Priapismo y leucemia mieloide crónica en adolescente. Debut poco frecuente. Reporte de caso / Priapism and chronic myeloid leukemia in an adolescent. Rare debut presentation. A case report

El priapismo es una erección dolorosa y persistente acompañada o no de estímulo sexual. Una causa poco frecuente de esta anormalidad es la leucemia mieloide crónica. Se han reportado pocos casos de priapismo como manifestación inicial de una leucemia de este tipo en pacientes adolescentes. A continuación, se informa el caso de un paciente de 16 años de edad que presentó priapismo como manifestación inicial de una leucemia mieloide crónica. Durante su evolución, no se realizó aspiración de los cuerpos cavernosos. Se inició tratamiento hematológico específico y, ante la persistencia del priapismo, fue necesario realizar un shunt de cuerpos cavernosos en dos ocasiones, tratamiento a pesar del cual existen altas probabilidades de secuelas.

Priapism is a painful and persistent erection, with or without sexual stimulation. A rare cause of such abnormality is chronic myeloid leukemia. Few cases of priapism as an initial manifestation of this type of leukemia have been reported in adolescent patients. Here we describe the case of a 16-year-old patient who presented with priapism as the initial manifestation of chronic myeloid leukemia. No cavernosal aspiration was performed. A specific hematological treatment was started and, given the persistence of priapism, the patient required 2 corpora cavernosa shunt procedures; despite this treatment, there is a high probability of sequelae.

Systematic review: interventions in sickle cell disease-related priapism in reducing overall morbidity, recurrence, and side effects / Revisión sistemática: intervenciones en priapismo relacionado con enfermedad de células falciformes (ECF), en reducción de morbilidad, recurrencia y efectos secundarios

Pediatric priapism is a rare, underreported urological emergency. Sickle cell disease (SCD)-related priapism cases should be assessed considering specific pathophysiologic characteristics. Chronic control of the disease has an impact on a patient's quality of life. A systematic review in different databases was done, for defining if management in All-type priapism in SCD patients was equally effective in reducing overall morbidity, disability and comorbidities, recurrence, and therapy-related side effects. Qualitative analysis was performed. Nine studies were included in the study; the majority were case series, and 300 patients were included in the analysis. The interventions and outcomes were clinically heterogeneous but displayed perspectives for further studies. This is the first analysis approach for a consensus for SCD-related priapism treatment. Studies with internal validity and causality designs are needed, to evaluate further causality relationships and establish evidence-based approaches. Etilefrine, Pseudoephedrine/etilefrine-5 inhibitors, and finasteride are promising strategies. Quality of life scores should be applied to these patients, and molecular studies should be developed for pharmacological designs.

El priapismo pediátrico es una entidad poco común, sin embargo, es una urgencia urológica infranotificada. Los casos de priapismo relacionados con enfermedad de células falciformes (ECF) deben evaluarse teniendo en cuenta características fisiopatológicas específicas. El control crónico de la enfermedad tiene impacto en la calidad de vida del paciente. Se realizó una revisión sistemática en diferentes bases de datos, para definir si las intervenciones en pacientes con priapismo de todo tipo relacionado con ECF fueron igualmente efectivas en la reducción de morbilidad general, discapacidad, comorbilidades, recurrencia y efectos secundarios relacionados con la terapia. Se realizó un análisis cualitativo de nueve estudios; la mayoría series de casos, para un total de 300 pacientes. Las intervenciones y los resultados fueron clínicamente heterogéneos, pero mostraron perspectivas para futuros estudios. Este es el primer análisis de información para llegar a un consenso para el tratamiento del priapismo relacionado con la ECF. La perspectiva principal es la necesidad de estudios con validez interna y diseños elaborados para profundizar las relaciones de causalidad y el abordaje basado en la evidencia de esta condición. La etilefrina, los inhibidores de la PDE-5 y la finasterida son estrategias prometedoras. Se deben aplicar puntajes de calidad de vida a estos pacientes y se deben desarrollar estudios moleculares para diseños farmacológicos.

