High‐flow priapism complicating ischemic priapism following iatrogenic laceration of the dorsal artery during a Winter procedure

Bertolotto, Michele; Ciampalini, S.; Martingano, Paola; Mucelli, Fabio Pozzi

doi:10.1002/jcu.20479

Cited by 18 publications

(17 citation statements)

References 13 publications

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“…Several authors have noted that following either aggressive medical management of ischemic priapism with aspiration and intracavernous alpha‐adrenergic injections or surgical shunting that priapism may rapidly recur with conversion from ischemia to high flow. High‐flow priapism has been reported following medical and surgical management of ischemic priapism [47–49]. Color Doppler ultrasound in these cases reveals formation of an arteriolar‐sinusoidal fistula as in typical high‐flow priapism or, on rare occasion, a high‐flow hemodynamic state of the cavernous arteries with no evident fistula formation.…”

Section: Epidemiology and Pathophysiology Of Priapismmentioning

confidence: 98%

Priapism: Pathogenesis, Epidemiology, and Management

Broderick

Kadıoğlu

Bivalacqua

et al. 2010

The Journal of Sexual Medicine

308

379

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Introduction Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of priapism is a matter of urgency requiring identification of underlying hemodynamics. Aims To define the types of priapism, address its pathogenesis and epidemiology, and develop an evidence-based guideline for effective management. Methods Six experts from four countries developed a consensus document on priapism; this document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. This report focuses on guidelines written over the past decade and reviews the priapism literature from 2003 to 2009. Although the literature is predominantly case series, recent reports have more detailed methodology including duration of priapism, etiology of priapism, and erectile function outcomes. Main Outcome Measures Consensus recommendations were based on evidence-based literature, best medical practices, and bench research. Results Basic science supporting current concepts in the pathophysiology of priapism, and clinical research supporting the most effective treatment strategies are summarized in this review. Conclusions Prompt diagnosis and appropriate management of priapism are necessary to spare patients ineffective interventions and maximize erectile function outcomes. Future research is needed to understand corporal smooth muscle pathology associated with genetic and acquired conditions resulting in ischemic priapism. Better understanding of molecular mechanisms involved in the pathogenesis of stuttering ischemic priapism will offer new avenues for medical intervention. Documenting erectile function outcomes based on duration of ischemic priapism, time to interventions, and types of interventions is needed to establish evidence-based guidance. In contrast, pathogenesis of nonischemic priapism is understood, and largely attributable to trauma. Better documentation of onset of high-flow priapism in relation to time of injury, and response to conservative management vs. angiogroaphic or surgical interventions is needed to establish evidence-based guidance.

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Section: Epidemiology and Pathophysiology Of Priapismmentioning

confidence: 98%

Priapism: Pathogenesis, Epidemiology, and Management

Broderick

Kadıoğlu

Bivalacqua

et al. 2010

The Journal of Sexual Medicine

308

379

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“…Few idiopathic cases have been described [12]. There are a few reports of iatrogenic causes after treatment for a low-flow state [13–16] and there is one due to an iatrogenic laceration of the cavernosal artery [17]. This series describes two cases of high-flow priapism after surgical intervention to treat a low-flow state.…”

Section: Introductionmentioning

confidence: 99%

Conversion of Low-Flow Priapism to High-Flow State Using T-Shunt with Tunneling

Mistry

Tadros

Hedges

2017

Case Reports in Urology

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Introduction. The three types of priapism are stuttering, arterial (high-flow, nonischemic), and venoocclusive (low-flow, ischemic). These are usually distinct entities and rarely occur in the same patient. T-shunts and other distal shunts are frequently combined with tunneling, but a seldom recognized potential complication is conversion to a high-flow state. Case Presentation. We describe 2 cases of men who presented with low-flow priapism episodes that were treated using T-shunts with tunneling that resulted with both men having recurrent erections shortly after surgery that were found to be consistent with high-flow states. Case 1 was a 33-year-old male with sickle cell anemia and case 2 was a 24-year-old male with idiopathic thrombocytopenic purpura. In both cases the men were observed over several weeks and both men returned to normal erectile function. Conclusions. Historically, proximal shunts were performed only in cases when distal shunts failed and carry a higher risk of serious complications. T-shunts and other distal shunts combined with tunneling are being used more frequently in place of proximal shunts. These cases illustrate how postoperative erections after T-shunts with tunneling can signify a conversion from low-flow to high-flow states and could potentially be misdiagnosed as an operative failure.

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“…They may later represent to other physicians with erectile dysfunction after getting married or when sexually active. Bertolotto et al 18 reported a case of high flow priapism following Winter shunt due to injury to dorsal artery. This rare complication was observed in one patient in our series which was managed conservatively.…”

Section: Discussionmentioning

confidence: 99%

Pattern and management of priapism in a tertiary hospital of North-Western Nigeria

Muhammad¹,

Agwu²,

Abdulwahab-Ahmed³

et al. 2017

East. Cent. Afr. J. Surg.

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Background: Priapism is a persistent penile erection that continues for more than four hours beyond sexual stimulation and orgasm or unrelated to sexual stimulation 1 . The objective is to document the pattern and management of priapism in our hospital. Methods: This is a retrospective study of patients managed for Priapism by Urology Unit of our hospital, from January 2009 to December 2015. Results: Thirty patients were managed for managed for priapism within the study period. The mean age at presentation was 23.9 ± 12.2 years with a range of 8-55 years. Fifteen patients (57.7 %) presented beyond 72 hours of the onset of priapism. All the patients had ischaemic priapism. Half of the patients had sickle cell disease, two (7.7 %) had chronic myeloid leukaemia, five (19.2%) used aphrodisiacs and cause was not established in six (23.1%). The most effective forms of treatments were corporal aspiration and glanulocavernosal shunt. Hydroxyurea was used for the patients with leukaemia. Thirteen (50.0%) of the patients were loss to follow-up after their first visits. Three patients (11.5%) developed erectile dysfunction. Conclusion: Sickle cell disease is the commonest cause of ischaemic priapism in our practice. Late presentation is common and is usually associated with the development of erectile dysfunction.

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High‐flow priapism complicating ischemic priapism following iatrogenic laceration of the dorsal artery during a Winter procedure

Cited by 18 publications

References 13 publications

Priapism: Pathogenesis, Epidemiology, and Management

Priapism: Pathogenesis, Epidemiology, and Management

Conversion of Low-Flow Priapism to High-Flow State Using T-Shunt with Tunneling

Pattern and management of priapism in a tertiary hospital of North-Western Nigeria

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