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1.
Einstein (Sao Paulo) ; 18: eAO5070, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32321079

RESUMO

OBJECTIVE: To evaluate epidemiological aspects of priapism in patients with sickle cell disease, and these aspects impact on adult sexual function. METHODS: This was a cross-sectional study including individuals with sickle cell disease who were evaluated at a reference center for sickle cell. Participants completed a structured questionnaire about their sociodemographic characteristics and priapism events. Sexual function was assessed using validated two instruments, the Erection Hardness Score and one about the sex life satisfaction. RESULTS: Sixty-four individuals with median aged of 12 (7 to 28) years were interviewed. The prevalence of priapism was 35.9% (23/64). The earliest priapism episode occurred at 2 years of age and the latest at 42 years. The statistical projection was that 71.1% of individuals of the study would have at least one episode of priapism throughout life. Patients with episodes of priapism (10/23) had significantly worse erectile function Erection Hardness Score of 2 [1-3]; p=0.01 and were less satisfied with sexual life 3 [3-5]; p=0.02. CONCLUSION: Priapism is usually present in childhood, and severe episodes are associated with cavernous damage, impairment in the quality of the erection, and lower sexual satisfaction.


Assuntos
Anemia Falciforme/epidemiologia , Anemia Falciforme/fisiopatologia , Disfunção Erétil/epidemiologia , Disfunção Erétil/fisiopatologia , Priapismo/epidemiologia , Priapismo/fisiopatologia , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Criança , Estudos Transversais , Intervalo Livre de Doença , Humanos , Masculino , Ereção Peniana/fisiologia , Prevalência , Priapismo/etiologia , Qualidade de Vida , Estudos Retrospectivos , Estatísticas não Paramétricas , Inquéritos e Questionários , Adulto Jovem
2.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936333

RESUMO

We present a case of intractable acute ischaemic priapism occurring secondary to newly commenced olanzapine. It demonstrates rapid intervention in a stepwise approach aiming to restore penile flaccidity in order to prevent chronic damage to the corpora cavernosa. After an unsuccessful conservative approach, our patient underwent two formal distal penile shunt procedures with no effective penile detumescence. Subsequently, bilateral proximal penile shunts were performed comprising a right corpus cavernosum to corpus spongiosum anastomosis and a left saphenous vein to left corpus cavernosum anastomosis. The patient remained an inpatient for observation, and detumescence was gradually achieved over several days after this procedure. However, follow-up revealed erectile dysfunction, and it was explained to the patient that he was unlikely to achieve further erections and that a penile implant was the only realistic option.


Assuntos
Antipsicóticos/efeitos adversos , Olanzapina/efeitos adversos , Pênis/cirurgia , Priapismo/induzido quimicamente , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Antipsicóticos/administração & dosagem , Humanos , Masculino , Olanzapina/administração & dosagem , Pênis/irrigação sanguínea , Pênis/efeitos dos fármacos , Priapismo/fisiopatologia , Priapismo/cirurgia , Prisioneiros , Resultado do Tratamento
3.
BMJ Case Rep ; 12(4)2019 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-30988105

RESUMO

Priapism is a relatively uncommon clinical presentation. The well-recognised causes are sickle cell anaemia and the use of medications, such as vasoactive erectile agents. Infrequently, it could be the result of lumbar spinal stenosis. The authors reported an elderly man with 1-year history of isolated intermittent priapism aggravated by walking. MRI showed lumbosacral spondylosis with severe stenosis at the level of L4-L5. Total laminectomy of L4 and L5 was done, resulting in a rapid and complete resolution of symptom without recurrence during the follow-up time of 10 years.


Assuntos
Laminectomia , Vértebras Lombares/diagnóstico por imagem , Priapismo/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Estenose Espinal/diagnóstico por imagem , Idoso , Humanos , Vértebras Lombares/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Priapismo/diagnóstico por imagem , Priapismo/etiologia , Priapismo/cirurgia , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia , Resultado do Tratamento , Caminhada
4.
Physiol Rep ; 7(6): e13999, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30916476

