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1.
Radiol Med ; 125(3): 288-295, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31823294

RESUMO

PURPOSE: High-flow priapism is an incomplete and painless persistent erection caused by trauma. Its diagnosis is performed thanks to clinic and imaging evaluation with detection of fistula/pseudoaneurysm in the cavernous tissue. This paper aims to retrospectively assess the efficacy and safety of superselective arterial embolization in patients with high-flow priapism. MATERIALS AND METHODS: From January 2008 to March 2017, nine patients with high-flow priapism have been treated in a single center with embolization. The main etiology was trauma in eight subjects. The patients were evaluated with laboratory examinations and clinical and imaging findings (color Doppler ultrasonography and angiography). The mean follow-up time after embolization was 24 months. RESULTS: Eleven procedures were performed in nine patients: two of them required a second treatment session because of recurrence after 1-2 weeks. Embolic agents were microcoils, microparticles (300-500 µm) and Spongostan. Restoration of erectile function was monitored by clinical and color Doppler evaluation during follow-up. CONCLUSIONS: Superselective embolization should be the procedure of choice in patients affected by high-flow priapism; this technique appears to be successful in preserving erectile function. The choice of the embolic agent is crucial, and it should be tailored for each patient.


Assuntos
Embolização Terapêutica/métodos , Pênis/irrigação sanguínea , Priapismo/terapia , Adolescente , Adulto , Angiografia , Criança , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis/lesões , Priapismo/diagnóstico por imagem , Priapismo/etiologia , Recidiva , Fluxo Sanguíneo Regional , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Adulto Jovem
2.
Urologiia ; (5): 112-113, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808643

RESUMO

Blood disorders, in particular chronic myeloid leukemia (CML), are among the rare etiological factors of priapism. A clinical observation of ischemic priapism lasting 18 hours, which developed in patients with previously not diagnosed CML, is presented in the article. The CML was subsequently diagnosed based on the results of blood analyses and bone marrow aspiration. Treatment strategy consisted of immediate aspiration of blood from the cavernous bodies (19G) followed by the intracavernous injection of phenylephrine solution. After resolving priapism, CML therapy was carried out, which allowed to avoid a recurrence of priapism.


Assuntos
Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Fenilefrina/administração & dosagem , Priapismo/terapia , Irrigação Terapêutica , Adulto , Antineoplásicos/uso terapêutico , Medula Óssea/patologia , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Masculino , Pênis/irrigação sanguínea , Fenilefrina/uso terapêutico , Priapismo/etiologia , Recidiva , Resultado do Tratamento
3.
Emerg Med Clin North Am ; 37(4): 583-592, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563196

RESUMO

The penis is an organ of enormous importance and is vital for both excretory and reproductive function. The anatomy of the penis itself can lead to many of its emergent conditions and a thorough understanding of the anatomy and physiology is central to recognition of these conditions. Physicians should have a high clinical suspicion for penile emergencies and perform a thorough physical examination to make a proper diagnosis. Prompt diagnosis and proper management are essential for minimizing dysfunction of this vital organ.


Assuntos
Doenças do Pênis/diagnóstico , Emergências , Humanos , Masculino , Parafimose/diagnóstico , Parafimose/terapia , Doenças do Pênis/terapia , Pênis/lesões , Fimose/diagnóstico , Fimose/terapia , Priapismo/diagnóstico , Priapismo/terapia
5.
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
8.
Cir Pediatr ; 31(4): 200-203, 2018 Oct 17.
Artigo em Espanhol | MEDLINE | ID: mdl-30371034

RESUMO

INTRODUCTION: High-flow priapism is infrequent in pediatric patients. It is mostly secondary to perineal trauma resulting in laceration of a penile artery and the formation of an arterio-cavernous fistula. It does not constitute a medical emergency in itself, and allows conservative management awaiting spontaneous resolution. CLINICAL CASE: A six-year-old boy with painless persistent erection preceded by perineal trauma. Ultrasound imaging confirmed the clinical suspicion of high flow priapism secondary to arterio-cavernous fistula. After adopting a conservative approach, the patient presented progressive detumescence, as well as ultrasound resolution one month after the episode. COMMENTS: In high-flow priapism, venous drainage of the penis is preserved. The classical approach in adults is based on therapeutic angiography, which presents greater technical complexity and the risk of iatrogenic hypoxia in pediatric patients.


