Colour Doppler ultrasound hemodynamic characteristics of patients with priapism before and after therapeutic interventions

Introduction:Priapism has a devastating consequence on the sexual function of men if not promptly managed. We are presenting our experience of the treatment of priapism and the status of sexual function even following successful detumescence achieved after treatment.Materials and Methods:Nineteen patients, who presented with priapism from January 2012 to December 2014, were included in the study. After obtaining a detailed history; color Doppler ultrasonography of penis and blood gas analysis of the initial corporal aspirate were done to ascertain the type of priapism. Standard protocol in our institute for management of priaprism was to start with conservative treatment by corporal aspiration and intracorporeal injection (ICI) of phenylephrine. On the failure of conservative management, distal shunts were performed. Proximal shunts were performed on the failure of distal shunt procedures. Erectile function was evaluated with International Index of Erectile Function-5 questionnaire on admission and during follow-up.Results:All the patients had ischemic type priapism. Age of the patients ranged from 22 to 55 years. Duration of priapism varied from 20 to 480 h (mean 96.7). Etiologies attributed were; over-the-counter sildenafil use, chlorpromazine, opium intake and intracorporeal papaverine injection, chronic myeloid leukemia, and idiopathic. Five patients had preserved erectile function during follow-up. Preservation of normal erectile function following aspiration and ICI, proximal and distal shunt procedures were 66.7%, 18.1% and 20%, respectively.Conclusion:Patients with late presentation and those patients requiring higher treatment modalities (e.g., proximal shunts) for achieving detumescence will subsequently have a poor erectile function. These patients should be counseled about the early penile prosthesis placement during initial surgical management.

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“…In postoperative period, CDU is important for diagnosing the patency of shunt in doubtful cases. [ 14 16 ]…”

Section: Discussionmentioning

confidence: 99%

Outcome and erectile function following treatment of priapism: An institutional experience

2016

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“…Color Doppler ultrasound in patients with carotid-cavernous fistula could show colored blood flow signals, with the corpus cavernosum revealing arterial spectrum. Chiou et al [ 8 ] proposed that color Doppler ultrasound is useful for assessing relief in arteriogenesis and veno-occlusion and making decision for subsequent therapy.…”

Section: Discussionmentioning

confidence: 99%

Multimodality magnetic resonance imaging for the diagnosis of high-flow priapism following a straddle injury

Zhu

Fan²,

Xiang³

2020

Medicine

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Rationale: Priapism is a common urologic emergency, but high-flow penile priapism (HFP) caused by trauma is very rare. Therefore, HFP diagnosis and treatment are still not standardized. Patient concerns: A 29-year-old man was admitted to the urology department of our hospital on August 01, 2019, due to “persistent penile erection caused by a straddle injury.” Diagnosis: On July 17, 2019, the patient underwent Doppler ultrasonography, which indicated swollen corpus cavernosum. Interventions: The patient took over-the-counter anti-inflammatory drugs but the erectile state of the penis remained unchanged. A second perineal injury resulted in hospital admission. Multimodality magnetic resonance imaging (MRI) scan showed nodular abnormal signals at the right corpus cavernosum root. Subsequently, selective arterial interventional angiography confirmed the MRI findings. Spring coils were then inserted for embolization, and the pseudoaneurysm, fistula, and priapism disappeared. Outcomes: Two months after surgery, sexual stimuli could normally cause penile erection, with normal hardness. The patient's sexual life returned to normal 3 months after surgery. Conclusion: Multimodality MRI is very effective in detecting high blood flow priapism. Its application would improve the clinical management of this ailment.

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“…(Moderate Recommendation, Evidence Level: Grade C) In cases where a patient is refractory to shunting, subsequent intervention may be necessary. 41 In this scenario, the clinician must perform a confirmatory test to assess penile hemodynamic characteristics and extent of necrosis/fibrosis to inform secondary treatment decisions 41,42 and should not base further surgical decisions on exam alone. The Panel acknowledges this is a complex scenario; therefore, corporal blood gas or imaging should be utilized following shunt procedures to differentiate persistent ischemic priapism from reactive hyperemia or conversion to non-ischemic priapism.…”

Section: Surgical Management Of Acute Ischemic Priapismmentioning

confidence: 99%

Acute Ischemic Priapism: An AUA/SMSNA Guideline

et al. 2021

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Purpose: Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation and results in a prolonged and uncontrolled erection. Given its time-dependent and progressive nature, priapism is a situation that both urologists and emergency medicine practitioners must be familiar with and comfortable managing. Acute ischemic priapism, characterized by little or no cavernous blood flow and abnormal cavernous blood gases (ie, hypoxic, hypercarbic, acidotic) represents a medical emergency and may lead to cavernosal fibrosis and subsequent erectile dysfunction. Materials and Methods: A comprehensive search of the literature was performed by Emergency Care Research Institute for articles published between January 1, 1960 and May 1, 2020. Searches identified 2948 potentially relevant articles, and 2516 of these were excluded at the title or abstract level for not meeting inclusion criteria for any key question. Full texts for the remaining 432 articles were reviewed, and ultimately 137 unique articles were included in the report. Results: This Guideline was developed to inform clinicians on the proper diagnosis and surgical and non-surgical treatment of patients with acute ischemic priapism. This Guideline addresses the role of imaging, adjunctive laboratory testing, early involvement of urologists when presenting to the emergency room, discussion of conservative therapies, enhanced data for patient counseling on risks of erectile dysfunction and surgical complications, specific recommendations on intracavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques (eg, tunneling), and early penile prosthesis placement. Conclusions: All patients with priapism should be evaluated emergently to identify the sub-type of priapism (acute ischemic versus non-ischemic) and those with an acute ischemic event should be provided early intervention. Treatment of the acute ischemic patient must be based on patient objectives, available resources, and clinician experience. As such, a single pathway for managing the condition is oversimplified and no longer appropriate. Using a diversified Abbreviations and Acronyms AUA [ American Urological Association ED [ erectile dysfunction ICI [ intracavernosal injection MAOI [ monoamine oxidase inhibitors PDUS [ penile duplex Doppler ultrasonography SMSNA [ Sexual Medicine Society of North America

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Colour Doppler ultrasound hemodynamic characteristics of patients with priapism before and after therapeutic interventions

Abstract: Background: Information in the literature on the hemodynamic char-

Cited by 12 publications

References 13 publications

Outcome and erectile function following treatment of priapism: An institutional experience

Outcome and erectile function following treatment of priapism: An institutional experience

Multimodality magnetic resonance imaging for the diagnosis of high-flow priapism following a straddle injury

Acute Ischemic Priapism: An AUA/SMSNA Guideline

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