RESUMO

In vivo metabolic studies typically concern complex open systems. However, a closed system allows better assessment of the metabolic limits. Ischemic priapism (IP) constitutes a special model of the compartment syndrome that allows direct sampling from a relatively large blood compartment formed by the corpora cavernosa (CC). The purpose of our study was to measure metabolic changes and the accumulation of end products within the CC during IP. Blood gas and biochemical analyses of aspirates of the CC were analyzed over an 8-year period. Mean ± SD pH, pCO2 , pO2 , O2 -saturation, lactate, and glucose of the aspirated blood were determined with a point-of-care analyzer. Forty-seven initial samples from 21 patients had a pH of 6.91 ± 0.16, pCO2 of 15.3 ± 4.4 kPa, pO2 of 2.4 ± 2.0 kPa, and an O2 -saturation of 19 ± 24% indicating severe hypoxia with severe combined respiratory and metabolic acidosis. Glucose and lactate levels were 1.1 ± 1.5 and 14.6 ± 4.8 mmol/L, respectively. pH and pCO2 were inversely correlated (R2  = 0.86; P < 0.001), glucose and O2 -saturation were positively correlated (R2  = 0.83; P < 0.001), and glucose and lactate were inversely correlated (R2  = 0.72; P < 0.001). The positive correlation of CO2 and lactate (R2  = 0.69; P < 0.001) was similar to that observed in vitro, when blood was titrated with lactic acid. The observed combined acidosis underscores that IP behaves as a closed system where severe hypoxia and glycopenia coexist, indicating that virtually all energy reserves have been consumed.


Assuntos
Acidose Láctica/sangue , Acidose Respiratória/sangue , Metabolismo Energético , Hipóxia/sangue , Isquemia/sangue , Ereção Peniana , Pênis/irrigação sanguínea , Priapismo/sangue , Acidose Láctica/fisiopatologia , Acidose Respiratória/fisiopatologia , Adulto , Biomarcadores/sangue , Glicemia/metabolismo , Dióxido de Carbono/sangue , Humanos , Concentração de Íons de Hidrogênio , Hipóxia/fisiopatologia , Isquemia/fisiopatologia , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Priapismo/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
5.
Sex Med Rev ; 7(3): 530-534, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30898595

RESUMO

INTRODUCTION: Ischemic priapism (IP) is the most common form of priapism. In cases of priapism persisting for >36 hours, conservative management usually fails, and the patients' erectile tissue will be inevitably compromised, resulting in corporal fibrosis, shortening of the penis, and refractory erectile dysfunction. In this subset of patients, early implantation of a penile prosthesis (PP) could be a solution for both the priapic episode and the erectile dysfunction. AIM: To analyze the current literature with regard to the correlation between refractory ischemic priapism and immediate implantation of PP. METHODS: An extensive literature research was conducted to retrieve studies focusing on immediate PP implantation in patients suffering from refractory ischemic priapism (RIP). MAIN OUTCOME MEASURES: We evaluated the functional outcomes of patients who have undergone the immediate insertion of a PP as treatment for an acute episode of IP refractory to medical therapy or shunt surgery. RESULTS: Nine studies were included in this systematic review, including 3 case reports and 6 retrospective analyses. All studies agreed that in patients with RIP, early insertion of a PP is a safe and effective procedure, and all studies but 1 preferred malleable implants to inflatable implants. CONCLUSION: The systematic review does not demonstrate superiority of immediatePP implantation over delayed PP implantation, because none of the studies was designed with this purpose. However, considering the reduced complication rate and the ease of the procedure, all studies are in favor of early implantation over delayed implantation. Capece M, La Rocca R, Mirone V, et al. A Systematic Review on Ischemic Priapism and Immediate Implantation: Do We Need More Data? Sex Med Rev 2018;7:530-534.


Assuntos
Isquemia/cirurgia , Ereção Peniana/fisiologia , Implante Peniano/métodos , Prótese de Pênis , Priapismo/cirurgia , Humanos , Isquemia/fisiopatologia , Masculino , Priapismo/fisiopatologia , Fatores de Tempo
6.
J Pediatr Urol ; 15(2): 187.e1-187.e6, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30910454

