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Pathophysiology and Treatment of Priapism

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Color Doppler US of the Penis

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

Priapism is defined as a persistent erection of the penis not accompanied by sexual desire or stimulation, usually lasting more than 6 h and typically involving only the corpora cavernosa and resulting in dorsal penile erection with the ventral penis and glans being flaccid (Keoghane et al. 2002). Rare exceptions with involvement of the corpus spongiosum and sparing of the cavernosal spaces have been reported (Tarry et al. 1987). This condition has many different causes and in some cases can be a urological emergency. The recently published American Urological Association Guideline on the management of priapism sheds further light on the management of this potentially emergent condition, but the guideline does not establish a fixed set of rules or define the legal standard of care for the treatment of priapism (Montague et al. 2003).

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References

  • Al Jam’a AH, Al Dabbous IA (1998) Hydroxyurea in the treatment of sickle cell associated priapism. J Urol 159:1642

    Article  Google Scholar 

  • Baba H, Maezawa Y, Furusawa N, et al. (1995) Lumbar spinal stenosis causing intermittent priapism. Paraplegia 33:338–345

    PubMed  CAS  Google Scholar 

  • Bastuba MD, Saenz de Tejada I, Dinlenc CZ et al (1994) Arterial priapism: diagnosis, treatment and long-term followup. J Urol 151:1231–1237

    PubMed  CAS  Google Scholar 

  • Berger R, Billups K, Brock G et al (2001) Report of the American Foundation for Urologic Disease (AFUD) Thought Leader Panel for evaluation and treatment of priapism. Int J Impot Res 13[Suppl 5]:S39–43

    PubMed  Google Scholar 

  • Bertholon F, Krajewski Y, el Allali A (1996) [Adverse effects: priapism caused by paroxetine]. Ann Med Psychol (Paris) 154:145–146; discussion 146–147

    CAS  Google Scholar 

  • Broderick GA, Gordon D, Hypolite J, Levin RM (1994) Anoxia and corporal smooth muscle dysfunction: a model for ischemic priapism. J Urol 151:259–262

    PubMed  CAS  Google Scholar 

  • Broderick GA, Harkaway R (1994) Pharmacologic erection: time-dependent changes in the corporal environment. Int J Impot Res 6:9–16

    PubMed  CAS  Google Scholar 

  • Burnett AL (2003) Pathophysiology of priapism: dysregulatory erection physiology thesis. J Urol 170:26–34

    Article  PubMed  Google Scholar 

  • Carter RG, Thomas CE, Tomskey GC (1976) Cavernospongiosum shunts in treatment of priapism. Urology 7:292–295

    Article  PubMed  CAS  Google Scholar 

  • Chan PT, Begin LR, Arnold D et al (1998) Priapism secondary to penile metastasis: a report of two cases and a review of the literature. J Surg Oncol 68:51–59

    Article  PubMed  CAS  Google Scholar 

  • Daley JT, Brown ML, Watkins T et al (1996a) Prostanoid production in rabbit corpus cavernosum: I. regulation by oxygen tension. J Urol 155:1482–1487

    Article  PubMed  CAS  Google Scholar 

  • Daley JT, Watkins MT, Brown ML et al (1996b) Prostanoid production in rabbit corpus cavernosum. II. Inhibition by oxidative stress. J Urol 156:1169–1173

    Article  PubMed  CAS  Google Scholar 

  • De Stefani S, Savoca G, Ciampalini S et al (2001) Urethrocutaneous fistula as a severe complication of treatment for priapism. BJU Int 88:642–643

    Article  PubMed  Google Scholar 

  • Dubin NN, Razack AH (2000) Priapism: ecstasy related? Urology 56:1057

    Article  Google Scholar 

  • Dutta JK (1992) Priapism in rabies. J Assoc Physicians India 40:555

    PubMed  CAS  Google Scholar 

  • Dutta JK (1994) Rabies presenting with priapism. J Assoc Physicians India 42:430