Priapism in a patient on hemodialysis and with COVID-19. Case report / Priapismo en paciente en diálisis y con COVID-19. Reporte de caso

Abstract Introduction: Priapism is rare in dialysis patients. It is associated with several risk factors inherent to therapy and kidney disease. This condition has been reported in severe COVID-19 cases, probably caused by coagulopathy secondary to the infection. However, it has not been reported in patients with mild COVID-19. Case presentation: A 65-year-old patient on hemodialysis and with mild COVID-19 presented with a 30-hour painful penile erection. Physical examination revealed an erection, but no other significant findings were observed. Based on the clinical history, physical examination and laboratory test results, the patient was diagnosed with ischemic priapism. Corpora cavernosa drainage was performed and two injections of epinephrine (each with a dose of 2mL of epinephrine solution 1/100 000) were administered, achieving complete resolution of the symptoms. Conclusions: At the time of writing this case report, there is no information available on cases of priapism in patients with mild manifestations of COVID-19, nor is it clear how the risk of thrombosis should be assessed in this group of patients. From a pathophysiological point of view, factors related to dialysis and kidney disease could have predisposed this patient to priapism, although the role of SARS-CoV-2 infection is uncertain. Therefore, further studies are required to confirm or rule out the association between COVID-19 and priapism in dialysis patients.

Resumen Introducción. El priapismo es una condición infrecuente en pacientes en diálisis que se puede presentar por factores inherentes a esta terapia y a la enfermedad renal. Por otra parte, es una entidad que se ha reportado en pacientes con síntomas severos de COVID-19 y se ha asociado a coagulopatía secundaria a la infección, pero de la que no hay registro en casos leves de esta enfermedad. Presentación de caso. Paciente masculino de 65 años en hemodiálisis y con infección por SARS-CoV-2 con síntomas leves, quien consultó al servicio de urgencias de un hospital de cuarto nivel por erección peneana dolorosa de 30 horas de evolución. Al examen físico se evidenció la erección, sin otros hallazgos relevantes. Con base en la historia clínica, el examen físico y los resultados de laboratorio, se diagnosticó priapismo isquémico y se realizó drenaje de senos cavernosos y aplicación de dos inyecciones de epinefrina (cada una con una dosis de 2mL de solución de epinefrina 1/100 000), lográndose resolución completa de la condición. Conclusiones. Hasta el momento de la elaboración del presente reporte de caso no hay información disponible de casos de priapismo en pacientes con manifestaciones leves de COVID-19, y tampoco hay claridad de cómo se debe evaluar el riesgo de trombosis en este grupo de pacientes. Desde el punto de vista fisiopatológico, factores relacionados con la diálisis y la enfermedad renal pudieron predisponer a este paciente al priapismo, aunque no es claro el rol de la infección por SARS-CoV-2. Por tanto, se requieren estudios que permitan confirmar o descartar la asociación entre COVID-19 y priapismo en pacientes en diálisis.

Penile prosthesis implant in the special populations: Diabetics, neurogenic conditions, fibrotic cases, concurrent urinary continence surgery, and salvage implants / 亚洲男科学杂志(英文版)

Penile prosthesis implant (PPI) remains an effective and safe treatment option for men with erectile dysfunction (ED). However, PPI surgery can be associated with a higher risk of complications in certain populations. This article provides a critical review of relevant publications pertaining to PPI in men with diabetes, significant corporal fibrosis, spinal cord injury, concurrent continence surgery, and complex salvage cases. The discussion of each category of special populations includes a brief review of the surgical challenges and a practical action-based set of recommendations. While specific patient populations posed considerable challenges in PPI surgery, strict pre- and postoperative management coupled with safe surgical practice is a prerequisite to achieving excellent clinical outcomes and high patient satisfaction rate.

Prevalence of priapism in individuals with sickle cell disease and implications on male sexual function / Prevalência de priapismo em indivíduos com doença falciforme e suas implicações na função sexual masculina

ABSTRACT 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.

RESUMO Objetivo Avaliar aspectos epidemiológicos do priapismo em pacientes com doença falciforme e o impacto desses aspectos na função sexual de adultos. Métodos Trata-se de estudo transversal, que incluiu indivíduos com doença falciforme acompanhados em um centro de referência. Os participantes responderam a um questionário estruturado acerca das características sociodemográficas e eventos de priapismo. A função sexual foi avaliada por meio de dois instrumentos validados, a Escala de Rigidez de Ereção e um sobre satisfação com a vida sexual. Resultados Foram entrevistados 64 indivíduos com média de idade de 12 (7-28) anos. A prevalência de priapismo foi de 35,9% (23/64). O episódio mais precoce ocorreu aos 2 anos de idade e o mais tardio, aos 42 anos. A projeção estatística foi de que 71,1% desses sujeitos teriam pelo menos um episódio de priapismo ao longo da vida. Pacientes adultos com episódios de priapismo (10/23) apresentaram função erétil significativamente pior Escala de Rigidez de Ereção de 2 [1-3]; p=0,01 e estavam menos satisfeitos com a vida sexual 3 [3-5]; p=0,02. Conclusão O priapismo manifesta-se desde a infância, e episódios graves estão associados a dano cavernoso, prejuízo na qualidade da ereção e menor satisfação sexual.