RESUMO

INTRODUCTION: High-flow priapism in children is a very rare condition, and there is no clear consensus on its management. High-flow priapism is associated with increased cavernosal blood flow and broadly divided into two groups based on the presence or absence of arteriocavernous fistula in the corpora cavernosa. OBJECTIVE: This study aimed to determine the appropriate management of high-flow priapism based on the existence of arteriocavernous fistula using penile color Doppler ultrasonography (CDU) findings in the pediatric population. STUDY DESIGN: The cases of four boys aged between 6 and 11 years with high-flow priapism treated between 2009 and 2017 are reported. Two boys had prior perineal trauma, one boy had blunt penile glans trauma, and one had no obvious cause for the condition. All boys initially underwent penile CDU and were treated conservatively or via selective arterial embolization depending upon the presence or absence of an arteriocavernous fistula. RESULTS: Penile CDU revealed an arteriocavernous fistula inside the corpus cavernosum penis in two of four boys and increased blood flow inside the corpus spongiosum in the remaining boys. The former two boys underwent selective arterial embolization and one boy underwent repeated embolization because of remaining arteriocavernous fistula feeding from the contralateral cavernosal artery, whereas the boys with no arteriocavernous fistula on CDU were managed conservatively. All boys were successfully treated within 1 month, and they had normal morning erection and no evidence of recurrent priapism at the follow-up. DISCUSSION: Unlike low-flow priapism, high-flow priapism is not a medical emergency. Therefore, conservative therapy is an appropriate initial treatment, although selective arterial embolization can be effective for high-flow priapism with arteriocavernous fistula, with a success rate of 97% and no reported complications to date. Penile CDU is an imaging technique that can detect focal areas of turbulent flow with sensitivity close to 100%. This study has several limitations including a small number of cases, limited follow-up duration, and possibility of spontaneous arteriocavernous fistula closure in cases treated by arterial embolization. CONCLUSION: Penile CDU could be a reliable tool to diagnose high-flow priapism and detect the presence or absence of arteriocavernous fistula. Although conservative therapy remains the first choice, selective arterial embolization may be an early treatment option when CDU reveals an arteriocavernous fistula.


Assuntos
Priapismo/diagnóstico por imagem , Priapismo/terapia , Ultrassonografia Doppler em Cores , Velocidade do Fluxo Sanguíneo , Criança , Embolização Terapêutica , Humanos , Masculino , Pênis/irrigação sanguínea , Priapismo/etiologia , Priapismo/fisiopatologia , Fluxo Sanguíneo Regional , Fístula Vascular/complicações , Fístula Vascular/terapia
7.
CJEM ; 21(1): 150-153, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29547365

RESUMO

Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature. Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed. Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism. If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.


Assuntos
Serviço Hospitalar de Emergência , Terapia por Exercício/métodos , Priapismo/terapia , Adulto , Humanos , Masculino , Ereção Peniana/fisiologia , Priapismo/fisiopatologia
8.
Sex Med Rev ; 7(2): 283-292, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30503727

RESUMO

BACKGROUND: Priapism has been linked to many commonly prescribed medications, as well as recreational drugs and toxins. Although the incidence of priapism as a result of medication is small, the increasing use of antidepressants, antipsychotics, and recreational drugs may lead to more cases of pharmacologically-induced priapism in the future. AIM: To provide a comprehensive, up-to-date review of the most common causes of pharmacologically induced priapism and discuss incidence, pathophysiology, and basic management strategies. METHODS: A review of the available literature from 1960 to 2018 was performed using PubMed with regards to pharmacologically induced priapism. MAIN OUTCOME MEASURE: We reviewed publications that outlined incidence, pathophysiology, and management strategies for various pharmacologic causes of priapism: antidepressants, antipsychotics, antihypertensives, methylphenidate, cocaine, heparin, gonadotropin-releasing hormone, propofol, spider bites, and other miscellaneous causes. RESULTS: An understanding of the pathophysiology behind common pharmacologic causes of priapism can assist in the development of better treatment strategies and prevent future episodes of priapism. By understanding the potential risks associated with the use of medications with α-blocking or sympathomimetic properties, physicians can reduce the likelihood of priapism in their patients, especially those with other medical conditions that put them at increased baseline risk. Early corporal aspiration and injection of phenylephrine reduces additional complications related to priapism. In select patients, early placement of a penile prosthesis may prevent further morbidity. CONCLUSION: By developing a greater understanding of common pharmacologic causes of priapism, physicians can promptly identify and manage symptoms, leading to decreased patient morbidity. Scherzer ND, Reddy AG, Le TV, Chernobylsky D, Hellstrom WJG. Unintended Consequences: A Review of Pharmacologically-Induced Priapism. Sex Med Rev 2019;7:283-292.


Assuntos
Priapismo/induzido quimicamente , Humanos , Incidência , Masculino , Priapismo/epidemiologia , Priapismo/fisiopatologia , Priapismo/terapia
9.
Urology ; 122: 116-120, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30059714