Assuntos
Tratamento Conservador/métodos , Fístula/complicações , Períneo/lesões , Priapismo/terapia , Criança , Humanos , Masculino , Pênis/irrigação sanguínea , Pênis/diagnóstico por imagem , Priapismo/diagnóstico por imagem , Priapismo/etiologia , Ultrassonografia
9.
Arch Ital Urol Androl ; 90(3): 218-219, 2018 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-30362692

RESUMO

INTRODUCTION: High-flow priapism is a rare condition in children, usually due to a perineal trauma. MATERIALS AND METHODS: We present a case of traumatic highflow priapism investigated by Doppler ultrasound and managed by angiography and selective embolization of a branch of the internal pudendal artery. RESULTS: A 13-year-old gymnast underwent perineal trauma during training and developed a high-flow priapism. The first ultrasound (immediately after the trauma) showed the presence of an inhomogeneous area of 3 x 2 cm associated with an anechoic vascularized area (pseudoaneurysm) in the right corpus cavernosum. On the left side there was a similar finding, but of smaller size. After 3 weeks the pseudoaneurysm on the left was completely obliterated while the right one was still present. Angiography and superselective catheterization of a branch of the left pudendal artery and its embolization with microspheres and with metal microcoils were performed. After the procedure, ultrasound showed that the right pseudoaneurysm was completely obliterated and there were no more branches reaching it. The cavernous arteries were both pervious. CONCLUSIONS: Selective arterial embolization is a safe treatment that can also be used in pediatric patients.


Assuntos
Embolização Terapêutica/métodos , Ginástica/lesões , Períneo/lesões , Priapismo/terapia , Adolescente , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Angiografia/métodos , Humanos , Masculino , Priapismo/etiologia , Resultado do Tratamento , Ultrassonografia Doppler/métodos
10.
Rev Bras Enferm ; 71(5): 2418-2424, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30304171

RESUMO

OBJECTIVE: To identify self-care demands of men with sickle cell disease and priapism and describe self-care measures in light of Orem's Self-Care Theory. METHOD: This is a descriptive exploratory study with qualitative approach conducted with nine men with a history of sickle cell disease and priapism. Data were analyzed using Orem's Self-Care Theory. RESULTS: Some demands were identified: from universal self-care - difficulty in social interaction and solitude, changes in self-image, self-esteem and sexual activity; from development - the experience with priapism and little knowledge about the pathophysiology of the disease; regarding health deviations - pain crises. CONCLUSION: Orem's theory allowed to identify self-care demands, which are essential for the nursing care provided for men with priapism. Nursing has an essential role in the measures for the different demands presented.


Assuntos
Anemia Falciforme/complicações , Priapismo/terapia , Autocuidado/métodos , Adulto , Humanos , Masculino , Teoria de Enfermagem , Priapismo/psicologia , Pesquisa Qualitativa
11.
Cir. pediátr ; 31(4): 200-203, oct. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-172936

RESUMO

Introducción: El priapismo de alto flujo es una entidad infrecuente en la edad pediátrica. Es, en su mayoría, secundario a traumatismo perineal que provoca la laceración de una arteria peneana y formación de una fístula arterio-cavernosa. No constituye una emergencia médica, permitiendo un manejo conservador a la espera de su resolución espontánea. Caso clínico: Niño de seis años con erección persistente e indolora tras traumatismo perineal. El diagnóstico ecográfico confirma la sospecha de priapismo de alto flujo secundario a fístula arteria-cavernosa. Tras manejo conservador, presenta detumescencia progresiva y resolución ecográfica al mes del episodio. Comentarios: En el priapismo de alto flujo el drenaje venoso del pene se encuentra conservado. El manejo clásico en adultos se fundamenta en la angiografía terapéutica, de mayor complejidad técnica y riesgo de hipoxia iatrogénica en el paciente pediátrico


Introduction: High-flow priapism is infrequent in pediatric patients. It is mostly secondary to perineal trauma resulting in laceration of a penile artery and the formation of an arterio-cavernous fistula. It does not constitute a medical emergency in itself, and allows conservative management awaiting spontaneous resolution. Clinical case: A six-year-old boy with painless persistent erection preceded by perineal trauma. Ultrasound imaging confirmed the clinical suspicion of high flow priapism secondary to arterio-cavernous fistula. After adopting a conservative approach, the patient presented progressive detumescence, as well as ultrasound resolution one month after the episode. Comments: In high-flow priapism, venous drainage of the penis is preserved. The classical approach in adults is based on therapeutic angiography, which presents greater technical complexity and the risk of iatrogenic hypoxia in pediatric patients