Priapism: a rare presentation in chronic myeloid leukemia

Priapism is a rare presenting feature of Chronic Myeloid Leukemia (CML). It is an urological emergency which requires urgent treatment to prevent long term complications, in particular erectile dysfunction. Author report a case of 18 year old male presenting with persistent painful erection of penis for around 14 hours. The patient underwent immediate irrigation and decompression of priapism in emergency and was started on cytoreductive therapy. During hospitalization, peripheral blood smear and bone marrow aspiration confirmed the diagnosis of CML

Access of men with sickle cell disease and priapism in emergency services / Acesso de homens com doença falciforme e priapismo nos serviços de emergência

ABSTRACT BACKGROUND AND OBJECTIVES: Priapism is one of the complications of sickle cell disease characterized by a persistent and painful erection, which can lead to erectile dysfunction and sexual impotence. The objective of this study was to understand how men with sickle cell disease and priapism access emergency care. METHODS: A qualitative study conducted in a reference healthcare unit to people with sickle cell disease in the second largest city in Bahia. Seven adult men with sickle cell disease who had experienced priapism participated in the study. The data were collected by semi-structured interview and thematic story designs and submitted to content analysis. RESULTS: Priapism is seen as a lack of genital health. Participants use strategies to manage it at home to avoid embarrassment, which ends up in cocooning. Access to emergency services is motivated by persistent and relentless pain; and limited by the fear of priapism being mistaken for sexual deviance, lack of knowledge about the complication as a urologic emergency and financial shortfall, which confers a worse prognosis about erectile function. Men are embarrassed and discriminated by healthcare and support professionals, which discourages them from accessing these services in the future. CONCLUSION: This study emphasizes the importance of early diagnosis of sickle cell disease, the orientation of family members and the need for healthcare professionals to educate young boys and men with sickle cell disease and their caregivers about priapism in advance to allow adequate self-care and prevent complications.

RESUMO JUSTIFICATIVA E OBJETIVOS: O priapismo é uma das complicações da doença falciforme caracterizada por ereção persistente e dolorosa, podendo levar à disfunção erétil e impotência sexual. O objetivo deste estudo foi compreender como os homens com doença falciforme e priapismo acessam os cuidados nos serviços de emergência. MÉTODOS: Estudo qualitativo realizado em unidade de saúde referência para pessoas com doença falciforme no segundo maior município baiano. Participaram do estudo 7 homens adultos com doença falciforme que já vivenciaram priapismo. Utilizou-se entrevista semiestruturada e desenhos-história com o tema, analisados por análise de conteúdo. RESULTADOS: O priapismo é visto como uma falta de saúde genital. Os participantes usam estratégias para seu manuseio em domicílio para evitar constrangimentos, o que acaba isolando-os socialmente. O acesso aos serviços de emergência é motivado pela dor persistente e irredutível; e limitado pelo temor do priapismo ser confundido como resultado de desvio sexual, desconhecimento da complicação como emergência urológica e carência financeira, o que confere pior prognóstico sobre a função erétil. Os homens sofrem constrangimento e discriminação pelos profissionais de saúde e de apoio das unidades, o que os desmotiva a acessar esses serviços no futuro. CONCLUSÃO: Este estudo ressalta a importância do diagnóstico precoce da doença falciforme, da orientação de familiares e da necessidade de os profissionais de saúde educarem os meninos/homens jovens com doença falciforme e seus cuidadores sobre o priapismo de forma prévia, para permitir o adequado autocuidado futuro e prevenção de complicações.

