Acute management of priapism in men.

UNLABELLED: What's known on the subject? and What does the study add? Priapism is a rare event. However, various medications and medical conditions may increase the risk. Priapism can be ischaemic, non-ischaemic or stuttering. It is paramount to distinguish the type of priapism, as misdiagnosis may lead to significant morbidity. Ischaemic priapism represents a compartment syndrome of the penis and is therefore a medical emergency. A delay in management may significantly affect future erectile function. Stuttering priapism represents recurrent subacute episodes of ischaemic priapism, which may lead to erectile dysfunction. Thus episodes must be minimised. Non-ischaemic priapism is not a medical emergency. However, misdiagnosis and injection with sympathomimetic agents can result in system absorption and toxicity. This review article provides a summary of the evaluation and management of priapism. Furthermore, a step by step flow chart is provided to guide the clinician through the assessment and management of this complex issue. OBJECTIVES: To review the literature regarding ischaemic, non-ischaemic and stuttering priapism. To provide management recommendations. PATIENTS AND METHODS: A Medline search was carried out to identify all relevant papers with management guidelines for priapism. RESULTS: Ischaemic priapism represents a compartment syndrome of the penis and urgent intervention is required to decrease the risk of erectile dysfunction. Non-ischaemic priapism is not a medical emergency; however, it can result in erectile dysfunction. The treatment objective for stuttering priapism is to reduce future episodes with systemic treatments, whilst treating each ischaemic episode as an emergency. CONCLUSIONS: Priapism is a complex condition that requires expert care to prevent complications and irreversible erectile dysfunction.

Active surveillance for prostate cancer: an Australian experience.

OBJECTIVE: To assess the patient and cancer characteristics as well as outcomes of a large cohort of Australian men who chose active surveillance (AS) as initial management of their low-risk prostate cancer. PATIENTS AND METHODS: Men treated by one surgeon who had chosen AS as the primary management for prostate cancer were identified from the records. The patient and cancer data recorded included: patient age, prostate-specific antigen (PSA) concentration at diagnosis, mode of prostate cancer detection. For prostate cancer diagnosed at prostate biopsy, data were collected for the number of cores taken as well as positive core number, cancer burden, and Gleason grade. Survival analysis was used to determine the duration of AS. RESULTS: In all, 154 men with low-risk prostate cancer with a median (range) age 63.0 (36-81) years and a mean (range) PSA concentration of 6.5 (0.3-22) ng/mL underwent AS. The median (range) duration of AS was 1.9 (0.1-16.6) years. AS was ceased in 29 patients (19%) after a mean (range) of 2.4 (0.2-7.9) years. Of these, 26 were upstaged, one chose curative treatment despite stable disease, and two died from disease not related to prostate cancer. Actuarial analysis on the probability of still being on AS after 5 years was 61.9% (95% confidence interval [CI] 46.2-74.2%) and after 10 years was 45.0% (95% CI 21.3-66.2%). While the period of follow-up is short, there were no biochemical recurrences in men who underwent curative treatment and no deaths from prostate cancer. CONCLUSION: AS is an acceptable mode of initial treatment in Australian men with low-risk prostate cancer.