RESUMO

OBJECTIVE: To report long term outcomes of selective arterial embolization for nonischemic priapism on erectile function utilizing validated outcome questionnaires after selective arterial embolization. MATERIALS AND METHODS: Twenty men, mean age of 36 years (range: 8-58 years), underwent selective penile embolization for nonischemic priapism between December 1997 and February 2016 (218 months). Each identified case of nonischemic priapism was embolized using gelatin sponge, autologous blood clot, platinum microcoils, polyvinyl alcohol particles, or a combination of these. A variety of procedural details, immediate complications, recurrence of nonischemic priapism, post-procedure performance on Sexual Health Inventory for Men and International Index of Erectile Function Questionnaires, and follow-up duration were recorded. RESULTS: Mean time from development of symptoms until treatment was 117 days (range: 1-1,042 days). After selective arterial embolization, nonischemic priapism resolved in 18 (90%) patients. No patients with successful treatment of their nonischemic priapism developed a recurrence of nonischemic priapism during the study period following the initial treatment. Eight (40%) patients experienced ischemic priapism following embolization with 4 (50%) resolving after treatment. Mean post-procedure Sexual Health Inventory for Men score was 22.1 (range: 16-25). Mean post-embolization erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains on the International Index of Erectile Function were 25.8 (range: 16-30), 7.8 (range: 6-10), 7.4 (range: 5-10), 10.9 (range: 6-14), and 7.9 (range: 6-10), respectively. Mean follow-up was 4,601 days (range: 970-6,711 days). CONCLUSION: Resolution of nonischemic priapism following selective arterial embolization occurred in 90% of the patients. Two validated questionnaires showed no erectile dysfunction following treatment. Mild orgasmic dysfunction, sexual desire dysfunction, intercourse dissatisfaction, and overall satisfaction dysfunction were noted following treatment.


Assuntos
Embolização Terapêutica/métodos , Disfunção Erétil/epidemiologia , Ereção Peniana/fisiologia , Complicações Pós-Operatórias/epidemiologia , Priapismo/terapia , Adolescente , Adulto , Angiografia , Artérias/diagnóstico por imagem , Criança , Embolização Terapêutica/efeitos adversos , Disfunção Erétil/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pênis/irrigação sanguínea , Pênis/diagnóstico por imagem , Pênis/fisiopatologia , Complicações Pós-Operatórias/etiologia , Priapismo/diagnóstico por imagem , Priapismo/fisiopatologia , Recidiva , Saúde Sexual/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Adulto Jovem
11.
Turk J Med Sci ; 48(1): 191-195, 2018 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-29479984

RESUMO

Background/aim: This study aimed to investigate the effects of apoptosis-inducing Bcl-2/adenovirus E1B 19 kDa-interacting protein 3 (BNIP 3) and antiapoptotic epidermal growth factor (EGF) on the pathophysiology of experimental low-flow priapism. Materials and methods: Twenty-four adult Sprague-Dawley rats were divided into four equal groups. Group I was the control group. Ischemic priapism was induced for 4 h in Group II rats. In Group III, intraperitoneal EGF at 10 µg/kg was given for 7 days before induction of ischemic priapism for 4 h. In Group IV, intraperitoneal EGF at 20 µg/kg was given for 7 days before induction of ischemic priapism for 4 h. The western blot method was used to determine BNIP 3 expression levels and the TUNEL method was used to determine the apoptotic cells in the cavernosal tissue samples. Results: Although BNIP 3 expression levels were significantly higher in all three study groups compared to the controls, BNIP 3 was significantly higher in EGF-administered groups when compared to Group II (P < 0.05). The TUNEL score of group II was significantly higher than those of the other groups. Conclusion: Decreased apoptosis in cavernosal tissues obtained by antagonizing the apoptotic effect of BNIP 3 with EGF may facilitate the development of new conservative treatment methods via those pathways.


Assuntos
Apoptose/efeitos dos fármacos , Fator de Crescimento Epidérmico/uso terapêutico , Proteínas de Membrana/metabolismo , Proteínas Mitocondriais/metabolismo , Ereção Peniana/efeitos dos fármacos , Pênis/efeitos dos fármacos , Priapismo/tratamento farmacológico , Animais , Modelos Animais de Doenças , Fator de Crescimento Epidérmico/farmacologia , Isquemia , Masculino , Pênis/irrigação sanguínea , Pênis/fisiologia , Priapismo/etiologia , Priapismo/fisiopatologia , Ratos Sprague-Dawley
12.
J Proteome Res ; 17(3): 1031-1040, 2018 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-29394072

