High-flow priapism (HFP) secondary to Nesbit operation: management by percutaneous embolization and colour Doppler-guided compression

Liguori, Giovanni; Garaffa, Giulio; Trombetta, Carlo; Capone, M; Bertolotto, Michele; Mucelli, Fabio Pozzi; Belgrano, E.

doi:10.1038/sj.ijir.3901251

Cited by 15 publications

(6 citation statements)

References 13 publications

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“…The mechanisms include: straddle injury, coital trauma, kicks to the penis or perineum, pelvic fractures, birth canal trauma to the newborn male, needle lacerations, complications of penile diagnostics, and vascular erosions complicating metastatic infiltration of the corpora [40–44]. Although blunt trauma is the most commonly reported etiology, high‐flow priapism has been described following surgical interventions: cold‐knife urethrotomy, Nesbitt corporoplasty, deep dorsal vein arterialization [45,46]. Any mechanism which lacerates a cavernous artery or arteriole can produce unregulated pooling of blood in sinusoidal space with consequent erection.…”

Section: Epidemiology and Pathophysiology Of Priapismmentioning

confidence: 99%

Priapism: Pathogenesis, Epidemiology, and Management

Broderick

Kadıoğlu

Bivalacqua

et al. 2010

The Journal of Sexual Medicine

296

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: 99%

Priapism: Pathogenesis, Epidemiology, and Management

Broderick

Kadıoğlu

Bivalacqua

et al. 2010

The Journal of Sexual Medicine

296

379

View full text Add to dashboard Cite

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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 erection rapidly recurs with conversion from ischemia to high flow. High‐flow priapism has been reported following needle aspiration/irrigation and surgical management of ischemic priapism [45–49]. Color Doppler ultrasound in these cases reveals formation of an arteriolar‐sinusoidal fistula as in typical high‐flow priapism secondary to trauma.…”

Section: Epidemiology and Pathophysiology Of Priapismmentioning

confidence: 96%

Priapism and Sickle-Cell Anemia: Diagnosis and Nonsurgical Therapy

Broderick

2012

The Journal of Sexual Medicine

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Introduction Priapism describes a persistent erection lasting longer than 4 hours. Ischemic priapism and stuttering priapism are phenotypic manifestations of sickle-cell disease (SCD). Aims To define the types of priapism associated with SCD, to address pathogenesis, and to recommend best practices. Sources Literature review and published clinical guidelines. Summary of Findings Priapism is a full or partial erection that persists more than 4 hours. There are three kinds of priapism: ischemic priapism (veno-occlusive, low flow), stuttering priapism (recurrent ischemic priapism), and nonischemic priapism (arterial, high flow). Ischemic priapism is a pathologic phenotype of SCD. Ischemic priapism is a urologic emergency when untreated priapism results in corporal fibrosis and erectile dysfunction. The recommended treatment for ischemic priapism is decompression of the penis by needle aspiration and if needed, injection (or irrigation) with dilute sympathomimetic drugs. Stuttering priapism describes a pattern of recurring unwanted painful erections in men with SCD. Patients typically awaken with an erection that persists for several hours and becomes painful. The goals of managing stuttering ischemic priapism are: prevention of future episodes, preservation of erectile function, and balancing the risks vs. benefits of various treatment options. The current molecular hypothesis for stuttering priapism in SCD proposes that insufficient basal levels of phosphodiesterase type-5 are available in the corpora to degrade cyclic guanosine monophosphate (cGMP). Nocturnal erections result from normal neuronal production and surges of cGMP. In the context of SCD stuttering priapism, these nocturnal surges in cGMP go unchecked, resulting in stuttering priapism. Conclusions Considering the embarrassing nature of the problem and the dire consequences to erectile function, it is important to inform patients, parents, and providers about the relationship of SCD to prolonged painful erections. Prompt diagnosis and appropriate medical management of priapism are necessary to spare patients surgical interventions and preserve erectile function.

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“…Non-ischemic priapism has been reported as a complication of medical and surgical management of ischemic priapism. 56–58 Other surgical procedures associated with non-ischemic priapism include cold-knife internal urethrotomy for urethral stenosis, 59 hydraulic erection during Nesbit corporoplasty, 60 deep dorsal vein arterialization for vasculogenic impotence, 61 and self-administered ICP for ED. 62 …”

Section: Non-ischemic Priapismmentioning

confidence: 99%

Evaluation and management of priapism: 2009 update

et al. 2009

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SUMMARY Priapism is a persistent penile erection that is unrelated to sexual stimulation. The condition may be divided into ischemic and non-ischemic subtypes. Ischemic priapism, the most common variant of the disorder, is typically accompanied with pain and the potential for penile end-organ damage. An erection duration of 4 hours or more is oftentimes quoted as diagnostic of priapism. The initial management of non-ischemic priapism should be conservative. Prompt attention is indicated in cases of ischemic priapism; the initial management of choice is corporal aspiration with injection of sympathomimetic agents. If medical management fails, a cavernosal shunt procedure is indicated. At our institution, we favor the T-shunt with or without tunneling for the management of refractory ischemic priapism. Stuttering (recurrent) ischemic priapism challenges the clinician to develop a management strategy to prevent future episodes of priapism. Daily treatment with low dose Phosphodiesterase Type 5 Inhibitors is a promising but investigational means of preventing stuttering priapism. This review will focus on new directions and our own experience in the treatment of priapism.

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High-flow priapism (HFP) secondary to Nesbit operation: management by percutaneous embolization and colour Doppler-guided compression

Cited by 15 publications

References 13 publications

Priapism: Pathogenesis, Epidemiology, and Management

Priapism: Pathogenesis, Epidemiology, and Management

Priapism and Sickle-Cell Anemia: Diagnosis and Nonsurgical Therapy

Evaluation and management of priapism: 2009 update

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