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.

[Priapism associated to zuclopentixol and the choice for an alternative]. / Priapisme bij gebruik van zuclopentixol en de keuze voor een alternatief.

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.

Cocaine-related ischemic priapism. Systematic review and presentation of a single center series.

INTRODUCTION: Ischemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing. This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism? METHODS: We conducted a systematic review according to PRISMA guidelines and described our case series. RESULTS: Eight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6 h, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75 h and 2, respectively. CONCLUSION: Cocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.

Ischaemic Priapism: A Complication of Self-Administered Hyaluronic Acid Gel as an Injectable Filler for Penile Augmentation

Background: Injectable hyaluronic acid (HA) gel has emerged as a widely used soft tissue filler for surgeries. In penile reconstructivesurgery, HA gel has been employed for penile or glans augmentation in selected patients diagnosed with micropenis.This augmentation technique involves injecting the gel into submucosal tissue and increasing the size of the penis for approximately1 year. A few studies have investigated the possible complications correlated with medically assisted penile injections ofHA gel. However, no previous reports have shown the complications of self-administered HA injection. This case report aims topresent the first documented case of ischaemic priapism as a complication of self-administered HA injection.Case Presentation: We present the case of a 43-year-old male who self-administered a 20 mL injection of HA into the dorsal sideof his penis. The injected material probably reached the corpora cavernosa, leading to priapism within a few hours. However,the patient did not seek medical attention until 72 h later. The first two initial conservative attempts of blood drainage wereunsuccessful because the gel had obstructed vein drainage, causing the penis to remain in a state of priapism. The final treatmentapproach involved shunting, high enoxaparin doses and oral Effortil administration.Conclusions: While complications from medically assisted HA injections have been documented, this case report sheds light onthe complications arising from self-administered penile injections. Priapism is a severe medical condition that requires immediatetreatment to avoid potentially serious long-term consequences. Healthcare providers and patients must acknowledge itssymptoms and its appropriate course of treatment, especially in the context of penile medical injections. (AU)

Ischaemic Priapism: A Complication of Self-Administered Hyaluronic Acid Gel as an Injectable Filler for Penile Augmentation.

BACKGROUND: Injectable hyaluronic acid (HA) gel has emerged as a widely used soft tissue filler for surgeries. In penile reconstructive surgery, HA gel has been employed for penile or glans augmentation in selected patients diagnosed with micropenis. This augmentation technique involves injecting the gel into submucosal tissue and increasing the size of the penis for approximately 1 year. A few studies have investigated the possible complications correlated with medically assisted penile injections of HA gel. However, no previous reports have shown the complications of self-administered HA injection. This case report aims to present the first documented case of ischaemic priapism as a complication of self-administered HA injection. CASE PRESENTATION: We present the case of a 43-year-old male who self-administered a 20 mL injection of HA into the dorsal side of his penis. The injected material probably reached the corpora cavernosa, leading to priapism within a few hours. However, the patient did not seek medical attention until 72 h later. The first two initial conservative attempts of blood drainage were unsuccessful because the gel had obstructed vein drainage, causing the penis to remain in a state of priapism. The final treatment approach involved shunting, high enoxaparin doses and oral Effortil administration. CONCLUSIONS: While complications from medically assisted HA injections have been documented, this case report sheds light on the complications arising from self-administered penile injections. Priapism is a severe medical condition that requires immediate treatment to avoid potentially serious long-term consequences. Healthcare providers and patients must acknowledge its symptoms and its appropriate course of treatment, especially in the context of penile medical injections.

Physiopathology of the Priapism Secondary to Tamsulosin: Clinical Cases of Our Hospital and Literature Review