RESUMO

Priapism is a disorder in which prolonged penile erection persists uncontrollably, potentially leading to tissue damage. Priapism commonly afflicts patient populations with severely low nitric oxide (NO) bioavailability. Because NO is a primary mediator of erection, the molecular mechanisms involved in priapism pathophysiology associated with low NO bioavailability are not well-understood. The objective of this study was to identify dysregulated molecular targets and signaling pathways in penile tissue of a mouse model of low NO bioavailability that have potential relevance to priapism. Neuronal plus endothelial NO synthase double knockout mice (NOS1/3-/-) were used as a model of low NO bioavailability. Priapic-like activity was demonstrated in the NOS1/3-/- mice relative to wild-type (WT) mice by the measurement of prolonged erections following cessation of electrical stimulation of the cavernous nerve. Penile tissue was processed and analyzed by reverse-phase liquid chromatography tandem mass spectrometry. As a result, 1279 total proteins were identified and quantified by spectral counting, 46 of which were down-regulated and 110 of which were up-regulated in NOS1/3-/- versus WT (P < 0.05). Ingenuity Pathway Analysis of differentially expressed proteins revealed increased protein kinase A and G-protein coupled receptor signaling in NOS1/3-/- penises, which represent potential mechanisms contributing to priapism for secondary to low NO bioavailability.


Assuntos
Óxido Nítrico Sintase Tipo III/genética , Óxido Nítrico Sintase Tipo I/genética , Óxido Nítrico/metabolismo , Pênis/metabolismo , Priapismo/genética , Animais , Cromatografia de Fase Reversa , Proteínas Quinases Dependentes de AMP Cíclico/genética , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Modelos Animais de Doenças , Estimulação Elétrica , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Regulação da Expressão Gênica , Ontologia Genética , Humanos , Masculino , Camundongos , Camundongos Knockout , Anotação de Sequência Molecular , Neurônios/metabolismo , Neurônios/patologia , Óxido Nítrico Sintase Tipo I/deficiência , Óxido Nítrico Sintase Tipo III/deficiência , Ereção Peniana/fisiologia , Pênis/irrigação sanguínea , Pênis/inervação , Priapismo/metabolismo , Priapismo/patologia , Priapismo/fisiopatologia , Proteoma/genética , Proteoma/metabolismo , Receptores Acoplados a Proteínas-G/genética , Receptores Acoplados a Proteínas-G/metabolismo , Transdução de Sinais , Nervos Esplâncnicos/metabolismo , Nervos Esplâncnicos/fisiopatologia , Espectrometria de Massas em Tandem
13.
MedEdPORTAL ; 14: 10731, 2018 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-30800931

RESUMO

Introduction: Ischemic priapism is a urologic emergency managed by both urologic and nonurologic providers in the community. Given ischemic priapism's rare occurrence and the time-sensitive nature of treatment, effective provider education on management of this entity is imperative. We sought to develop a low-cost effective simulation model and curriculum to enhance trainee education. Methods: A comprehensive didactic curriculum based on national urologic guidelines was developed, along with a low-cost, easily reproducible priapism simulator using hot dogs and Red Vines candy. The simulators cost $1.25 each, and assembly took 10 minutes. All materials were reviewed by three urology faculty members. The curriculum was piloted with two andrology fellowship-trained urology faculty among eight urology residents (PGY2-PGY4/U1-U2) and one medical student. Participants provided feedback regarding the overall course as well as the face and content validity of the simulator. Results: Cognitive test scores significantly improved on average by 15.0% (p = .002), and confidence improved from baseline somewhat or very much among 88.9% of participants after completion of the curriculum. The task trainer was rated easy to use (average score: 4.78 out of 5), and 77.8% of participants though it was somewhat or very useful for training (average score: 4.00 out of 5). Additionally, 77.8% recommended its incorporation into resident training (average score: 4.00 out of 5). Discussion: This simulation curriculum is effective, inexpensive, and easily reproducible, making it ideal for groups with limited resources. Expanding access to simulation-based curricula on priapism management may improve education of both urologic and nonurologic trainees.


Assuntos
Isquemia/terapia , Priapismo/complicações , Urologia/educação , Adulto , Currículo , Educação de Pós-Graduação em Medicina , Avaliação Educacional/métodos , Avaliação Educacional/estatística & dados numéricos , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Masculino , Simulação de Paciente , Projetos Piloto , Priapismo/fisiopatologia , Estudos Prospectivos , Urologia/métodos
14.
J Cell Mol Med ; 22(3): 2018-2022, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29278308