A comparison of the therapeutic efficacy of superselective arterial embolization and watchful waiting in high-flow priapism / 中华泌尿外科杂志

Objective Compare the efficacy of superselective arterial embolization with observation in the treatment of HFP caused by trauma.Methods From Jan,2013 to Dec,2017,6 traumatic HFP patients were involved into the study,the age range from 18 to 44 years old,with an average age of 26.2 years.The fistula was measured by doppler ultrasonography before the treatment with its longest diameter,and which ranges from 0.8 to 1.4 cm,the average diameter is 1.14 cm.All patients are divided into two groups according to their treatment.Operation group:4 patients underwent the pudendal artery superselective gelatin sponge vascular embolization.Control group:2 cases were treated with local cold compressing under watchful waiting.In control group,patients are treated by local cold compress with ice bag for 3 weeks:15 mins × 10 times every day.The erectile hardness of the patients was observed and the fistula was evaluated by doppler ultrasonography 3 weeks later,and all the patients were reexamined by doppler ultrasonography 1 year later.The erectile hardness was divided into four grades according to the patient~ subjective feelings:grade Ⅰ,the penis was enlarged but not rigid;grade Ⅱ,the penis had hardness,but not enough to insert into the vagina;grade Ⅲ,the penis could be inserted into the vagina,but not to achieve complete erection;grade Ⅳ,the penis fully erect and firm.The erectile function was evaluated with the International Index of Erectile Function-5(IIEF-5) after 1-year's follow-up.Results 4 patients in the operation group were operated successfully without obvious complications after operation.Median follow-up time of all the patients was 21 months (5-50).In group operation,4 cases of surgical patients did not have the recurrence of priapism.There was no obvious abnormality in the color doppler ultrasound of penis.The score of IIEF-5 was 25,24,24 and 23,respectively.Postoperative erectile function made a complete recovery.In group observation,2 patients under watchful waiting still have grade Ⅱ-Ⅲ sustained priapism,IIEF-5 score is 21 and 19 respectively,the penis color doppler ultrasound scan still showed the change of arteriovenous fistula.Conclusion Superselective arterial embolization is effective in the treatment of HFP,and the recovery of sexual function is better after operation compared with watchful waiting.

Self-care of men with priapism and sickle cell disease / Autocuidado de hombres con priapismo y enfermedad falciforme / Autocuidado de homens com priapismo e doença falciforme

ABSTRACT 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.

RESUMEN Objetivo: Identificar las demandas sobre autocuidado de hombres con enfermedad falciforme y priapismo y describir las medidas del autocuidado a la luz de la Teoría de Orem. Método: Se trata de una investigación descriptiva, exploratoria, de abordaje cualitativo, realizada entre nueve hombres con historia clínica de enfermedad falciforme y priapismo. El análisis de los datos se llevó a cabo según la Teoría del Autocuidado de Orem. Resultados: se identificaron algunas demandas: del autocuidado universal: dificultad de interacción social y soledad, alteraciones de la autoimagen y autoestima y actividad sexual; del desarrollo: la experiencia con el priapismo y el conocimiento insuficiente sobre la fisiopatología de la enfermedad; sobre desviaciones de la salud: crisis de dolor. Conclusión: La teoría de Orem permitió identificar las demandas del autocuidado, esenciales para la atención de enfermería en hombres con priapismo y resaltó la importancia de la enfermería acerca de las medidas a ser tomadas en las diferentes demandas.

RESUMO Objetivo: Identificar as demandas de autocuidado de homens com doença falciforme e priapismo e descrever as medidas de autocuidado à luz da Teoria do Autocuidado de Orem. Método: Trata-se de uma pesquisa descritiva, exploratória, de abordagem qualitativa, com nove homens com história clínica de doença falciforme e priapismo. A análise dos dados foi realizada por meio da Teoria do Autocuidado de Orem. Resultados: Foram identificadas algumas demandas: de autocuidado universal - dificuldade de interação social e solidão, alterações na autoimagem e autoestima e atividade sexual; de desenvolvimento - a experiência com o priapismo o e pouco conhecimento sobre a fisiopatologia da doença; em relação a desvios de saúde - crises de dor. Conclusão: A teoria de Orem possibilitou identificar as demandas de autocuidado, que são essenciais para cuidado de enfermagem a homens com priapismo, e a importância da enfermagem frente às medidas para diferentes demandas apresentadas.

