Diagnosis and treatment of priapism (report of 10 cases) / 中华泌尿外科杂志

ABSTRACT

Objective To ascertain the causes of priapism and to differentiate between the ischemic low-flow type and nonischemic high-flow type so as to improve the clinicians' ability for emergency treatment of priapism. Methods Ten cases of priapism were included.Their mean age was 41 years (range,22～64 years).The priapism lasted 8 to 212 h with a mean of 21.2 h.Of them 1 case had received prostaglandin E,papaverine and phentolamine injection into cavernous body of penis,which led to ED;1 had priapism when experiencing sexual intercourse after taking sildenafil;1 had primary sarcoma of the penis;1 had transitional cell carcinoma of bladder, which metastasized to the penis;1 had leukemia; 2 had traumatic history;and 3 had unknown causes.The types,causes,treatment and outcomes of priapism were analyzed. Results Of the 10 cases,8 were of ischemic low-flow type and 2 of nonischemic high-flow type. In the 8 cases of ischemic low-flow type priapism, 4 achieved detumescence after receiving metaraminol injection (2～8 mg) at the root of cavernous body,and perfusion of haparinized saline at glans and root of cavernous body of the penis by contrecoup if necessary (1 had ED).One case undergoing glandular-cavernosal shunting achieved detumescence with preservation of erectile function.One case with leukemia was cured after chemotherapy.One case suffered from penile sarcoma and the rest 1 from metastasis of transitional cell carcinoma; the prognoses of both were unfavorable.Of the 2 cases of high-flow type,1 achieved detumescence after selective embolization of internal pudendal artery;the other was discharged after conservative treatment,but experienced ED. Conclusions Blood gas analysis of cavernosal blood,color Doppler ultrasound,and internal pudendal arteriography are useful in differentiating the types of priapism.If conservative treatment fails to achieve detumescence of the penis,surgical treatment should be performed immediately for both types of priapism.