Priapism: Current Updates in Clinical Management

송필현,문기학 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.12

Priapism is a persistent penile erection that continues for hours beyond, or is unrelated to, sexual stimulation. Priapism requires a prompt evaluation and usually requires an emergency management. There are two types of priapism: 1) ischemic (veno-occlusive or low-flow), which is found in 95% of cases, and 2) nonischemic (arterial or high-flow). Stuttering (intermittent or recurrent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must decide whether the priapism is ischemic or nonischemic. In the management of an ischemic priapism, resolution should be achieved as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic agents is the next step. Surgical shunts should be performed in cases involving failure of nonsurgical treatment. The first management of a nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in cases that request treatment. The goal of management for stuttering priapism is prevention of future episodes. This article provides a review of recent clinical developments in the medical and surgical management of priapism and an investigation of scientific research activity in this rapidly developing field of study.

Clinical Management of Priapism: A Review

Kazuyoshi Shigehara,Mikio Namiki 대한남성과학회 2016 The World Journal of Men's Health Vol.34 No.1

Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. Based on episode history and pathophysiology, priapism is classified into three subtypes: ischemic (low-flow), non-ischemic (high-flow), and stuttering priapism. Ischemic priapism is characterized by a persistent, painful erection with remarkable rigidity of the corpora cavernosa caused by a disorder of venous blood outflow from this tissue mass, and is similar to penile compartment syndrome. Stuttering priapism is characterized by a self-limited, recurrent, and intermittent erection, frequently occurring in patients with sickle cell disease. Non-ischemic priapism is characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. Because ischemic and non-ischemic priapism differ based on emergency status and treatment options, appropriate discrimination of each type of priapism is required to initiate adequate clinical management. The goal of management of priapism is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.

Chlorpromazine으로 유발된 음경지속발기증 1례

신유호,윤도준,이충현,송지영,이상철 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.3

저자들은 항정신병약물 chlorpromazine 치료 중에 음경지속발기증이 발생하여 수술까지 시행하여 회복된 환자 1례를 체험하였기에 문헌고찰과 함께 보고하였다. 항우울제 trazodone과 함께 chlorpromazine, thioridazine과 같은 항정신병약물이 음경지속발기증의 원인과 관련이 있는 것으로 알려지고 있다. 이러한 약물에 의해 유발되는 음경지속발기증의 기전에 대해서는 알파-아드레날린 차단으로 인한다는 설이 많은 지지를 받고 있다. 치료는 보존적인 치료와 외과적인 치료가 있으며, 외과적인 치료로는 음경해면체 천자와 흡입 세척술 그리고 분로를 만들어 주는 방법들이 있다. 음경지속발기증은 신속한 진단과 치료를 하지 않을 경우 영구적인 발기불능을 초래할 수도 있는 부작용이므로 향정신약물 투여시 이에 대한 관심과 주의를 가져야 할 것이다. Antipsychotic drugs can induce several sexual side effects. Priapism, one of the side effects, is defined as "the persistent abnormal erection of the penis, which usually occurs without sexual desire". There has been an increasing number of reports recently linking the etiology of priapism with psychotropic medication. The drugs known to be associated with priapism are psychotropic drugs such as trazodone, chlorpromazine, thioridazine as well as antihypertensives, anticoagulants and so on. The mechanism of a drug which induces priapism is proposed to be mediated by its alpha-adrenergic blocking effect. Prompt diagnosis and treatment are essential. Priapism is a severe side effect, which can lead to impotence if prompt diagnosis and treatment are not carried out. There are medical and surgical treatments for priapism. The surgical treatments usually involve aspiration, irrigation and the creation of shunt. We report a case of priapism which developed after two years of chlorpromazine treatment. He is a 20-year-old man with schizophrenia. He experienced two times of brief episode of prolonged penile erection before developing intractable priapism. He was treated by shunt operation which showed satisfactory relief of priapism. It seemed by this case that duration and dosage of chlorpromazine were not closely related with priapism. Psychiatrist is needed to give attention to the priapism as one of sexual side effects due to antipsychotics though it is not common.

재발성 음경지속발기증 1례

박성환,백선호,한수련,안영민,안세영,이병철,Park, Sung-Hwan,Paik, Sun-Ho,Han, Su-Ryun,Ahn, Young-Min,Ahn, Se-Young,Lee, Byung-Cheol 대한한방내과학회 2011 大韓韓方內科學會誌 Vol.32 No.1

Priapism is a persistent penile erection that continues for more than 4 hours beyond, or is unrelated to, sexual stimulation. Because priapism is a medical emergency, all patients with priapism should be evaluated and treated urgently. Subtypes of priapism are ischemic, non-ischemic and stuttering priapism. Stuttering type is a recurrent form of ischemic priapism in which unwanted painful erections occur repeatedly with intervening periods of detumescence. The etiology of this type is often idiopathic and the treatments are still not clearly established. We present one case of stuttering priapism which occurred after suppression of his sexual desire. A 23-year-old man visited our clinic complaining of recurrent pain and erections persisting for about 5 weeks. We performed evaluation and confirmed the diagnosis of Rigid swollen penis. Jibaekjihwang-tang gamibang (ZhiBaiDihuang-Tang Jiaweifang) was administerd to the patient for 9 days. After the treatment, duration of erections and pain showed remarkable improvements. This will be recorded as the first case report of treating priapism with a Korean medical approach and suggests that Korean medicine therapy can be efficient to treat priapism.