Objective: To describe two cases of man with the diagnosis of ischemic priapism after the intake of tamsulosin and to revise the scientific literature. Methods: We present two cases of men that developed an ischemic priapism after the intake of tamsulosin prescribed for STUI and were treated in our hospital. We described the two cases, from the diagnosis until the surgery that was performed. Also, we review the scientific literature about this topic. Results: In one hand, a 67 years old man with the previous diagnosis of diabetes mellitus, hypertension and dyslipidemia that take a one single dosis of tamsulosin and developed a priapism of 9 hours of duration. He was diagnosticated of low-flow priapism that was reverted after the use of intracavernosal phenylephrine. On the other hand, a 61 years old man without any medical condition. He developed a priapism after the intake of also one single dosis of tamsulosin and came to the hospital after 48 hours of the beginning of the erection. In this case, the use of intracavernosal phenylephrine wasn´t effective so we decided to performed a distal shunt between cavernosal and spongy body according to the techniques of Winter, Ebbehoj and Al-Ghorab. All of them without results. At the end, we tried a proximal shunt according Quackles technique, also ineffective. The patient declined another surgery for implantation of a pennis prothesis and went home after four days of hospitalization with the disappearance of the pain. Conclusions: The tamsulosin is a drug well known by urologist that have a safety profile probed with the years. Nevertheless, it's association with a disease like the priapism forced us to explain to our patients this rare adverse effect (AU)

Objetivo: Describir la fisiopatología del priapismoasociado a tamsulosina a través de dos casos clínicos tratados en nuestro centro.Método: Se presentan dos casos de varones que desarrollan un priapismo isquémico tras la toma de tamsulosina yque fueron tratados en nuestro hospital. Describimos amboscasos, desde el diagnóstico hasta el tratamiento. Además,revisamos la literatura científica sobre dicho tema.Resultado: Introducimos el caso de un hombre de 67años con comorbilidad cardiovascular que desarrolla un priapismo isquémico de 9 horas de duración que revirtió confenilefrina intracavernosa. Por otro lado, se presenta el casode un varón de 61 años sin patología de base con un priapismo de 48 horas que no mejoró tras tratamiento conservador ni tras cirugía de derivación cavernoso-esponjosa.Conclusiones: La tamsulosina es un fármaco seguroque en, raras ocasiones, puede asociarse a un priapismo isquémico. (AU)

Priapismo inducido por doxazosina / Priapism induced by doxazosin

El priapismo es la erección peneana que persiste más allá o no tiene relación con la actividad sexual y que puede estar producida por fármacos entre otras múltiples causas. Los alfa-bloqueantes pueden producir priapismo, aunque su incidencia es muy baja. Presentamos el caso de un varón de 55 años en tratamiento con enalapril por hipertensión arterial y con tamsulosina por hiperplasia de próstata, que a las 48 h de iniciar tratamiento con doxazosina por mal control de la tensión arterial comienza con priapismo, el cual se resuelve tras varias maniobras que incluyen frío local, lavado y aspiración, inyección de fenilefrina y shunts distales. Los alfa-bloqueantes son una causa muy infrecuente de priapismo, pero que debemos de tener en cuenta —aún más en pacientes que están tomando previamente tratamiento para la hiperplasia de próstata con otro alfa-bloqueante aunque sea selectivo— para evitar la aparición de esta complicación (AU)

Priapism is a penile erection that persists beyond or is unrelated to sexual activity and can be caused by drugs among many other causes. Alpha-blockers can cause priapism, although the incidence is very low. We report the case of a 55 year-old male treated with enalapril for hypertension and prostate hyperplasia treated with tamsulosin, who at 48 hours of starting treatment with doxazosin due to poorly controlled blood pressure begins with priapism, which resolves after several maneuvers including local cold, washing and aspiration, injection of phenylephrine and distal shunts. Alpha-blockers are a very rare priapism cause, but we must take them into account—even in patients previously taking treatment for prostatic hyperplasia with another selective alpha-blocker—to avoid the occurrence of this complication (AU)

Priapism secondary to tamsulosin: a case report / Priapismo secundario a tratamiento con tamsulosina: caso clínico

Priapism is defined as a continuous erection of the penis without any sexual desire and with a duration of more than 4 h; this phenomenon represents a medical emergency requiring urgent treatment and can be followed by fibrosis of the corpora cavernosa and permanent impotence. Priapism can be divided into three subtypes depending on the cause and can be induced by certain agents. We present a case report of priapism induced by tamsulosin treatment in a patient with obstructive lower urinary tract symptoms (LUTS) and also review the relevant literature. Priapism secondary to tamsulosin treatment is a rare event that has seldom been reported in the literature. In cases of priapism secondary to medical treatment, interruption of treatment should avoid further events (AU)