    PubMed  CAS  Google Scholar 

  • Ebbehoj J (1974) A new operation for priapism. Scand J Plast Reconst Surg 8:241–245

    Article  CAS  Google Scholar 

  • Eland IA, van der Lei J, Stricker BH, Sturkenboom MJ (2001) Incidence of priapism in the general population. Urology 57:970–972

    Article  PubMed  CAS  Google Scholar 

  • Emond AM, Holman R, Hayes RJ, Serjeant GR (1980) Priapism and impotence in homozygous sickle cell disease. Arch Intern Med 140:1434–1437

    Article  PubMed  CAS  Google Scholar 

  • Ercole CJ, Pontes JE, Pierce JM Jr (1981) Changing surgical concepts in the treatment of priapism. J Urol 125:210–211

    PubMed  CAS  Google Scholar 

  • Ewalt D, Cavender J, Buchanan G, Rogers Z (1996a) Characterization and incidence of priapism in boys with sickle cell anaemia. Paediatrics 88:643

    Google Scholar 

  • Ewalt D, Cavender J, Buchanan G, Rogers Z (1996b) Leuprolide therapy prevents recurrent priapism in teenage boys with sickle cell anaemia. Paediatrics 88:610

    Google Scholar 

  • Foda MM, Mahmood K, Rasuli P et al (1996) High-flow priapism associated with Fabry’s disease in a child: a case report and review of the literature. Urology 48:949–952

    Article  PubMed  CAS  Google Scholar 

  • Friedman J (1998) Priapism: an unusual presentation of appendicitis. Pediatr Emerg Care 14:143–144

    Article  PubMed  CAS  Google Scholar 

  • Jiva T, Anwer S (1994) Priapism associated with chronic cocaine abuse. Arch Intern Med 154:1770

    Article  PubMed  CAS  Google Scholar 

  • Junemann K, Alken P (1989) Pharmacotherapy of erectile function: a review. Int J Impot Res 1:71–93

    Google Scholar 

  • Keoghane SR, Sullivan ME, Miller MA (2002) The aetiology, pathogenesis and management of priapism. BJU Int 90:149–154

    Article  PubMed  CAS  Google Scholar 

  • Kim N, Vardi Y, Padma-Nathan H et al (1993) Oxygen tension regulates the nitric oxide pathway. Physiological role in penile erection. J Clin Invest 91:437–442

    PubMed  CAS  Google Scholar 

  • Krco MJ, Jacobs SC, Lawson RK (1984) Priapism due to solid malignancy. Urology 23:264–266

    Article  PubMed  CAS  Google Scholar 

  • Linet OI, Ogrinc FG (1996) Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group. N Engl J Med 334:873–877

    Article  PubMed  CAS  Google Scholar 

  • Lowe FC, Jarow JP (1993) Placebo-controlled study of oral terbutaline and pseudoephedrine in management of prostaglandin E1-induced prolonged erections. Urology 42:51–53; discussion 53–54

    Article  PubMed  CAS  Google Scholar 

  • Lue TF, Hellstrom WJ, McAninch JW, Tanagho EA (1986) Priapism: a refined approach to diagnosis and treatment. J Urol 136:104–108

    PubMed  CAS  Google Scholar 

  • Mantadakis E, Cavender JD, Rogers ZR et al (1999) Prevalence of priapism in children and adolescents with sickle cell anemia. J Pediatr Hematol Oncol 21:518–522

    Article  PubMed  CAS  Google Scholar 

  • Martinez Portillo F, Hoang-Boehm J, Weiss J et al (2001) Methylene blue as a successful treatment alternative for pharmacologically induced priapism. Eur Urol 39:20–23

    Article  PubMed  CAS  Google Scholar 

  • Miller ST, Rao SP, Dunn EK, Glassberg KI (1995) Priapism in children with sickle cell disease. J Urol 154:844–847

    Article  PubMed  CAS  Google Scholar 

  • Montague DK, Jarow J, Broderick GA et al (2003) American Urological Association guideline on the management of priapism. J Urol 170:1318–1324

