damage, one permanent shunt and two cases of transient hypertonia with ECG changes were seen. In order to save time, glandulocavernosal shunts should be performed without delay once priapism has lasted > 36 h.

Permanent open shunt as a reason for impotence or reduced potency after surgical treatment of priapism in 26 patients.

A permanent open shunt as a cause of impotence or impaired potency after a shunt operation for priapism is an unusual situation. In this series we studied the persistence of an open shunt in 26 patients who had developed impotence or impaired potency after operative treatment for priapism. All patients had been examined by cavernosography on the suspicion of an open shunt, giving a positive finding in five of 26 cases, in all of which impotence was cured by closure of the shunt. In five patients without a permanent open shunt potency returned to normal only after 6-12 months.

Priapism, its incidence and seasonal distribution in Finland.

Priapism is regarded as an uncommon disease in white populations, although no previous research has been done into its incidence in a certain geographical area. All cases of priapism in Finland during the years 1975-90 are reviewed here. Its incidence varied from 0.34 to 0.52/100,000 males per year, being very stable during the whole period of 16 years, when cases due to intracorporeal injections for treatment of impotence are excluded. Typical patients were 40-50 years old, and the incidence was higher in the eastern part of the country. Most cases of priapism were seen during the lighter half of the year, between March and August (65%). The use of intracorporeally injected vasoactive drugs for impotence increased the incidence more than two-fold.

Preservation of potency after treatment for priapism.

Impotence is the most serious complication of priapism. In order to study its incidence and risk factors, the final outcomes of 124 cases of priapism in previously potent patients were analyzed and correlated with the duration of symptoms, age of the patients, aetiology and modality of treatment. Thirty-nine per cent of the patients became impotent. The duration of symptoms before treatment correlated markedly with the risk of impotence, in that 92% of those whose priapism had lasted less than 24 h remained potent but only 22% of those for whom it had lasted longer than 7 days. The younger the patients the better the prognosis, so that 88% of those younger than 30 years preserved their potency but only 40% of those older than 50 years. The prognosis was poorest when heparin therapy or a combination of alcohol drinking and psychopharmaceuticals was the aetiological factor behind priapism. Only 31% of patients preserved their potency after conservative treatment for priapism, whereas 69% of those treated with small glandocorporeal shunts did so. Priapism is an emergency state, in which immediate procedures are necessary to ensure detumescence as soon as possible. If puncture with lavation and intracorporeal injection of alpha-sympathomimetics does not restore detumescence, small glandocorporeal shunts should be performed.

Malignant fibrous histiocytoma of the prostate. Case report.

A prostatic tumour removed suprapubically in a 57-year old man was found to be a malignant fibrous histiocytoma. Postoperative radiation therapy was given and 3 1/2 years later chemotherapy, epirubicin was initiated due to a local recurrence and lung metastases. Now 6 years later the health condition is good, lung metastases have not proceeded. Adjuvant radiation and chemotherapy after surgery may have a favourable effect on the outcome of MFH of the prostate.