RESUMO

Penile fibrosis caused by ischemic priapism (IP) adversely affects patients' erectile function. We explored the role of lysyl oxidase (LOX) in rat and human penes after ischemic priapism (IP) to verify the effects of anti-LOX in relieving penile fibrosis and preventing erectile dysfunction caused by IP in rats. Seventy-two rats were randomly divided into six groups: control group, control + ß-aminopropionitrile (BAPN) group, 9 hrs group, 9 hrs + BAPN group, 24 hrs group, and 24 hrs + BAPN group. ß-aminopropionitrile (BAPN), a specific inhibitor of LOX, was administered in the drinking water. At 1 week and 4 weeks, half of the rats in each group were randomly selected for the experiment. Compared to the control group, the erectile function of IP rats was significantly decreased while the expression of LOX in the corpus cavernosum was significantly up-regulated in both 9 and 24 hrs group. Proliferated fibroblasts, decreased corpus cavernosum smooth muscle cells/collagen ratios, destroyed endothelial continuity, deposited abnormal collagen and disorganized fibers were observed in IP rats. The relative content of collage I and III was not obviously different among the groups. ß-aminopropionitrile (BAPN) could effectively improve the structure and erectile function of the penis, and enhance recovery. The data in this study suggests that LOX may play an important role in the fibrosis of corpus cavernosum after IP and anti-LOX may be a novel target for patients suffering with IP.


Assuntos
Aminopropionitrilo/farmacologia , Inibidores Enzimáticos/farmacologia , Fibroblastos/efeitos dos fármacos , Isquemia/tratamento farmacológico , Priapismo/prevenção & controle , Animais , Proliferação de Células/efeitos dos fármacos , Colágeno Tipo I/antagonistas & inibidores , Colágeno Tipo I/genética , Colágeno Tipo I/metabolismo , Colágeno Tipo III/antagonistas & inibidores , Colágeno Tipo III/genética , Colágeno Tipo III/metabolismo , Modelos Animais de Doenças , Água Potável/administração & dosagem , Fibroblastos/enzimologia , Fibroblastos/patologia , Fibrose/prevenção & controle , Expressão Gênica , Humanos , Isquemia/enzimologia , Isquemia/genética , Isquemia/fisiopatologia , Isoenzimas/antagonistas & inibidores , Isoenzimas/genética , Isoenzimas/metabolismo , Masculino , Ereção Peniana/fisiologia , Pênis/enzimologia , Pênis/fisiopatologia , Priapismo/enzimologia , Priapismo/genética , Priapismo/fisiopatologia , Proteína-Lisina 6-Oxidase/antagonistas & inibidores , Proteína-Lisina 6-Oxidase/genética , Proteína-Lisina 6-Oxidase/metabolismo , Ratos , Ratos Sprague-Dawley
15.
J Inherit Metab Dis ; 41(2): 231-238, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29110178

RESUMO

Fabry disease is a glycosphingolipidosis caused by deficient activity of α-galactosidase A; it is one of a few diseases that are associated with priapism, an abnormal prolonged erection of the penis. The goal of this study was to investigate the pathogenesis of Fabry disease-associated priapism in a mouse model of the disease. We found that Fabry mice develop late-onset priapism. Neuronal nitric oxide synthase (nNOS), which was predominantly present as the 120-kDa N-terminus-truncated form, was significantly upregulated in the penis of 18-month-old Fabry mice compared to wild type controls (~fivefold). Endothelial NOS (eNOS) was also upregulated (~twofold). NO level in penile tissues of Fabry mice was significantly higher than wild type controls at 18 months. Gene transfer-mediated enzyme replacement therapy reversed abnormal nNOS expression in the Fabry mouse penis. The penile nNOS level was restored by antiandrogen treatment, suggesting that hyperactive androgen receptor signaling in Fabry mice may contribute to nNOS upregulation. However, the phosphodiesterase-5A expression level and the adenosine content in the penis, which are known to play roles in the development of priapism in other etiologies, were unchanged in Fabry mice. In conclusion, these data suggested that increased nNOS (and probably eNOS) content and the consequential elevated NO production and high arterial blood flow in the penis may be the underlying mechanism of priapism in Fabry mice. Furthermore, in combination with previous findings, this study suggested that regulation of NOS expression is susceptible to α-galactosidase A deficiency, and this may represent a general pathogenic mechanism of Fabry vasculopathy.


Assuntos
Doença de Fabry/complicações , Óxido Nítrico Sintase Tipo III/metabolismo , Óxido Nítrico Sintase Tipo I/metabolismo , Ereção Peniana , Pênis/enzimologia , Priapismo/etiologia , Animais , Modelos Animais de Doenças , Terapia de Reposição de Enzimas/métodos , Doença de Fabry/enzimologia , Doença de Fabry/fisiopatologia , Doença de Fabry/terapia , Terapia Genética/métodos , Masculino , Camundongos da Linhagem 129 , Camundongos Endogâmicos C57BL , Óxido Nítrico/metabolismo , Pênis/fisiopatologia , Priapismo/enzimologia , Priapismo/fisiopatologia , Priapismo/terapia , Fluxo Sanguíneo Regional , Transdução de Sinais , Regulação para Cima , alfa-Galactosidase/biossíntese , alfa-Galactosidase/genética
16.
J Sex Med ; 15(1): 5-19, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29208538

