ABSTRACT
PURPOSE: Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism. MATERIALS AND METHODS: This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention. RESULTS: Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases. CONCLUSIONS: The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects.
Subject(s)
Humans , Male , Middle Aged , Alprostadil/adverse effects , Drug Evaluation/methods , Penile Erection , Penile Induration/diagnostic imaging , Phenylephrine/therapeutic use , Pilot Projects , Priapism/chemically induced , Retrospective Studies , Ultrasonography, Doppler, Duplex/adverse effects , Vasoconstrictor Agents/therapeutic use , Vasodilator Agents/adverse effectsABSTRACT
Background: The use of drugs with α-adrenergic antagonistic effect is one of the most prominent etiologies of priapism. We report a 32-year-old schizophrenic male in treatment with risperidone who consulted in the emergency room for a painful priapism. A low flow priapism was diagnosed. Medical treatment was unsuccessful and the patient was subjected to a proximal corporo-spongiosal shunt (Quackels technique), with good results. The patient was discharged in good conditions.
Subject(s)
Adult , Humans , Male , Antipsychotic Agents/adverse effects , Priapism/chemically induced , Risperidone/adverse effects , Penile Erection/drug effects , Priapism/therapyABSTRACT
La erección prolongada es la principal complicación de la inyección intracavernosa de papaverina y/o phentolamina. En 1700 inyecciones tuvimos esta complicación en un 3,06%(52/1700). Cuando se usa papaverina mezclada con Phentolamina sube a 19%. Se tratan a las 6 horas con medicamentos simpaticomiméticos con excelente rendimiento. 5 de ellas se trataron con Ketamina 30 mg en IIC con resultados espectaculares y sin complicaciones secundarias.
Subject(s)
Adult , Middle Aged , Humans , Male , Papaverine/adverse effects , Priapism/drug therapy , Erectile Dysfunction/complications , Priapism/chemically inducedABSTRACT
Se presentan 11 enfermos con erección peneana sostenida por raquianestesia con 20 mg de bupivacaine, que fueron tratados con 10 mg de etilefrina inyectados por vía intracavernosa. En 10 casos se obtuvo detumescencia total y un paciente en forma parcial. No se registraron complicaciones, solo un leve hematoma en el sitio de la inyección en 1 enfermo. Todos presentaron hipertensión arterial fácilmente controlable. Se analiza el mecanismo de la erección y la bibliografía