Sildenafil-induced priapism in a dog : an unusual case report.

BACKGROUND: Priapism is defined as erection that lasts for more than 4 h without sexual stimulation. There are various causes of priapism, but there are no reports of sildenafil-induced priapism in dogs. In human medicine, there were no pre-marketing reports of priapism caused by sildenafil, but post-marketing surveillance has shown that it is rare. In cases of pulmonary hypertension in dogs, sildenafil is the first-line drug of choice for symptomatic relief. CASE PRESENTATION: An 11-year-old neutered male Maltese dog that presented with tachypnea and cough was diagnosed with myxomatous mitral valve disease, American College of Veterinary Internal Medicine (ACVIM) stage C, and was treated medically. Eighteen months after the diagnosis, severe pulmonary hypertension occurred due to left heart disease. At 20 months postdiagnosis, pleural effusion occurred, and sildenafil (2 mg/kg twice daily) was added to the existing treatment. Two weeks later, the dyspnea recurred, confirming pleural fluid recurrence, and sildenafil was increased to 2 mg/kg thrice daily. One day later, the patient developed persistent erections and penile pain. Penile amputation and urethrostomy were recommended but were refused; therefore, analgesia and palliative care were provided. The patient died of acute dyspnea 22 months after the first presentation, with no specific priapism recurrence at the time of death. CONCLUSION: To the best of our knowledge, this is the first report of sildenafil-induced priapism in a dog with pulmonary hypertension.

A case of priapism following intrathecal morphine injection in a dog.

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.

Managing Reproduction Emergencies in the Field: Part 1: Injuries in Stallions; Injury of the External Portion of the Reproductive Tract and Gestational Conditions in the Mare.

Selected emergency conditions of male and female reproductive tracts in horses are described, including injuries affecting the external genitalia of male horses and emergent conditions arising during gestation in mares. Conditions affecting male horses are discussed in the context of breeding stallions, but kicks or other mechanisms of trauma in the groin can also affect geldings. Priapism, paraphimosis, trauma to the scrotum and testicles, and penile injury are discussed. In mares, traumatic vestibular injury, placentitis, hydropsic conditions, prepubic tendon and abdominal wall compromise, and uterine torsion are included. Clinical recognition of the problem, diagnostic procedures, and treatments are summarized.

Priapism associated with lumbar stenosis in a dog.

Priapism, a persistent long-lasting involuntary erection of the penis, is uncommon in dogs. In this report, the case of a 13-year-old male Pointer, referred to our services due to persistent exposition of the penis, is described. This condition was consecutive to an intermittent priapism situation lasting for several days, which has been initially attributed to the inflammation and haematoma associated with a perianal bite. The owners became unable to retract the penis into the prepuce. At presentation, the dog was anorectic for 48 h, intolerant to manipulation, and showed poor body condition and unsteady locomotion. During physical evaluation, a marked engorgement of the local vessels in the prepuce and penis was found. An abdominal X-ray was asked under the suspicion of a neurogenic origin for the clinical situation, which showed evidences of spondylosis. After discussion of the clinical condition, the owners asked for euthanasia. The necropsy confirmed the engorgement of the regional vessels deriving from the pudendal arteries and blood accumulation within all the cavernous spaces, accompanied by congestion and thrombosis within the erectile structures of the penis. No significant changes were observed in the pelvic organs that could be at the origin of priapism. The lumbar-sacral spinal regions were carefully inspected and evidenced signs of L7-S1 stenosis due to spondylosis. The case presented herein is a rare situation of priapism of neurogenic origin in a dog. Necropsy findings suggest that it was consecutive to cauda equina compression due to lumbar spinal stenosis.

Use of a modified Vinsot technique for partial phallectomy in 11 standing horses.