RESUMO

BACKGROUND: Patients with sleep-related painful erections (SRPEs) have frequent awakenings from deep penile pain during nocturnal erections. This results in severe sleep deprivation. AIM: To review the current literature on SRPEs and discuss the pathophysiologic theories and risks and benefits of medical treatments. METHODS: PubMed was searched using the terms sleep-related painful erections, nocturnal priapism, treatment, and sleep-related erections. OUTCOME: Variables included patient demographics, medical history, diagnostics, hypotheses on pathophysiology, and treatment modalities and their effect on SRPE in the short and long term. RESULTS: The search yielded in 66 SRPE cases that were analyzed, including our mono-institutional series of 24 patients. The phenomenon of SRPEs is not well understood. Theories about pathophysiology concerned increased serum testosterone levels, altered autonomic function, compression of the lateral preoptic area, coexistent obstructive sleep apnea syndrome, the existence of a "compartment syndrome," and psychosomatic factors. Except for polysomnographic findings that showed sleep fragmentation and decreased sleep efficiency in all patients, other diagnostic results varied widely. Multiple agents were tried. Baclofen and, to lesser degree, clonazepam showed noticeable results, most likely due to their influence on the γ-aminobutyric acid system and, hence, suppression of glutamate release. In addition, baclofen relaxes the ischiocavernosus and bulbospongiosus muscles, which are involved in penile erection. CLINICAL IMPLICATIONS: By providing a critical analysis and complete overview on the limited literature about this overlooked and undermanaged condition, this review contributes to a better understanding of the pathophysiology and provides directions for future research on the treatment of SRPE. STRENGTHS AND LIMITATIONS: Because the literature on SRPEs includes only case reports and small case series, the level of evidence of treatment advice is limited. CONCLUSION: The pathophysiology of SRPEs is not yet clarified. Further diagnostic evaluation, including electromyography of the ischiocavernosus and bulbospongiosus muscles to elucidate the pathophysiology, is recommended. Prospective controlled investigations are warranted to assess the efficacy and safety of long-term use of baclofen and develop evidence-based treatment advice. Vreungdenhil S, Weidenaar AC, de Jong IJ, van Driel MF. Sleep-Related Painful Erections: A Meta-Analysis on the Pathophysiology and Risks and Benefits of Medical Treatments. J Sex Med 2018;15:5-19.


Assuntos
Pênis/fisiopatologia , Priapismo/fisiopatologia , Parassonias do Sono REM/fisiopatologia , Humanos , Masculino , Ereção Peniana/fisiologia , Medição de Risco , Sono/fisiologia , Apneia Obstrutiva do Sono/complicações , Privação do Sono/complicações
17.
Sex Med Rev ; 6(2): 310-318, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28916463

RESUMO

INTRODUCTION: Priapism is defined as a full or partial erection lasting longer than 4 hours after sexual stimulation and orgasm or unrelated to sexual stimulation. The main goal of priapism management is to resolve the episode immediately to preserve erectile function and penile length. Corporal smooth muscle necrosis is likely to have already occurred, and medically refractory erectile dysfunction is expected in patients with a protracted episode. Penile prosthesis implantation (PPI) in the early or late phase of priapism can restore erectile function. AIM: To review the literature on PPI in priapism. METHODS: A PubMed search of all English-language articles published before 2017 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using the following search terms: penile prosthesis implantation, priapism, and corporal fibrosis. All publications reporting on PPI during or after priapism episodes were included for review. MAIN OUTCOME MEASURES: Three types of priapism were reviewed for management using PPI. Surgical techniques, outcomes, and patient satisfaction were reported. RESULTS: Early implantation (during the episode) is technically easier and has lower complication rates compared with delayed (electively, after the erectile dysfunction is observed) surgery. Immediate PPI also allows preservation of penile length, which is related to higher satisfaction rates. CONCLUSIONS: The paradigm is shifting toward immediate PPI in the management of ischemic priapism. Patients with non-ischemic priapism or recurrent priapism, even without a major ischemic episode, are at high risk for erectile dysfunction and are candidates for PPI. Yücel ÖB, Pazir Y, Kadioglu A. Penile Prosthesis Implantation in Priapism. Sex Med Rev 2018;6:310-318.