수면 중 발생한 재발성 음경지속발기증

송현동,조인래,이안구,조성용 대한남성과학회 2009 The World Journal of Men's Health Vol.27 No.1

Priapism is an abnormal persistent penile erection that continues for more than 4 hours, without sexual stimulation according to the definition of the AUA (American Urological Association) guideline on the management of priapism. It was relatively rare in the past but has been increasing in the incidence since the advent of pharmacological agents. Stuttering priapism is a recurrent form of ischemic priapism and its treatment goal is to prevent the recurrences of priapism and resultant erectile dysfunction. We present the case of a patient who took tadalafil and thereafter had idiopathic recurrent episodes of ischemic priapism during the sleep and we show several treatment options of stuttering priapism with review of recent related articles.

Transient Distal Penile Corporoglanular Shunt as an Adjunct to Aspiration and Irrigation Procedures in the Treatment of Early Ischemic Priapism

Onder Canguven,Cihangir Çetinel,Rahim Horuz,Fatih Tarhan,Bilal Hamarat,Cemal Goktas 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.6

Purpose: Ischemic priapism, a compartment syndrome, requires urgent treatment in order to nourish the corpora cavernosa. As the first step, aspiration of blood and irrigation of the cavernosal bodies is performed to prevent fibrotic activity and secure erectile capability. During aspiration, there are risks of cardiovascular side effects of adrenergic agonists. We aimed to evaluate a transient distal penile corporoglanular shunt technique in place of aspiration and irrigation techniques for treatment of early ischemic priapism. Materials and Methods: A transient distal penile shunt was applied to 15 patients with early ischemic priapism between January 2011 and May 2012. Priapism duration, history,causes, pain, and any prior management of priapism were assessed in all patients. A complete blood count and penile Doppler ultrasonography were performed, which showed attenuated blood flow in the cavernosal artery. A sterile closed system blood collection set, which has two needles and tubing, was used for the transient distal penile shunt. Results: Ten of 15 patients with early ischemic priapism were successfully treated with this transient shunt technique. No additional procedures were needed after the resolution of rigidity in the 10 successfully treated patients. Conclusions: The transient nature of this technique is an advantage over aspiration and irrigation in the treatment of early ischemic priapism. Our results indicate that the technique can be offered for patients with an ischemic priapism episode of no more than 7 hours.

타다라필 복용 후 발생한 음경지속발기증 1례

배장호,현창호,송필현,김현태,신홍석,문기학 대한남성과학회 2009 The World Journal of Men's Health Vol.27 No.1

We report here on a case of priapism that was associated with the use of tadalafil. A 41 year-old-man visited our urology outpatient department with a relapsed erection he’d experienced for 3 days. He had no contributing factors for the priapism. He had taken tadalafil, which was prescribed at a local medical center 3 days previously. After the development of priapism, he first visited the emergency department of other hospital. Aspiration was done and then the priapism was resolved. Yet the priapism recurred 2 days later, andaspiration and other bedside management failed to resolve it. After his arrival to our department, we immediately performed a caverno-glandular shunt with 18-gauge needle and we observed bright reddish-color blood. An intracorporal ephedrine injection and saline irrigation were then done. After that, the patient gradually experienced detumescence. The priapism did not recur during the 2 days of the hospitalization period. At the outpatient follow-up of 3 months later, patient almost recovered to his full erectile function and he had normal sexual activity.

Prophylactic Phenylephrine for Iatrogenic Priapism: A Pilot Study With Peyronie's Patients

Pengbo Jiang,Athena Christakos,Mina Fam,Hossein Sadeghi-Nejad 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.10

Purpose: Although penile duplex Doppler ultrasonography (PDDU) is a common andintegral procedure in a Peyronie’s disease workup, the intracavernosal injection of vasoactiveagents can carry a serious risk of priapism. Risk factors include young age, goodbaseline erectile function, and no coronary artery disease. In addition, patients withPeyronie’s disease undergoing PDDU in an outpatient setting are at increased risk giventhe inability to predict optimal dosing. The present study was conducted to providesupport for a standard protocol of early administration of phenylephrine in patientswith a sustained erection after diagnostic intracavernosal injection of vasoactiveagents to prevent the deleterious effects of iatrogenic priapism. Materials and Methods: This was a retrospective review of Peyronie’s disease patientswho received phenylephrine reversal after intracavernosal alprostadil (prostaglandinE1) administration to look at the priapism rate. Safety was determined on the basisof adverse events reported by subjects and efficacy was determined on the basis of therate of priapism following intervention. Results: Patients with Peyronie’s disease only had better hemodynamic values onPDDU than did patients with Peyronie’s disease and erectile dysfunction. All of thepatients receiving prophylactic phenylephrine had complete detumescence of erectionswithout adverse events, including no priapism cases. Conclusions: The reversal of erections with phenylephrine after intracavernosal injectionsof alprostadil to prevent iatrogenic priapism can be effective without increasedadverse effects.

Role of Penile Prosthesis in Priapism: A Review

Amit G. Reddy,Laith M. Alzweri,Andrew T. Gabrielson,Gabriel Leinwand,Wayne J.G. Hellstrom 대한남성과학회 2018 The World Journal of Men's Health Vol.36 No.1

Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.

고혈류성 음경지속발기증 환자에서 양측 해면체동맥색전술을 이용한 치험 1례

고우진,홍창희,정현직,이무상 大韓泌尿器科學會 1999 Korean Journal of Urology Vol.40 No.11