CASE DESCRIPTION: 6 geldings and 5 stallions were evaluated from January 2007 through April 2009 for the following conditions requiring phallectomy: chronic paraphimosis (n = 7), squamous cell carcinoma of the penis (3), and priapism (1). CLINICAL FINDINGS: None of the 7 horses with paraphimosis was able to retract the penis. Chronicity of the paraphimosis in 6 horses ranged from 2 weeks to 2 months and was unknown in the seventh horse. Horses with paraphimosis had been medically treated without success. The horse with priapism had developed the condition secondary to acepromazine administration 2 days prior to referral and was unsuccessfully treated once by intracavernosal administration of phenylephrine and irrigation of the cavernosal tissues prior to surgery. The 3 horses with squamous cell carcinoma of the penis had had the condition for 2 years and had been treated by repeated application of a cryogen or chemotherapeutic agent to the lesions. TREATMENT AND OUTCOME: All 11 horses underwent a partial phallectomy by means of a modified Vinsot technique. Modifications to the original technique included creation of a linear urethrostomy, alteration of the location and shape of the urethrostomy, application of a latex tourniquet, concurrent castration of stallions, and use of the procedure in standing horses. The procedure was technically easy to perform, well tolerated by the horses, and cosmetically acceptable to the owners, and had minimal postoperative complications. Long-term follow-up information was obtained from owners of 10 horses a median of 454 days after surgery; 2 owners reported mild urine scalding as the only adverse effect. CONCLUSIONS AND CLINICAL RELEVANCE: The modified Vinsot technique of partial phallectomy was effective and may be useful for horses that are unsuitable candidates for general anesthesia because of medical or owner financial constraints.

Priapism secondary to perineal abscess in a dog - a case report.

A 7-year-old intact male Boxer was referred to our services at the Veterinary Teaching Hospital of the University of Trás-os-Montes and Alto Douro, suffering from a persistently erect penis (including the bulbus glandis) that had been exposed for several days. Radiographic and ultrasonographic examinations detected a 5.0 x 3.5 cm mass located dorso-laterally to the urinary bladder. The microbial culture of the mass revealed Staphylococcus spp. At that time, we suspected the involvement of an abscess in the origin of the priapism. Medical and surgical treatments were promptly instituted, which allowed for penile withdrawal into the prepuce; however, the resolution of the penile erection was not accomplished in the following days and penile amputation was required. Histological evaluation of the excised penis revealed extensive infarction of the erectile tissue of the pars longa and bulbus glandis, and also of the blood vessels of the penis. Following penile amputation and antimicrobial therapy, the animal fully recovered. Ultimately, the animal died as a consequence of gastric torsion. At necropsy, some lesions compatible with a previous perforation of the intestinal wall were recorded. The data gathered from the anamnesis, the physical and imaging examinations, along with the post-mortem findings, allowed us to conclude that in this clinical case the primary cause of priapism was a perineal abscess due to bowel perforation.

Priapism in dogs.

Priapism is a persistent penile erection lasting longer than 4 hours, without sexual stimulation. Priapism is categorized as either nonischemic (arterial, high flow) or ischemic (veno-occlusive, low flow). Ischemic priapism is considered an emergency in people. Reports of priapism in dogs are uncommon. This report describes 3 dogs with priapism; the first was considered idiopathic, the second was due to acute disc extrusion and subsequent T12-T13 hemilaminectomy, and the third was secondary to a lumbar meningomyelocoele. All 3 cases were suspected to be nonischemic priapism. The pathophysiology of the canine erection and a review of priapism in dogs and cats are discussed. Distinguishing ischemic versus nonischemic priapism and identifying and treating the underlying cause are important. Aspiration to obtain blood gas analysis may help classify the priapism and may provide pain relief. Ultrasonography aids in evaluation for vascular abnormalities and identifying etiology. If determined to be ischemic, then aspiration with the patient under sedation or anesthesia with or without irrigation should be done. Intracavernosal injections of phenylephrine and lubrication of the exposed penis are also recommended. If intracavernosal drainage and injections are not successful, or significant tissue damage has occurred, then penile amputation and perineal urethrostomy may become necessary. Systemic therapy could be considered if the priapism is not considered an emergency, and if intracavernous injections or surgical treatment are declined.

Priapism in a castrated cat associated with feline infectious peritonitis.

This report describes a case of feline infectious peritonitis (FIP) in a castrated cat which first presented with the unusual sign of priapism. Laboratory examinations showed increased serum protein content and decreased albumin/globulin ratio. Serum electrophoresis revealed increased alpha 2- and gamma-globulin content. One month after the first examination, the cat died. At necropsy, histopathological evaluation of organs showed inflammatory granulomatous lesions compatible with non-effusive FIP and coronavirus-specific polymerase chain reaction confirmed the diagnosis. FIP antigen was demonstrated immunohistochemically in penile tissue.