Combination of corpus cavernosum flushing and surgical shunt for low-flow priapism / 局解手术学杂志

Objective To evaluate the efficacy of corpus cavernosum flushing combined with surgical shunt in the treatment of low-flow priapism(LFP).Methods We retrospectively reviewed 10 cases of LFP patients who were diagnosed and treated in our hospital from August 2010 to March 2017.The ages were from 28 to 67 years old,with average ages 44.8 years old,and the duration of erectile pain was 19 to 264 hours,with mean time 58.3 hours.Both doppler ultrasonography and analysis of blood gas indicated LFP.Comprehensive strategies were car-ried out to treat these patients.Results One case with chronic granulocytic leukemia(CGL) gave up treatment and died of acute transforma-tion three months later.Successful detumescence was achieved by combination of cavernosal flushing and different operation procedures for all of the other 9 cases.The follow-up duration ranged from 6 months to 12 months,which exhibited 3 cases with partial erectile dysfunction(ED) and 2 cases with complete ED respectively.Conclusion With the combination of cavernosal flushing and surgical shunt procedures,penis detumescence was successfully achieved.Treatment strategies should be carried out immediately as soon as LFP was diagnosed.

Role of Penile Prosthesis in Priapism: A Review

Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.

Considerations on priapism / 中华男科学杂志

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.

Priapismo en la drepanocitosis. Diagnóstico y opciones terapéuticas / Priapism in sickle cell disease. Diagnosis and therapeutics options

El priapismo es una complicación de la anemia drepanocítica y se define como una erección prolongada, dolorosa y persistente del pene de más de 4 horas de duración sin estimulación sexual asociada. El 95 por ciento de las crisis de priapismo en estos pacientes es de tipo isquémico o de bajo flujo y constituyen una emergencia médica que, de no diagnosticarse y tratarse adecuadamente, provoca necrosis del tejido y disfunción eréctil. En este trabajo se revisan el diagnóstico y las opciones terapéuticas actuales y futuras de esta grave complicación(AU)

Priapism is a common complication of sickle cell disease and it is characterized by a prolonged, painful and persistent erection of the penis lasting more than 4 hours without associated sexual stimulation. The 95 percent of priapism crisis in these patients is ischemic type and represents a medical emergency that can provoke erectile tissue necrosis and erectile dysfunction if not treated properly. In this paper we reviewed the diagnosisand the current and perspectives therapeutic options of this severe complication(AU)

Daily use of phosphodiesterase type 5 inhibitors as prevention for recurrent priapism / Prevenção do priapismo recorrente com a utilização diária de inibidores da fosfodiesterase tipo 5

Summary Objective: The pathogenesis of recurrent priapism is currently being investigated based on the regulation of the phosphodiesterase 5 (PDE5) enzyme. We explored the daily use of PDE5 inhibitors to treat and prevent priapism recurrences. Method: We administered PDE5 inhibitors using a long-term therapeutic regimen in seven men with recurrent priapism, with a mean age of 29.2 years (range 21 to 35 years). Six men (85.7%) had idiopathic priapism recurrences and one man (24.3%) had sickle cell disease-associated priapism recurrences. Tadalafil 5 mg was administered daily. The mean follow-up was 6.6 months (range 3 to 12 months). Results: Daily long-term oral PDE5 inhibitor therapy alleviated priapism recurrences in all patients. Five (71.4%) had no episodes of priapism and two (28.6%) referred decrease in their episodes of priapism. All patients referred improvement in erectile function. Conclusion: These findings suggest the hypothesis that PDE5 dysregulation exerts a pathogenic role for both sickle cell disease-associated priapism and for idiopathic priapism, and that it offers a molecular target for the therapeutic management of priapism. These preliminary observations suggest that continuous long-term oral PDE5 inhibitor therapy may treat and prevent recurrent priapism.

Resumo Objetivo: Uma das teorias propostas para explicar a etiologia do priapismo recorrente está baseada no mecanismo de regulação da fosfodiesterase tipo 5. Estudamos o uso diário dos inibidores de fosfodiesterase tipo 5 no tratamento e na prevenção do priapismo recorrente. Método: Sete homens com diagnóstico de priapismo recorrente, com idade média de 29,5 anos (21 a 35 anos), utilizaram inibidor de fosfodiesterase tipo 5 em dose diária (tadalafila 5 mg/dia) por período prolongado. Seis homens (85,7%) apresentavam priapismo recorrente de etiologia idiopática, e um homem (24,3%), de etiologia associada à anemia falciforme. O seguimento médio foi de 6,6 meses (3 a 12 meses). Resultados: Todos os pacientes se beneficiaram com a utilização de inibidores de fosfodiesterase tipo 5. Cinco (71,4%) não apresentaram nenhum episódio de priapismo e dois (28,6%) relataram diminuição dos episódios. Todos os pacientes relataram melhora da função erétil. Conclusão: Estes achados sugerem que a hipótese do mecanismo de regulação da fosfodiesterase tipo 5 exerce papel importante na patogenia do priapismo recorrente. O uso contínuo e diário de inibidores da fosfodiesterase tipo 5 pode ser uma opção no tratamento do priapismo recorrente.

