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)

Partial Priapism Treated with Pentoxifylline

ABSTRACTMain findings:A 26-year-old man suffering from partial priapism was successfully treated with a regimen including pentoxifylline, a nonspecific phosphodiesterase inhibitor that is often used to conservatively treat Peyronie's disease.Case hypothesis:Partial priapism is an extremely rare urological condition that is characterized by thrombosis within the proximal segment of a single corpus cavernosum. There have only been 36 reported cases to date. Although several factors have been associated with this unusual disorder, such as trauma or bicycle riding, the etiology is still not completely understood. Treatment is usually conservative and consists of a non-steroidal anti-inflammatory and anti-thrombotic.Promising future implications:This case report supports the utilization of pentoxifylline in patients with partial priapism due to its anti-fibrogenic and anti-thrombotic properties.

Anestesia y priapismo / Anesthesia and priapism

Priapismo se define como la erección persistente del pene que no está asociado con la estimulación o deseo sexual. Su ocurrencia en el intraoperatorio durante anestesia general o neuroaxial (espinal, epidural) es poco frecuente, sin embargo, éste puede provocar complicaciones, como sangrado excesivo o trauma uretral, demoras, e incluso la cancelación del procedimiento quirúrgico. La literatura existente con respecto a este tema es escasa y en muchos casos contradictoria, sobre todo cuando se trata de definir la técnica anestésica (general o neuroaxial) responsable o capaz de resolver el caso. En la siguiente revisión analizaremos los agente farmacológicos y no farmacológicos, junto con las técnicas anestésicas capaces de producir y resolver el priapismo intraoperatorio.

Priapism is defined as a persistent penile erection that is not associated with stimulation or sexual desire. Its occurrence during general or neuraxial anesthesia (spinal, epidural) is rare, however, it can cause complications such as excessive bleeding or urethral trauma, delays and even cancellation of the surgical procedure. The literature on this subject is scarce and contradictory in many cases, especially when it comes to defining the anesthetic technique (general or neuraxial) responsible or able to resolve the case. The following review will discuss the pharmacological and non-pharmacological agents, along with anesthetic techniques capable of producing and resolve intraoperative priapism.

Finasteride for recurrent priapism in children and adolescents: a report on 5 cases

PURPOSE: Recurrent priapism is prevalent in children. Different medications have been used to avoid new episodes, however, there is no consensus regarding the best option. The use of finasteride to treat priapism in adults has already been tested. The aim of the present study was to test the hypothesis that a low dose of finasteride would be effective in preventing recurrent priapism in children. MATERIALS AND METHODS: Since 2007, five children and adolescents with recurrent episodes of priapism have been treated with finasteride in our department, and the medical records of these patients were reviewed for this study. In four cases, the dose used was 1 mg a day, while the remaining patient used 1 mg twice a day. RESULTS: Prior to initiating finasteride treatment, one patient reported having had 6 episodes of acute priapism, while the remaining patients had more than 10 episodes. One of the patients reported having stuttering priapism almost daily. With a mean follow-up of 20 months, four patients had no episodes and only one patient complained of sporadic and shorter duration episodes. CONCLUSIONS: These initial results suggest that a low daily dose of finasteride appears to represent an effective and safe form of treatment for recurrent priapism in children and adolescents with SCD. However, in order to confirm these initial findings, studies with a large population and a control group are essential.

Citalopram induced priapism-the hard fact

Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and is unable to drain. This condition appears to affect only the corpora cavernosa, while the corpora spongiosum of the glans penis and surrounding urethra remain flaccid. Priapism may be a urologic emergency that is associated with the development of irreversible erectile function problems. Therefore, immediate and aggressive management may be necessary. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction Citalopram is a relatively new selective serotonin reuptake inhibitor [SSRI] that is becoming widely administered for the treatment of depression. Selective serotonin reuptake inhibitors generally are associated with mild adverse sexual side effects; however, more serious reactions may occur. Although selective serotonin reuptake inhibitors [SSRIs] can induce sexual side effects, such as diminished libido, delayed orgasm, anorgasmia, ejaculatory disturbances, and erectile dysfunction, priapism occurs rarely [1]. We present a case report of 45 years old gentleman who presented in A and E of Gloucester Royal Infirmary, Gloucestershire UK, with priapism of 4 days' duration

Successful management of stuttering priapism using home self-injections of the alpha-agonist metaraminol

Low-flow priapism can result in impotence if treatment is delayed, yet patients with recurrent priapism often suffer delay before therapy. We describe management of recurrent priapism using self-administered injections of intracavernosal metaraminol (AramineÖ, Merck), a long-acting vasoconstricting amine that is considered safer than epinephrine. The patient injects as often as once daily using 5-10 mg of drug. Our patient reports rapid detumescence and has not required emergency room visits since starting injections. He denies complications. Treatment of priapism using metaraminol has been suggested in the hospital setting; however, this is the first report of successful home self-administration of the drug.

Urgências em hematologia / Hematological emergencies

Seräo abordados nesta revisäo apenas alguns dos quadros hematológicos com os quais o clínico se depara mais comumente em uma sala de urgência, como as crises vaso-oclusivas dos pacientes com doenças falciformes, a coagulaçäo intravascular disseminada e a febre no paciente neutropênico

Frecuencia, manejo y evolucion del priapismo en pacientes que acuden al Hospital "Dr. Francisco Moscoso Puello" / Frecuency, management and progression of priapism in patients at Hospital Dr. Francisco Moscoso Puello

Con el objetivo de conocer menejo, evolucion y frecuencia de los esquemas de tratamientos en pacientes con priapismo previamente diagnosticado en el Hospital Francisco Moscoso Puello revisamos 14 casos durante el 1983-1988; encontrandonos que el 78 por ciento asistio al hospital antes de las 72 horas de iniciado el cuadro, usandose tratamiento medico al 92.8 por ciento y persistiendo el 100 por ciento . Se aplico tratamiento quirurgico al 92.8 por ciento (tecnica Chester-Winter) presentado resolucion del cuadro 53.8 por ciento y cursando con persistencia 46.2 por ciento y de estos 23 por ciento sufrio impotencia sexual. Se concluye senalando que el tratamiento medico usado es inefectivo por lo que recomendamos ensayar medidas alternativas como el uso de neostigmina, ketamina y diazepan

Fenilefrina: su utilidad en la erección prolongada / Phenylephrine: its utility in prolonged erections

En 42 pacientes hemos tratado erecciones prolongadas, de diversas etiologías, mediante la utilización de 1 ml. de Fenilefrina al 0.01 por ciento inyectado en forma intracaversona. Se obtuvo detumescencia completa en todos los pacientes. No hemos observado complicaciones, o alteraciones cardiovasculares como se observa con la utilización de otras drogas simpaticomiméticas. Consediremas a esta droga como el tratamiento de primera línea para enfrentar esta afección, debido a su eficacia, a su rapidez de acción, y a su ausencia de efectos colaterales

Tratamiento de la erección prolongada secundaria a inyección intracavernosa de medicamentos / Treatment of the prolonged erection induced by an intracavernous drug injection

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.

Erección peneana sostenida y raquinestesia: detumescencia por inyección intracavernosa de etilefrina / Prolonged penile erection and rachianesthesia: detumescence by intracavernous etilefrine inyection

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