Priapism secondary to penile metastasis in a dog.

A 4-year-old, male Newfoundland cross was presented for lethargy, anorexia, and dysuria. The main clinical finding was an enlarged and painful prostate gland. While the dog was hospitalized, priapism developed. Following euthanasia, microscopic examination revealed that a carcinoma involving both bladder and prostate gland had widely metastasized to the penile vasculature.

[Priapism in the stallion]. / Priapismus bij de hengst.

A review of the literature is given concerning the anatomy and pathophysiology of the equine penis with regard to priapism: a prolonged erection of the penis not associated with sexual arousal. Several treatment options, such as flushing of the corpus cavernosum penis with heparinized saline and the creation of shunt between the corpus cavernosum penis and the corpus spongiosum penis are discussed. Subsequently, a case of priapism in a stallion following the injection of acepromazine, is discussed. The priapism resolved after the corpus cavernosum penis was flushed with the stallion under general anaesthesia.

Priapism: a review.

Priapism is persistent penile erection in the absence of sexual stimulation. The pattern of blood flow to the penis that occurs during normal erection is altered so that sustained priapism may result in edema, increased risk of abrasion, tissue drying and necrosis of the penis. Numerous causes have been reported in animals and humans. The prognosis depends on the type of priapism and the amount of time that passes before therapeutic intervention. Surgical methods, such as aspiration and shunting procedures, have traditionally been used to treat priapism but carry a risk of postsurgical complications. Use of alpha-agonists for treatment of priapism in humans is often successful and avoids the risks of impotence and other surgical complications. Investigation of the use of alpha-agonists for treatment of priapism in animals should be considered.

The effect of a surgically created shunt between the corpus cavernosum penis and corpus spongiosum penis of stallions on erectile and ejaculatory function.

OBJECTIVE: To evaluate the effect of a shunt created between the corpus cavernosum penis (CCP) and corpus spongiosum penis (CSP) on erectile and ejaculatory function of normal stallions and to verify persistence of the shunt. STUDY DESIGN: The capability of stallions to develop an erection and to ejaculate was evaluated before and after creation of a corporeal shunt. Persistence of the shunt was determined by dye injection into the CCP at necropsy. ANIMALS: Six stallions. METHODS: A CCP-CSP shunt was created in five stallions. Semen was collected before and 4 to 14 weeks after surgery, before the horses were euthanatized. Dye was injected into the CCP to determine persistence of the shunt. Dye was also injected into the CCP of a control stallion. RESULTS: All stallions had normal erectile and ejaculatory function before and after surgery. Dye, injected into the CCP, entered the CSP in three of five treated stallions, demonstrating persistence of the shunt, whereas in two stallions, dye was found only in the CCP, indicating closure of the shunt. No dye was detected in the CSP of the control stallion. CONCLUSIONS: Creation of a corporeal shunt does not interfere with normal erection and ejaculation of stallions. Shunt closure is not necessary for stallions to retain normal erectile and ejaculatory function. CLINICAL RELEVANCE: Failure of a stallion affected by priapism to achieve normal erection or to ejaculate after creation of a corporeal shunt would likely be because of damage to corporeal tissue than from an effect of the shunt.

Priapism in seven cats.

Priapism (persistent and painful erection) is an uncommon disorder in cats and dogs. This report describes the clinical and pathological features of seven cases of priapism in cats. Six of the cases were Siamese cats, and in four of them the priapism developed after attempted mating with an oestrus female, despite three of them having been neutered. Five cats were treated by perineal urethrotomy, which was successful in four. In five of the six amputated specimens, thrombosis of the corpus cavenosum was evident.

Pharmacologic treatment of priapism in two horses.

Benztropine mesylate was used successfully to treat priapism that developed during anesthesia in 2 horses. After IV injection, there was a rapid resolution of signs in both horses, and no side effects were observed. The choice of an effective method to treat priapism is challenging because precise causes in most patients have not been well-defined. Benztropine mesylate is a synthetic compound resulting from the combination of the active portions of atropine and diphenhydramine, and is believed effective because of its central acetyl-choline-antagonizing properties.