El priapismo se define como una erección continua del pene sin ningún deseo sexual y con una duración de más de 4 horas. Este fenómeno representa una emergencia médica que requiere tratamiento urgente y puede ser seguido por la fibrosis de los cuerpos cavernosos y la impotencia permanente. El priapismo puede dividirse en tres subtipos dependiendo de la causa y puede ser inducido por ciertos agentes. Presentamos un caso de priapismo inducido por tratamiento con tamsulosina en un paciente con síntomas del tracto urinario inferior obstructivos (STUI) y también revisamos la bibliografía pertinente. El priapismo secundario a tratamiento con tamsulosina es un evento raro que raramente se ha reportado en la literatura. En los casos de priapismo secundario a tratamiento médico, la interrupción del tratamiento debe evitar nuevos eventos (AU)

Prophylactic Phenylephrine for Iatrogenic Priapism: A Pilot Study With Peyronie's Patients

PURPOSE: Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism. MATERIALS AND METHODS: This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention. RESULTS: Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases. CONCLUSIONS: The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects.

Priapismo secundario a antipsicóticos: a propósito de un caso asociado a risperidona / Priapism associated with risperidone use: Report of one case

Background: The use of drugs with α-adrenergic antagonistic effect is one of the most prominent etiologies of priapism. We report a 32-year-old schizophrenic male in treatment with risperidone who consulted in the emergency room for a painful priapism. A low flow priapism was diagnosed. Medical treatment was unsuccessful and the patient was subjected to a proximal corporo-spongiosal shunt (Quackels technique), with good results. The patient was discharged in good conditions.

Regional brain c-fos activation associated with penile erection and other symptoms induced by the spider toxin Tx2-6

Brain areas expressing c-fos messenger RNA were mapped by quantitative in situhybridization after 1–2 h of intoxication with 10 mg/kg Tx2-6, a toxin obtained from the venom of the spider Phoneutria nigriventer. Relative to saline-treated controls, brains from toxin-treated animals showed pronounced c-fos activation in many brain areas, includingthe supraoptic nucleus, the paraventricular nucleus of the hypothalamus, the motor nucleus of the vagus, area postrema, paraventricular and paratenial nuclei of the thalamus,locus coeruleus, central amydaloid nucleus and the bed nucleus of the stria terminalis. The paraventricular hypothalamus and the bed nucleus of the stria terminalis have been implicated in erectile function in other studies. A possible role for central NO is considered. Acute stress also activates many brain areas activated by Tx2-6 as well as with NO stimulated Fos transcription. Brain areas that appear to be selectively activated by Tx2-6, include the paratenial and paraventricular thalamic nuclei, the bed nucleus of the stria terminalis and the area postrema and the dorsal motor n. of vagus in the medulla. However, direct injections of different doses of the toxin into the paraventricular hypothalamicn. failed to induce penile erection, arguing against CNS involvement in thisparticular effect.

Priapismo asociado con quetiapina en anciano / Priapism associated with quetiapine in an elderly patient

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Tratamiento de la erección prolongada secundaria a inyección intracavernosa de medicamentos / Treatment of the prolonged erection induced by an intracavernous drug injection

La erección prolongada es la principal complicación de la inyección intracavernosa de papaverina y/o phentolamina. En 1700 inyecciones tuvimos esta complicación en un 3,06%(52/1700). Cuando se usa papaverina mezclada con Phentolamina sube a 19%. Se tratan a las 6 horas con medicamentos simpaticomiméticos con excelente rendimiento. 5 de ellas se trataron con Ketamina 30 mg en IIC con resultados espectaculares y sin complicaciones secundarias.

Erección peneana sostenida y raquinestesia: detumescencia por inyección intracavernosa de etilefrina / Prolonged penile erection and rachianesthesia: detumescence by intracavernous etilefrine inyection

Se presentan 11 enfermos con erección peneana sostenida por raquianestesia con 20 mg de bupivacaine, que fueron tratados con 10 mg de etilefrina inyectados por vía intracavernosa. En 10 casos se obtuvo detumescencia total y un paciente en forma parcial. No se registraron complicaciones, solo un leve hematoma en el sitio de la inyección en 1 enfermo. Todos presentaron hipertensión arterial fácilmente controlable. Se analiza el mecanismo de la erección y la bibliografía