Clinical Features and Significance of Malignant Priapism

Abstract

Priapism is a disorder defined as a persistent erection maintained without an appropriate sexual stimulus lasting for longer than 4 hours. Priapism is generally classified into two categories, ischemic and non-ischemic. Ischemic priapism is considered a true urological emergency as prolongation of this subtype is often associated with loss of sinusoidal endothelial function, corporal fibrosis, and necrosis. Non-ischemic priapism is a type of priapism often caused by the formation of arteriovenous fistulas that create dysregulation of cavernosa blood flow. One less common cause of priapism includes malignancy. Malignancy, either primary or secondary, is considered a rare cause of priapism. During our review of malignant priapism, several etiologies have been identified as potential causes of malignant priapism. Pathologies such as chronic myelogenous leukemia, chronic lymphocytic leukemia, and myelodysplastic syndromes have been implicated in the development of priapism, most likely due to hyperleukocytosis. Metastasis from distal or regional tumors such as the lung, bladder, prostate have been shown to produce secondary tumors that can initiate the development of priapism. Thus, it is important to consider malignancy as a possible cause of a patients priapism. The clinical presentation and prognosis between patients vary greatly and modern treatment modalities have been shown to differ greatly in its efficacy. A comprehensive study that addresses the different forms of malignant priapism may benefit healthcare professionals by providing a better understanding of the complexities, etiologies, and early interventions that can be used for their patients.