    Article  PubMed  Google Scholar 

  • Mulhall JP, Honig SC (1996) Priapism: etiology and management. Acad Emerg Med 3:810–816

    PubMed  CAS  Google Scholar 

  • Nieminen P, Tammala T (1995) Aetiology of priapism in 207 patients. Eur Urol 28:241–245

    PubMed  Google Scholar 

  • O’Brien WM, O’Connor KP, Lynch JH (1989) Priapism: current concepts. Ann Emerg Med 18:980–983

    Article  CAS  Google Scholar 

  • Pohl J, Pott B, Kleinhans G (1986) Priapism: a three-phase concept of management according to aetiology and prognosis. Br J Urol 58:113–118

    Article  PubMed  CAS  Google Scholar 

  • Porst H (1996) The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. J Urol 155:802–815

    Article  PubMed  CAS  Google Scholar 

  • Pryor J, Akkus E, Alter G et al (2004) Priapism. J Sex Med 1:116–120

    Article  PubMed  Google Scholar 

  • Quigley M, Fawcett DP (1999) Thrombophilia and priapism. BJU Int 83:155

    Article  PubMed  CAS  Google Scholar 

  • Ricciardi R, Jr., Bhatt GM, Cynamon J et al (1993) Delayed high flow priapism: pathophysiology and management. J Urol 149:119–121

    PubMed  Google Scholar 

  • Routledge PA, Shetty HG, White JP, Collins P (1998) Case studies in therapeutics: warfarin resistance and inefficacy in a man with recurrent thromboembolism, and anticoagulant-associated priapism. Br J Clin Pharmacol 46:343–346

    Article  PubMed  CAS  Google Scholar 

  • Rutchik S, Sorbera T, Rayford RW, Sullivan J (2001) Successful treatment of recalcitrant priapism using intercorporeal injection of tissue plasminogen activator. J Urol 166:628

    Article  PubMed  CAS  Google Scholar 

  • Schroeder-Printzen I, Vosshenrich R, Weidner W, Ringert RH (1994) Malignant priapism in a patient with metastatic prostate adenocarcinoma. Urol Int 52:52–54

    Article  PubMed  CAS  Google Scholar 

  • Serjeant GR, de Ceulaer K, Maude GH (1985) Stilboestrol and stuttering priapism in homozygous sickle-cell disease. Lancet 2:1274–1276

    Article  PubMed  CAS  Google Scholar 

  • Spycher MA, Hauri D (1986) The ultrastructure of the erectile tissue in priapism. J Urol 135:142–147

    PubMed  CAS  Google Scholar 

  • Steers WD, Selby JB, Jr (1991) Use of methylene blue and selective embolization of the pudendal artery for high flow priapism refractory to medical and surgical treatments. J Urol 146:1361–1363

    PubMed  CAS  Google Scholar 

  • Tarry WF, Duckett JW Jr, Snyder HM 3rd (1987) Urological complications of sickle cell disease in a pediatric population. J Urol 138:592–594

    PubMed  CAS  Google Scholar 

  • Vilke GM, Harrigan RA, Ufberg JW, Chan TC (2004) Emergency evaluation and treatment of priapism. J Emerg Med 26:325–329

    Article  PubMed  Google Scholar 

  • Virag R, Bachir D, Lee K, Galacteros F (1996) Preventive treatment of priapism in sickle cell disease with oral and self-administered intracavernous injection of etilefrine. Urology 47:777–781; discussion 781

    Article  PubMed  CAS  Google Scholar 

  • Winter CC (1978) Priapism cured by creation of fistulas between glans penis and corpora cavernosa. J Urol 119:227–228

    PubMed  CAS  Google Scholar 

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Liguori, G., Bucci, S., Benvenuto, S., Trombetta, C., Belgrano, E. (2008). Pathophysiology and Treatment of Priapism. In: Bertolotto, M. (eds) Color Doppler US of the Penis. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-36677-5_9

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  • DOI: https://doi.org/10.1007/978-3-540-36677-5_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-36676-8

  • Online ISBN: 978-3-540-36677-5

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