The use of high‐resolution magnetic resonance imaging in the management of patients presenting with priapism

Abstract

Study Type – Diagnosis (exploratory cohort) Level of Evidence 2b OBJECTIVE To investigate the use of magnetic resonance imaging (MRI) of the penis during an episode of priapism and assess the viability of the corpus cavernosum (CC) smooth muscle, as prolonged ischaemic priapism is associated with a high rate of long‐term erectile dysfunction (ED), and the viability of CC smooth muscle influences the subsequent management in ischaemic priapism. PATIENTS AND METHODS The study was set in a single centre based in a large university teaching hospital. We investigated the correlation of T2‐weighted gadolinium‐ enhanced MRI with the histology from CC biopsies in the same patients. In all, 38 patients (mean age 42 years) presenting with priapism over a 3‐year period had MRI of the penis. The scans were reported by two dedicated uro‐radiologists who graded the MR images as showing viable or nonviable erectile tissue. One pathologist assessed the CC biopsies for necrosis. The findings were then correlated. Where no biopsies were taken a clinical follow‐up was used to assess erectile function. RESULTS In 23 patients undergoing both a CC biopsy and MRI, the sensitivity of MRI in predicting nonviable smooth muscle was 100%. In a further 10 patients MRI showed nonviable CC smooth muscle, but no biopsy was taken in these patients; on clinical follow‐up all of these patients subsequently developed ED. In a further five patients the imaging showed viable smooth muscle and these patients subsequently maintained erectile function on clinical follow up. CONCLUSIONS Penile MRI provides an accurate imaging method to assess smooth muscle viability in patients presenting with priapism.

Acute management of priapism in men

“…The fi nding of normal, high, unregulated or turbulent cavernosal arterial fl ow, or even an arteriolar-sinusoidal fi stula or pseudoaneurysm is strongly suggestive of non-ischaemic priapism [ 2,26 ] . If Doppler US is to be used for assessment, it is important to scan before surgical shunt procedures as multiple corporal aspirations or surgical shunting performed can make interpretation of US fi ndings challenging, as patchy reperfusion within corpora cavernosa can be misinterpreted to suggest nonischaemic priapism subtype [ 27 ] . Ralph et al .…”

“…Ralph et al . [ 27 ] recently published the use of gadolinium-enhanced MRI in ischaemic priapism. Non-enhancing corpora cavernosa on a T2-weighted signal appears to be very sensitive in predicting corporal smooth muscle necrosis [ 1,27 ] .…”

“…[ 27 ] recently published the use of gadolinium-enhanced MRI in ischaemic priapism. Non-enhancing corpora cavernosa on a T2-weighted signal appears to be very sensitive in predicting corporal smooth muscle necrosis [ 1,27 ] . For suspected non-ischaemic priapism, penile angiography showing the offending arteriolar-sinusoidal fi stula is diagnostic and concomitant embolisation therapeutic [ 26 ] .…”

Our Experiences on the Management of Priapism Cases in Guidelines Perspective

“…16 Bir başka teknik ise yüksek maliyeti, erişim zorluğu ve zaman sorunu gibi olumsuzlukları göz ardı edersek malign infiltrasyon ve segmental kavernozal tromboz gibi olağandışı durumları saptamada önem arz eden, priapizm atakları sonrasında korpus kavernozum içerisindeki canlı olmayan düz kası güveni-lir şekilde gösterebilen MRG'dir. 17 Tüm hastalarımızın priapizm tipinin belirlenmesinde korporal kan gazı kullanılmıştır. Travma sonrası prezante olan non-iskemik priapizmli iki hastada PDUS ve sonrasında tanı ve tedavi amaçlı selektif penil anjiyografi uygulanmıştır.…”

MRI of the penis

“…In low-flow priapism ( Figure 5) the degree of corporal infarction may influence the decision to intervene, but more definitively if the corpora cavernosa are completely thrombosed after surgical attempts at a shunt, the best functional outcome may be achieved by early insertion of a penile prosthesis [31]. The degree of infarction on MRI correlates well with more established (but less anatomically accurate) methods of assessment such as Doppler and blood gas measurement, and with histology [31]. It is important to emphasise that perfusion of the corpora can be slow, and in addition to dynamically enhanced sequences to assess the patency of the cavernosal arteries, delayed sequences at 5 and 10 min after contrast are necessary to assess tissue viability.…”