Assuntos
Implante Peniano , Prótese de Pênis , Priapismo , Adulto , Idoso , Disfunção Erétil , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Priapismo/fisiopatologia , Priapismo/cirurgia , Adulto Jovem
18.
Urology ; 106: 233-235, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28982618

RESUMO

INTRODUCTION AND OBJECTIVES: Implantation of a penile prosthesis in a patient with significant corporal fibrosis can pose a significant challenge to the surgeon, necessitating the knowledge of specific techniques used to dilate and close aggressively scarred corpora. The objective of our instructional video is to discuss 2 techniques used to approach corporal fibrosis: proper and safe use of cavernotomes for dilation and use of narrower prostheses. METHODS: In this video, we present a 53-year-old man with a history of priapism 3 years ago that lasted 4 days in the setting of trazodone use. He was managed with corporal irrigation and subsequently developed severe erectile dysfunction. Notably, the patient had a history of sickle cell anemia, and on physical examination was noted to have densely fibrotic corpora. After extensive counseling regarding options, he chose a penile implant. The surgical was planned using the "no touch technique." After the corporotomies were made, we began dilating the corpora. Hegar dilators and Dilamezinsert were attempted at first but met significant resistance. We switched to cutting cavernotomes and were able to dilate up to 11-Fr distally and up to 13-Fr proximally. The proper use of cavernotomes is highlighted in our video, with care being taken to aim the cutting edge of the cavernotome laterally away from the urethra. We also used the narrowest inflatable prosthesis available to us (Coloplast Titan narrow-base) and describe the narrower devices available in inflatable and malleable forms as an option for less-than-ideally dilated corpora. The pump and reservoir placement was completed uneventfully. RESULTS: The patient was admitted overnight for observation and check of a complete blood count given his history of sickle cell anemia. He was able to be discharged after 23 hours of observation. The patient presented to the clinic 4 weeks later for pump activation. He was able to achieve good rigidity and had a penile length adequate for penetration after maximal activation. CONCLUSION: This video discusses the approach to penile prosthesis placement in patients with significant corporal fibrosis. It highlights the proper use of cutting cavernotomes and the availability of narrow-diameter prostheses, both malleable and inflatable.


Assuntos
Implante Peniano/métodos , Prótese de Pênis , Pênis/cirurgia , Priapismo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana/fisiologia , Priapismo/fisiopatologia
19.
Emerg Med Pract ; 19(1 Suppl Points & Pearls): S1-S2, 2017 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-28745844

RESUMO

Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents. Evidence-based management and appropriate urologic follow-up of nonischemic and recurrent ischemic priapism maximizes patient outcomes and resource utilization. [Points & Pearls is a digest of Emergency Medicine Practice].


Assuntos
Pênis/anatomia & histologia , Priapismo/diagnóstico , Priapismo/fisiopatologia , Gasometria/métodos , Diagnóstico Diferencial , Serviço Hospitalar de Emergência/organização & administração , Humanos , Isquemia/complicações , Isquemia/diagnóstico , Masculino , Paracentese/métodos , Pênis/fisiopatologia , Ultrassonografia/métodos
20.
Andrology ; 5(4): 679-690, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28662541

RESUMO

In patients with sickle cell anemia, the sickling of red blood cells is known to cause end-organ damage by infarction. In some men who are affected by sickle cell anemia, the obstruction of venous outflow of the penis causes priapism, which could lead to erectile dysfunction. There is also evidence that the disease is linked to other reproductive issues in men-specifically delayed puberty, low testosterone, and sperm abnormalities-although the causes of these problems are less clear. Treatment of sickle cell anemia can have effects on the reproductive system as well. This review summarizes the findings from various publications pertaining to reproductive endocrinology, along with their conclusions and discrepancies.


Assuntos
Anemia Falciforme/complicações , Disfunção Erétil/etiologia , Hipogonadismo/etiologia , Infertilidade Masculina/etiologia , Priapismo/etiologia , Reprodução , Adolescente , Adulto , Anemia Falciforme/sangue , Anemia Falciforme/tratamento farmacológico , Anemia Falciforme/fisiopatologia , Antidrepanocíticos/efeitos adversos , Criança , Desenvolvimento Infantil , Pré-Escolar , Disfunção Erétil/sangue , Disfunção Erétil/fisiopatologia , Feminino , Hormônios/sangue , Humanos , Hipogonadismo/sangue , Hipogonadismo/fisiopatologia , Infertilidade Masculina/sangue , Infertilidade Masculina/fisiopatologia , Masculino , Ereção Peniana , Gravidez , Taxa de Gravidez , Priapismo/sangue , Priapismo/fisiopatologia , Puberdade , Reprodução/efeitos dos fármacos , Fatores de Risco , Análise do Sêmen , Testículo/crescimento & desenvolvimento , Testículo/metabolismo
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