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.

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)

Penile prosthesis implantation for treatment of postpriapism erectile dysfunction

Our aim to evaluate the procedure and outcome of penile prosthesis surgery in the treatment of men with postpriapism erectile dysfunction. During the period between 1997 and 2004, a total of 17 patients with postpriapism erectile dysfunction underwent penile prosthesis implantation at our institution. Prosthesis implantation was done electively 6 to 18 months after priapism, when the patients presented with erectile dysfunction. Of the prosthesis implanted, 11 were malleable, 4 were 2-piece, and 2 were 3-piece prostheses [AMS, Minnetonka, Minnesota, USA]. All the 17 patients were successfully implanted with penile prosthesis, which led to urethral injury in 2 patients. There were no major postoperative complications. The median hospital stay was 5 days. The follow-up period ranged from 2 to 9 years [median, 6 years]. All the patients were satisfied with the prosthesis. Penile prosthesis implantation is the modality of treatment for patients with postpriapism erectile dysfunction at our institution. It has a high patient satisfaction rate. Although procedure-related complications are common due to corporeal fibrosis, they wre mostly minor ones and did not affect the outcome of the procedure

Outcome of Priapism after early and late management

To assess the outcome of patients presenting with priapism during the last six years. Record of the patients presenting with priapism was evaluated retrospectively. Following parameters were assessed; etiology, duration, management, complications and final outcome. Fifteen patients with mean age of twenty seven years presented from Jan 2000 to Dec. 2006. Etiological factors were intracavernosal injection of papavarine 6 [40%]. hakeem medication 4 [26.7%], thalasemia 2 [13.3%] and idiopathic in 3[20%] patients. Mean duration of priapism was 80.8 hours. Initial conservative management was successful in 7 [46.7%] patients. Non responders were treated with distal cavernosospongiousus shunt. Out of eight, three [37.5%] patients responded and remaining four ended up with corporeal fibrosis and erectile dysfunction[ED]. One patient develop urethrocutaneous fistula. Intracavernosal injection of papaverine and hakeem medicines are common etiological factors. Patient usually present late because of embarrassment. Outcome of management depends upon duration of priapism

Priapismo: enfoque actual y manejo / Priapism: current approach and management

El priapismo es una erección anormal y persistente del pene, dolorosa e involuntaria, sin relación con estímulos sexuales y que no se alivia con la descarga de catecolaminas después del orgasmo. Según su mecanismo fisiopatológico se reconoce un priapismo isquémico o de bajo flujo y uno no isquémico o de alto flujo. Es muy importante diferenciarlos, ya que tienen causas y tratamientos distintos. El priapismo isquémico es una urgencia que debe ser resuelta a la brevedad. Su tratamiento debe ser secuencial, siguiendo un algoritmo y tratando de evitar acciones que aumenten el riesgo de una disfunción eréctil iatrogénica posterior. El priapismo de alto flujo no es una urgencia médica, por lo que su manejo inicial debe ser expectante. A pesar de ser poco frecuente, el priapismo debe ser conocido por el mÚdico general, quien debe ser capaz de diferenciar los casos isquémicos de los no isquémicos y de tratarlos de manera de evitar secuelas y disfunciones sexuales posteriores. Se propone un algoritmo de acuerdo a las recomendaciones de la Asociación Americana de Urología. En él se establecen las medidas a tomar en un orden secuencial que va aumentando en complejidad y el empleo de procedimientos invasivos.

Priapismo asociado a leucemia mieloide crónica: un caso clínico / Priapism in a patient with chronic myeloid leukemia: a clinical case

Priapism is a rare complication of hematological diseases. Among leukemia, it is most frequently seen in patients with chronic myeloid leukemia, due to the high leukocyte counts that these patients achieve. We report a 22 years old male who presented with a priapism lasting more than 24 hours. Thirty six hours after admission and subsequent to a leukopheresis, penile relaxation was obtained. Despite good hematological response to therapy, an extensive penile and uretral necrosis, associated to an Acinetobacter infection, ensued between the fourth and fifth day of admission, that required surgical treatment

Impotência e auto-injeçao de drogas vasoativas / Impotence and self-injection therapy with vasoactive drugs

Num período de cinco anos, foram estudados 331 pacientes impotentes, de etiologia desconhecida, submetidos a auto-injeção de drogas vasoativas. A solução utilizada foi associação da prostaglandina E, fentolamina e papaverina. O índice de sucesso foi de 98,7 por cento, representado pela obtenção de ereção plena, promovendo uma vida sexual satisfatória tanto para o paciente quanto para sua companheira. As complicações do tratamento foram bastante discretas, representadas por priapismo em 14 pacientes (4,28 por cento), porém correspondendo a apenas 0,04 por cento do total de aplicações realizadas durante o seguimento mediano de 29 meses. Não houve nenhum caso de fibrose dos corpos cavernosos. O índice de cura, ou seja, o retorno à atividade sexual sem qualquer forma de tratamento foi de 11,92 por cento. Noventa e oito pacientes (29,96 por cento) abandonaram o tratamento. Curiosamente, dos 98 pacientes que interromperam o tratamento por insucesso ou abandono, apenas dois (2,04 por cento) optaram por um outro tipo de tratamento, submetendo-se a implante de prótese peniana. A auto-injeção de drogas vasoativas apresenta alto índice de sucesso no tratamento da impotência de qualquer etiologia, com grande segurança e baixo índice de complicações

Tratamiento quirúrgico del priapismo / Surgical treatment of priapism

Se analizan los resultados del tratamiento quirúrgico en 29 pacientes portadores de priapismo. La técnica quirúrgica más empleada fué la anastomosis safeno-cavernosa, seguida de la anastomosis caverno-esponjosa y del shunt glande-cavernoso. No hubo complicaciones quirúrgicas con ninguno de los procedimientos empleados. La evolución alejada demuestra una tasa de impotencia cercana al 50%, todos los pacientes con duración promedio del priapismo mayor a 48 horas