Diagnosis and Treatment of Low-flow Priapism (Report of 35 Cases) / 现代生物医学进展

Objective:To discuss the diagnostic approaches and treatment choices of low-flow priapism.Methods:35 cases of patients suffered from the low-flow priapism in our hospital from September 2010 to October 2016 were selected and diagnosed with the low-flow (ischemic) priapism by combining cavernous blood gas analysisand and color duplex ultrasonography.The priapism lasted 12 to 240 h with a mean of 72 h.31 patients of them had ever been induced by Polysaccharide Sulfate.One appeared priapism after sexual life.One appeared priapism after micturition.2 of them were not known what drug they had taken.Results:The symptoms disappeared in 5 cases as a result of using cold compress,sedation method and intracavemous lavage in hospital.But 30 cases were still priapism.Their penis were in a flaccid state after they were performed with the operation of glandular cavemosum shunting.During the 6-24 months of follow-up,31 patients developed erectile dysfunction.Among them,13 cases were light to mid erectile dysfunction,10 cases were mildly and 8 cases were the worst.Conclusion:(1) Using cavernous blood gas analysis and color duplex ultrasonography is important way to diagnose priapism.(2) Cold compress,sedation method and intracavemous lavage are the first treatments for the the low-flow priapism.If they are not the effectual cure,the operation of glandular cavemosum shunting should be performed in time.

Fisiopatología del priapismo en el paciente con anemia drepanocítica / Physiopathology of priapism in sickle cell anaemia patients

La anemia drepanocítica es una enfermedad con un alto índice de morbilidad que afecta la calidad de vida de los pacientes que la padecen. El priapismo es una complicación frecuente de la enfermedad y se define como una erección dolorosa, prolongada y persistente del pene de más de 4 horas de duración,sin estimulación sexual asociada. El 95 por ciento de las crisis de priapismo en el paciente con anemia drepanocítica son de tipo isquémico o de bajo flujo. En este trabajo se revisan los nuevos mecanismos moleculares que explican la patogenia del priapismo isquémico y que son la base de futuras posibles dianas terapéuticas para su tratamiento(AU)

Sickle cell anaemia (SCD) is a disorder with a high index of morbidity, affecting the quality of life of these patients. Priapism is a common complication of SCD and it is characterized by a prolonged and persistent erection of the penis lasting more than 4 hours without associated sexual stimulation. The 95 percent of priapism crisis in SCD patients are ischemic type. In this paper we review the new molecular mechanisms implicated in the pathogenesis of ischemic priapism and provide the basis for potential future therapies(AU)

Recurring priapism may be a symptom of voiding dysfunction – case report and literature review

ABSTRACT Recurring priapism is rare in pre-pubertal children and may be attributed to multiple causes. We propose that voiding dysfunction (VD) may also justify this symptom and detail a clinical case of recurring stuttering priapism associated to overactive bladder that completely resolved after usage of anticholinergics and urotherapy. Sacral parasympathetic activity is responsible for detrusor contraction and for spontaneous erections and a relationship between erections and bladder status has been proved in healthy subjects (morning erections) and models of medullar trauma. High bladder pressures and/or volumes, voiding incoordination and posterior urethritis can potentially trigger reflex erections.

