High-flow priapism as a complication of a veno-occlusive priapism: two case reports

Rodríguez, J.; Cuadrado, J.M.; Francés, Albert; Franco, E

doi:10.1038/sj.ijir.3901398

Cited by 16 publications

(14 citation statements)

References 10 publications

(10 reference statements)

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“…Several authors have noted that following either aggressive medical management of ischemic priapism with aspiration and intracavernous alpha‐adrenergic injections or surgical shunting that priapism may rapidly recur with conversion from ischemia to high flow. High‐flow priapism has been reported following medical and surgical management of ischemic priapism [47–49]. Color Doppler ultrasound in these cases reveals formation of an arteriolar‐sinusoidal fistula as in typical high‐flow priapism or, on rare occasion, a high‐flow hemodynamic state of the cavernous arteries with no evident fistula formation.…”

Section: Epidemiology and Pathophysiology Of Priapismmentioning

confidence: 98%

Priapism: Pathogenesis, Epidemiology, and Management

Broderick

Kadıoğlu

Bivalacqua

et al. 2010

The Journal of Sexual Medicine

283

379

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Introduction Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of priapism is a matter of urgency requiring identification of underlying hemodynamics. Aims To define the types of priapism, address its pathogenesis and epidemiology, and develop an evidence-based guideline for effective management. Methods Six experts from four countries developed a consensus document on priapism; this document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. This report focuses on guidelines written over the past decade and reviews the priapism literature from 2003 to 2009. Although the literature is predominantly case series, recent reports have more detailed methodology including duration of priapism, etiology of priapism, and erectile function outcomes. Main Outcome Measures Consensus recommendations were based on evidence-based literature, best medical practices, and bench research. Results Basic science supporting current concepts in the pathophysiology of priapism, and clinical research supporting the most effective treatment strategies are summarized in this review. Conclusions Prompt diagnosis and appropriate management of priapism are necessary to spare patients ineffective interventions and maximize erectile function outcomes. Future research is needed to understand corporal smooth muscle pathology associated with genetic and acquired conditions resulting in ischemic priapism. Better understanding of molecular mechanisms involved in the pathogenesis of stuttering ischemic priapism will offer new avenues for medical intervention. Documenting erectile function outcomes based on duration of ischemic priapism, time to interventions, and types of interventions is needed to establish evidence-based guidance. In contrast, pathogenesis of nonischemic priapism is understood, and largely attributable to trauma. Better documentation of onset of high-flow priapism in relation to time of injury, and response to conservative management vs. angiogroaphic or surgical interventions is needed to establish evidence-based guidance.

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Section: Epidemiology and Pathophysiology Of Priapismmentioning

confidence: 98%

Priapism: Pathogenesis, Epidemiology, and Management

Broderick

Kadıoğlu

Bivalacqua

et al. 2010

The Journal of Sexual Medicine

283

379

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“…4,5,11,12 Injury to the cavernosal arteries may occur during corporal aspiration 11 due to the fixity of arteries in the rigid edematous corpora, or during proximal shunting procedures connecting the crura with the corpus spongiosum. 5 In some cases, however, color Doppler sonography reveals a high-flow cavernosal arterial state without angiographic evidence of a cavernosal-sinusoidal fistula. 4,12 In these patients, cavernosal artery embolization can be attempted to reduce penile inflow and intracorporal overpressure.…”

Section: Case Reportmentioning

confidence: 99%

“…5 To the best of our knowledge, high-flow priapism following laceration of the dorsal arteries after distal shunting procedures has not been reported previously.…”

mentioning

confidence: 99%

“…It usually follows perineal or penile blunt trauma with direct cavernosal artery injury, 2 but iatrogenic injury has been described occasionally. [3][4][5] Patients with high flow priapism usually develop a painless partial erection and are able to increase rigidity with sexual stimulation. Superselective embolization of the torn artery is commonly considered the treatment of choice.…”

mentioning

confidence: 99%

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High‐flow priapism complicating ischemic priapism following iatrogenic laceration of the dorsal artery during a Winter procedure

Bertolotto

Ciampalini

Martingano

et al. 2008

J of Clinical Ultrasound

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ABSTRACT:We report a case of a patient who developed high-flow priapism following a Winter procedure performed for the treatment of low-flow ischemic priapism. During the creation of bilateral cavernosal-glandular shunts, the tip of the left dorsal artery was accidentally lacerated. A fistula developed through the shunt between the torn artery and the cavernosal sinusoids of the tip of the left corpus cavernosum. Gray-scale and Doppler sonography and angiography allowed diagnosis and guided the therapeutic approach.

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“…High flow priapism has been reported to occur following shunting with return of heightened blood flow in the cavernosal arteries as demonstrated by ultrasonography. 101,102 Early penile prosthesis implantation is a third option, particularly in adult patients, that may be selected based on the likelihood of permanent ED. Priapism episodes lasting continuously for .36 hours are almost invariably associated with permanent ED.…”

Section: Surgical Managementmentioning

confidence: 99%

How I treat priapism

Anele

Resar

et al. 2015

Blood

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Priapism is a disorder of persistent penile erection unrelated to sexual interest or desire. This pathologic condition, specifically the ischemic variant, is often associated with devastating complications, notably erectile dysfunction. Because priapism demonstrates high prevalence in patients with hematologic disorders, most commonly sickle cell disease (SCD), there is significant concern for its sequelae in this affected population. Thus, timely diagnosis and management are critical for the prevention or at least reduction of cavernosal tissue ischemia and potential damage consequent to each episode. Current guidelines and management strategies focus primarily on reactive treatments. However, an increasing understanding of the molecular pathophysiology of SCD-associated priapism has led to the identification of new potential therapeutic targets. Future agents are being developed and explored for use in the prevention of priapism.

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High-flow priapism as a complication of a veno-occlusive priapism: two case reports

Cited by 16 publications

References 10 publications

Priapism: Pathogenesis, Epidemiology, and Management

Priapism: Pathogenesis, Epidemiology, and Management

High‐flow priapism complicating ischemic priapism following iatrogenic laceration of the dorsal artery during a Winter procedure

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