Ischaemic priapism: A clinical review

Abstract

Objective: Ischaemic priapism is a rare condition characterised by little or no cavernosal blood flow, pain and rigidity of the penis. Immediate intervention is required to restore blood flow, prevent necrosis and erectile dysfunction. This review was conducted to determine the best course of treatment and identify areas in current guidelines to which improvements could be made. PubMed, Ovid, MEDLINE (1946-December 2016 and the Cochrane Library were searched as sources for literature. Key studies in each of the areas of management were identified and analysed. Material and methods:Results: A total of 45 articles were reviewed. The first step in treatment should be aspiration of corporeal blood. Further studies are needed to make firm recommendations as to whether irrigation should follow, as currently literature is inconclusive. If this fails to cause detumescence, sympathomimetics should be injected. The sympathomimetic of choice is phenylephrine as it is effective, specific and causes minimal cardiovascular side effects. It should be injected at a concentration of 100-500 μg/mL, with 1 mL being injected every 3-5 minutes for up to an hour (maximum 1mg in an hour). Surgical shunting is the next step, except in the cases of delayed priapism (48-72 hours duration) where immediate penile prosthesis insertion may be considered more appropriate. Distal shunts should be performed first, followed by proximal ones to minimise damage leading to erectile dysfunction. There exists little evidence recommending one shunting procedure over another. The final intervention is insertion of a penile prosthesis. Literature suggests that an inflatable prosthesis inserted immediately will yield the greatest patient satisfaction. Conclusion:A review of the literature has highlighted areas in which further research needs to be done to make conclusive recommendations, including whether irrigation should accompany aspiration and efficacy of shunting procedures. Further studies are required to ensure that patients receive the treatment most likely to cause detumescence and maintain erectile function.

A novel approach to treatment of priapism refractory to non-surgical methods: A single-case experience

“…Failure of resolution of priapism by sympathomimetic agents has no strict timeline, and there is no evidence about when to deem treatment with cavernosal injections pointless. It is suggested that prolonged treatment is futile due to smooth muscle paralysis from cellular damage [2]; however, in our present case we found that after every series of injections we got a partial response before painful erection returned, indicating that cellular damage had not occurred.…”

“…Ischaemic priapism is a urological emergency resulting in complete erectile dysfunction (ED) if treatment is delayed [1]. Treatment strategies for ischaemic priapism, as in most medical conditions, gradually increases in invasiveness from local injections to invasive shunt procedures, and eventually surgical shunting procedures and recently an increasing trend towards early penile implant insertion [2]. We hereby present a case of ischaemic priapism refractory to cavernosal injections and percutaneous transglandular shunts who was eventually successfully treated by continuous intracavernosal infusion of phenylephrine.…”

Role of Penile Prosthesis in Priapism: A Review

“…Although proximal shunts have better efficacy in achieving detumescence, they also carry a greater risk of ED (50% with proximal vs . 25% or less with distal shunts) [ 15 ]. It should also be noted that less invasive distal shunts, such as the Winter shunt, can be performed in an emergency setting under local anesthesia, while more invasive shunts, such as the Al-Ghorab and proximal shunts, must be performed in an operating room under general anesthesia.…”

Discontinuation of treatment in a chronic myeloid leukemia patient caused priapism: A case report

“…A single attack of ischemic priapism may end up in cavernosal fibrosis with subsequent erectile dysfunction, if it is not managed urgently or properly. Several etiologies have been mentioned in the literature causing ischemic priapism, which include hemoglobinopathies including thalassemias and sickle cell anaemia, hypercoagulable status, neoplastic syndromes, compressive pelviabdominal masses and use of some recreational drugs and medications (intracavernosal injections of papaverine, phentolamine and PGE1, anticoagulants, α-blockers, antidepressants and antipsychotics) [2] . However, in the majority of cases of ischemic priapism, no cause could be identified and, in such cases, are known to be idiopathic.…”