Assuntos
Humanos , Masculino , Criança , Priapismo/diagnóstico por imagem , Priapismo/terapia , Períneo/lesões , Tratamento Conservador , Ultrassonografia Doppler/métodos , Biópsia por Agulha Fina/métodos , Embolização Terapêutica/métodos
12.
Prog Urol ; 28(14): 772-776, 2018 Nov.
Artigo em Francês | MEDLINE | ID: mdl-30201552

RESUMO

OBJECTIVE: Our aim was to present a synthesis on the diagnosis and treatment of priapism. METHODS: For this purpose, a literature search was performed through PubMed to analyze literature reviews and guidelines regarding priapism. RESULTS: Priapism is an erection that persists more than 4hours. There are 3 types of priapism: ischemic priapism, non-ischemic priapism and recurrent (stuttering) priapism. Ischemic priapism, often idiopathic, is the most frequent. When diagnosed, an urgent management is required to limit erectile dysfunction. Sickle-cell patients are prone to have ischemic and stuttering priapism. Non-ischemic priapism usually occurs after perineal trauma. Priapism management depends on the type of priapism. Medical treatment (corporal aspiration and injection of sympathomimetics) then if failed, surgery are indicated for ischemic priapism. The persistence of a non-ischemic priapism most likely requires a radiologic embolization. CONCLUSION: Priapism is a condition that often requires emergency treatment to spare erectile function. It appears crucial to know this condition and its management.


Assuntos
Ereção Peniana/fisiologia , Priapismo/diagnóstico , Humanos , Masculino , Priapismo/etiologia , Priapismo/terapia
13.
Zhonghua Nan Ke Xue ; 24(8): 675-680, 2018 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-30173423

RESUMO

Priapism is a rare pathological penile erection, and there are some inadequacies in its definition, classification, diagnosis, and therapeutic strategies. In this article, we sum up our years of experience with priapism and put forward some new views and ideas about its definition, classification, pathophysiologic process, pathological change, diagnostic essentials, therapeutic measures, indications of successful treatment, and post-therapeutic rehabilitation of erectile function. We also describe the clinical features, diagnosis and treatment of some special types of priapism, such as intermittent seizure, sleep-related painful erection, and tumor-related priapism, hoping to help urologists and andrologists in the further understanding and management of priapism.


Assuntos
Ereção Peniana , Priapismo , Humanos , Masculino , Priapismo/classificação , Priapismo/diagnóstico , Priapismo/etiologia , Priapismo/terapia
14.
Curr Med Sci ; 38(1): 101-106, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30074158

RESUMO

This study is aimed to evaluate the effectiveness and safety of the treatment of highflow priapism with superselective transcatheter embolization. From Sep. 1999 to Jan. 2013, six patients with high-flow priapism underwent superselective transcatheter embolization of the cavernous artery. Recurrence of priapism, and change in erectile function detected by nocturnal penile tumescence and rigidity (NPTR) test and the International Index of Erectile Function 5-item questionnaire (IIEF-5) were evaluated during a mean follow-up of 12 months. A single superselective transcatheter embolization was sufficient for complete resolution of priapism in the six patients. None of the patients had a relapse of priapism after embolization, and all the patients who had premorbid normal erectile function showed maintained potency with normal results of NPTR and a mean postoperative IIEF-5 score of 23.5 (range 23 to 24) during the follow-up period. In conclusion, superselective transcatheter embolization is an effective and safe treatment method for high-flow priapism, and it can ensure a high level of preservation of premorbid erectile function.


Assuntos
Embolização Terapêutica/métodos , Priapismo/terapia , Dispositivos de Acesso Vascular/efeitos adversos , Adolescente , Adulto , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Humanos , Masculino , Priapismo/diagnóstico por imagem
15.
Zhonghua Nan Ke Xue ; 24(1): 59-61, 2018.
Artigo em Chinês | MEDLINE | ID: mdl-30157362