The possible protective effects of dipyridamole on ischemic reperfusion injury of priapism

ABSTRACT Purpose To investigate the protective effects against ischemia reperfusion injury of dipyridamole in a model of induced priapism in rats. Materials and Methods Twenty-four male Sprague-Dawley rats were divided into four groups, control, P/R, P/R+DMSO and P/R+D. 3ml blood specimens were collected from vena cava inferior in order to determine serum MDA, IMA, TAS, TOS and OSI values, and penile tissue was taken for histopathological examination in control group. Priapism was induced in P/R group. After 1h, priapism was concluded and 30 min reperfusion was performed. In P/R+DMSO group 1ml/kg DMSO was administered intraperitoneally 30 min before reperfusion, while in P/R+D group 10mg/kg dipyridamole was administered intraperitoneally 30 min before reperfusion. Blood and penis specimens were collected after the end of 30 min reperfusion period. Sinusoidal area (µm2), tears in tunica albuginea and injury parameters in sinusoidal endothelium of penis were investigated. Results Histopathological examination revealed no significant changes in term of sinusoidal area. A decrease in tears was observed in P/R+D group compared to P/R group (p<0.05). Endothelial injury decreased in P/R+D group compared to P/R group (p>0.05). There were no significant differences in MDA and IMA values between groups. A significant increase in TOS and OSI values was observed in P/R+D group compared to P/R group. A significant decrease in TAS levels was observed in P/R+D group compared to the P/R group. Conclusions The administration of dipyridamole before reperfusion in ischemic priapism model has a potential protective effect against histopathological injury of the penis.

Does platelet activity play a role in the pathogenesis of idiopathic ischemic priapism?

ABSTRACT Purpose Mean platelet volume (MPV) is used to measure platelet size and is defined as a potential marker of platelet reactivity. Higher MPV levels have been defined as a risk factor for increased incidence of intravascular thrombosis and its associated diseases. We aimed to determine whether a relationship exists between the MPV and veno-occlusive component of idiopathic ischemic priapism (IIP). Materials and methods Between 2010 and 2014, 38 subjects were analyzed in two groups. One was composed of 15 patients with diagnosis as IIP in our institute, and the other contained 23 healthy control subjects. Complete blood count reports were retrospectively evaluated in both groups. MPV, platelet count (PLT), platelet distribution width (PDW), white blood cells (WBC), red blood cells (RBC), hemoglobin (Hb), reticulocyte distribution width (RDW) were measured in both groups. : Results The mean ages were similar in IIP patients (45.86±15.82) and control subjects (47.65±10.99). The mean MPV values of IIP patients were significantly higher than control subjects (p<0.05). In contrast, also PLT counts were significantly lower in IIP patients, compared to control subjects (p<0.05). The mean hemoglobin and WBC values were significantly lower in control group (p<0.05). There was no significant difference of RBC, PDW and RDW values in both groups. Conclusions We found that the MPV was significantly higher in IIP patients compared to control subjects. The high MPV levels may have contributed to the veno-occlusive etiopathogenesis of IIP disease. We strongly suggest further prospective studies to recommend the use of MPV in routine practice.

Clinical and preclinical treatment of urologic diseases with phosphodiesterase isoenzymes 5 inhibitors: An update / 亚洲男科学杂志(英文版)

Phosphodiesterase isoenzymes 5 inhibitors (PDE5-Is) are the first-line therapy for erectile dysfunction (ED). The constant discoveries of nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) cell-signaling pathway for smooth muscle (SM) control in other urogenital tracts (UGTs) make PDE5-Is promising pharmacologic agents against other benign urological diseases. This article reviews the literature and contains some previously unpublished data about characterizations and activities of PDE5 and its inhibitors in treating urological disorders. Scientific discoveries have improved our understanding of cell-signaling pathway in NO/cGMP-mediated SM relaxation in UGTs. Moreover, the clinical applications of PDE5-Is have been widely recognized. On-demand PDE5-Is are efficacious for most cases of ED, while daily-dosing and combination with testosterone are recommended for refractory cases. Soluble guanylate cyclase (sGC) stimulators also have promising role in the management of severe ED conditions. PDE5-Is are also the first rehabilitation strategy for postoperation or postradiotherapy ED for prostate cancer patients. PDE5-Is, especially combined with adrenoceptor antagonists, are very effective for benign prostatic hyperplasia (BPH) except on maximum urinary flow rate (Q max ) with tadalafil recently proved for BPH with/without ED. Furthermore, PDE5-Is are currently under various phases of clinical or preclinical researches with promising potential for other urinary and genital illnesses, such as priapism, premature ejaculation, urinary tract calculi, overactive bladder, Peyronie′s disease, and female sexual dysfunction. Inhibition of PDE5 is expected to be an effective strategy in treating benign urological diseases. However, further clinical studies and basic researches investigating mechanisms of PDE5-Is in disorders of UGTs are required.