Priapism: Current Updates in Clinical Management

다국어 초록 (Multilingual Abstract)

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.

참고문헌 (Reference)

1 김진현, "저혈류형 음경지속발기증 치료 후 발생한 고혈류형 음경지속발기증" 대한비뇨기과학회 46 (46): 876-878, 2005

2 Grayhack JT, "Venous bypass to control priapism" 1 : 509-513, 1964

3 Quackels R., "Treatment of a case of priapism by cavernospongious anastomosis" 32 : 5-13, 1964

4 Onder Canguven, "Transient Distal Penile Corporoglanular Shunt as an Adjunct to Aspiration and Irrigation Procedures in the Treatment of Early Ischemic Priapism" 대한비뇨기과학회 54 (54): 394-398, 2013

5 Ralph DJ, "The use of high-resolution magnetic resonance imaging in the management of patients presenting with priapism" 106 : 1714-1718, 2010

6 Chow K, "The pharmacological management of intermittent priapismic states" 102 : 1515-1521, 2008

7 Ralph DJ, "The immediate insertion of a penile prosthesis for acute ischaemic priapism" 56 : 1033-1038, 2009

8 Keoghane SR, "The aetiology, pathogenesis and management of priapism" 90 : 149-154, 2002

9 Brant WO, "T-shaped shunt and intracavernous tunneling for prolonged ischemic priapism" 181 : 1699-1705, 2009

10 Burnett AL, "Surgical management of ischemic priapism" 9 : 114-120, 2012

11 Takao T, "Successful superselective arterial embolization for post-traumatic high-flow priapism" 14 : 254-256, 2007

12 Barry JM, "Priapism: treatment with corpus cavernosum to dorsal vein of penis shunts" 116 : 754-756, 1976

13 Broderick GA, "Priapism: pathogenesis, epidemiology, and management" 7 (7): 476-500, 2010

14 Burnett AL, "Priapism: new concepts in medical and surgical management" 38 : 185-194, 2011

15 Burnett AL, "Priapism: current principles and practice" 34 : 631-642, 2007

16 Broderick GA, "Priapism, In Campbell-Walsh urology. 10th ed" Saunders 749-769, 2011

17 Kato GJ, "Priapism in sickle-cell disease: a hematologist's perspective" 9 : 70-78, 2012

18 Morrison BF, "Priapism in hematological and coagulative disorders: an update" 8 : 223-230, 2011

19 Pryor J, "Priapism" 1 : 116-120, 2004

20 Numan F, "Posttraumatic nonischemic priapism treated with autologous blood clot embolization" 5 : 173-179, 2008

21 Lowe FC, "Placebo-controlled study of oral terbutaline and pseudoephedrine in management of prostaglandin E1-induced prolonged erections" 42 : 51-53, 1993

22 Deveci S, "Penile length alterations following penile prosthesis surgery" 51 : 1128-1131, 2007

23 Munarriz R, "Management of ischemic priapism with high-dose intracavernosal phenylephrine: from bench to bedside" 3 : 918-922, 2006

24 Salem EA, "Management of ischemic priapism by penile prosthesis insertion: prevention of distal erosion" 183 : 2300-2303, 2010

25 Marotte JB, "Juvenile posttraumatic high-flow priapism: current management dilemmas" 40 : E25-E28, 2005

26 Cakan M, "Is the combination of superselective transcatheter autologous clot embolization and duplex sonography-guided compression therapy useful treatment option for the patients with high-flow priapism?" 18 : 141-145, 2006

27 Muneer A, "Investigating the effects of high-dose phenylephrine in the management of prolonged ischaemic priapism" 5 : 2152-2159, 2008

28 Ralph DJ, "Intracavernosal phenylephrine for recurrent priapism: self-administration by drug delivery implant" 165 : 1632-, 2001

29 Ciampalini S, "High-flow priapism: treatment and long-term follow-up" 59 : 110-113, 2002

30 Carson CC, "For: surgery for stuttering priapism" 181 : 449-450, 2009

31 Huang YC, "Evaluation and management of priapism: 2009 update" 6 : 262-271, 2009

32 Kulmala RV, "Effects of priapism lasting 24 hours or longer caused by intracavernosal injection of vasoactive drugs" 7 : 131-136, 1995

33 Sedigh O, "Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature" 23 : 158-164, 2011

34 Hanafy HM, "Early arabian medicine: contribution to urology" 8 : 63-67, 1976

35 LeRoy TJ, "Doppler blood flow analysis of erectile function: who, when, and how" 38 : 147-154, 2011

36 Winter CC, "Cure of idiopathic priapism: new procedure for creating fistula between glans penis and corpora cavernosa" 8 : 389-391, 1976

37 Burnett AL, "Corporal "snake" maneuver: corporoglanular shunt surgical modification for ischemic priapism" 6 : 1171-1176, 2009

38 Bertolotto M, "Color Doppler appearance of penile cavernosal-spongiosal communications in patients with high-flow priapism" 49 : 710-714, 2008

39 Sacher EC, "Cavernospongiosum shunt in the treatment of priapism" 108 : 97-100, 1972

40 Montague DK, "American Urological Association guideline on the management of priapism" 170 (170): 1318-1324, 2003

41 Burnett AL, "Against: no surgery for stuttering priapism" 181 : 450-451, 2009

42 Ebbehoj J., "A new operation for priapism" 8 : 241-242, 1974