RESUMO

Objective: To introduce our experience in the treatment of arterial priapism by superselective embolization. METHODS: This study included 5 cases of perineal trauma-induced arterial erectile dysfunction treated in our departmentbetween February 2011 and May 2015, all failingpreviously to respond to 3 weeks of conservative treatment. The patients were aged 25-47 (mean 35) years, with the onset of arterial priapism at 2-5 days after trauma, and all subjected to physical examination, blood gas analysis, color Doppler ultrasonography of the corpora cavernosum, and IIEF-5 scoring. All the patients underwent superselective embolization, followed by local pressing and cold compression, and IIEF-5 scores were obtained again at 6 and 12 months postoperatively. RESULTS: All the patients had normal erectile functionbefore trauma, with a mean IIEF-5 scoreof 24.60 ± 0.55. Complete detumescenceor painless flaccidity of the penis was achieved in 1 case immediately after surgery and in the other 4 after 3-17 days of postoperative conservative treatment. None of the patients needed a second embolization and no relapse was found during a mean follow-upof 27.2 (13-48)months. The IIEF-5 scores obtained at 6 (24.00 ± 1.02) and 12 months (24.20 ± 0.82) were normal, with no statistically significant differencesfrom that before trauma. CONCLUSIONS: Selective embolization is a safe and effective option for the treatment of arterial priapism. In case of no immediate painless flaccidity of the penis after surgery, conservative treatment can be extended rather than a second operation.


Assuntos
Embolização Terapêutica/métodos , Pênis/irrigação sanguínea , Priapismo/terapia , Adulto , Artérias , Disfunção Erétil/etiologia , Disfunção Erétil/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Períneo , Período Pós-Operatório , Priapismo/etiologia , Recidiva , Ultrassonografia Doppler em Cores
16.
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
17.
Ned Tijdschr Geneeskd ; 1622018 Jun 15.
Artigo em Holandês | MEDLINE | ID: mdl-30040312

RESUMO

The term priapism describes erections of >4 hours that arise in the absence of or last well beyond sexual stimulation. Ischaemic priapism is the most common form and treatment success is strongly dependent on the duration of priapism. The aetiology is widely variable as a result of which several specialisms can be confronted with this condition. Over the past few years, urologists increasingly have to deal with patients who do not suffer from erectile dysfunction, but nevertheless use intracavernous injections with priapism as a result. These men are often reluctant to see a doctor due to shame and ignorance, which often leads to delayed treatment. According to current guidelines, early prosthesis implantation is recommended if the priapism lasted >36 hours. Treatment of stuttering priapism should be focused on prevention of subsequent episodes. Non-ischaemic priapism generally follows a mild course and can initially be approached conservatively.


Assuntos
Tratamento Conservador/métodos , Serviços Médicos de Emergência , Priapismo , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Humanos , Masculino , Seleção de Pacientes , Priapismo/diagnóstico , Priapismo/etiologia , Priapismo/terapia , Tempo para o Tratamento
18.
J Fam Pract ; 67(6): E10-E11, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29879245

RESUMO

A 35-year-old African-American man, who was an active duty service member, presented to the Troop Medical Clinic with a 4-hour history of priapism. He had been taking sertraline 100 mg and prazosin 10 mg nightly for 4 months to treat his posttraumatic stress disorder (PTSD) with no reported adverse effects. These doses were titrated 2 months prior to presentation. The patient reported that he took his usual medication doses before bed and awoke at 3 am with a penile erection. At 7 am, he presented to the clinic because of pain from the continued erection.


Assuntos
Prazosina/efeitos adversos , Prazosina/uso terapêutico , Priapismo/induzido quimicamente , Priapismo/terapia , Sertralina/efeitos adversos , Sertralina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Adulto , Afro-Americanos , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Humanos , Masculino , Resultado do Tratamento
20.
Andrologia ; 50(6): e13019, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29687468

RESUMO

High-flow priapism is a rare condition mainly caused by perineal trauma. Laceration of cavernosal artery results in a formation of arterial-lacunar fistula with unregulated blood flow causing prolonged erection. We present a case of a 25-year-old man with high-flow priapism and concurrent erectile dysfunction treated with repeated selective embolisation with only a partial effect. When no further embolisation was possible, we assumed on conservative management even through the fistula was still present. Spontaneous detumescence occurred 9 months, and erectile function has fully restored 24 months after the injury. To the best of our knowledge, spontaneous detumescence with full restoration of erection even through the persistent arterial-lacunar fistula has not been reported previously. Therefore, we propose conservative approach after embolisation to be an option.


Assuntos
Disfunção Erétil/etiologia , Disfunção Erétil/terapia , Pênis/irrigação sanguínea , Priapismo/complicações , Priapismo/terapia , Adulto , Artérias , Embolização Terapêutica , Fístula , Humanos , Masculino , Ereção Peniana , Fluxo Sanguíneo Regional
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