Ultrasound-Guided Dorsal Penile Neurolysis for Malignant Priapism Pain Management

Carvajal, Gabriel; Rocha, Andrés

doi:10.1016/j.jpainsymman.2018.10.501

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…Therefore, neurolysis of the dorsal penile nerve was done under the guide of sonography which significantly decreased the pain. In line with our findings, the patient in the mentioned report died after two months of malignant priapism presentation ( 19 ). Our experience, however, shows that penile ring block may not achieve satisfactory and long-lasting pain reduction.…”

Section: Discussionsupporting

confidence: 90%

Malignant priapism: case report and update on management protocols

Tabei,

Baas,

Brooks

et al. 2023

Transl Androl Urol

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Background Malignant priapism, a rare disease with only about 500 reported cases to date, consists of persistent erection secondary to invasion or metastasis of a primary neoplasm. While treatment guidelines for priapism in non-malignant cases have been established, there is currently no guideline for treating malignant priapism. Herein, we describe three cases of malignant priapism and suggest a step-by-step approach for clinical management. Case Description This study reports three cases of malignant priapism resulting from advanced genitourinary cancers. All patients experienced a sub-acute progression of penile pain and ultimately underwent palliative penectomy, resulting in sustained symptom relief. Conclusions Treatment of malignant priapism needs to be individualized to the needs of the patient. No matter the primary or secondary nature of the disease, current data suggest that malignant priapism is associated with poor outcomes and emphasis should be put on palliative care. Similar to previous cases, our cases died shortly after the diagnosis of malignant priapism. Conventional procedures such as shunting may not necessarily provide symptom relief in these patients. Although new radiation techniques have shown favorable outcomes, penectomy should be considered the last resort in clinical management. Revisions to the existing management guidelines for priapism are necessary to address its occurrence in malignant contexts.

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Section: Discussionsupporting

confidence: 90%

Malignant priapism: case report and update on management protocols

Tabei,

Baas,

Brooks

et al. 2023

Transl Androl Urol

View full text Add to dashboard Cite

show abstract

“…One case report shows the use of DPNB (ultrasound-guided with 4% phenol) in a patient with chronic pain due to penile calciphylaxis, resulting in immediate pain relief [ 26 ]. This procedure has also shown to be effective in a case report of malignant priapism, a rare and painful condition usually managed with palliative pain treatment [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopic-Guided Bilateral Superior Hypogastric Plexus Neurolysis in the Treatment of Intractable Neoplasm-Related Penile Pain

Fisher¹,

Daoud²,

Gonzalez³

et al. 2021

Cureus

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Intractable penile pain can be a very difficult condition to address. Studies have shown that both locally advanced and metastatic penile cancer, along with its associated management options and subsequent complications, yield a very poor prognosis, with pain being the most feared symptom. Furthermore, a lack of palliative therapy has been demonstrated in this patient population, with an emphasis on the need for implementing future options. This case depicts a 67-year-old male, with a past medical history of metastatic prostate cancer involving the penis, who presented with intractable penile pain. To the authors' knowledge, this will be the first documented case of the successful utilization of a bilateral superior hypogastric plexus neurolysis in the management of intractable neoplasm-related penile pain attributed to both radiationinduced injury in the treatment of malignant neoplasm and penile pain secondary to metastatic prostate cancer to the penis. As a currently under-utilized treatment option in the management of intractable neoplasm-related penile pain, this case presentation acts to increase awareness of its potential use, therefore reducing the need for analgesics and the associated burdens, as well as improving patient palliation. Furthermore, this case offers evidence supporting the encouragement of its use in the general management of intractable penile pain due to other pathophysiology.

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Palliative Nerve Block for Penile Calciphylaxis: A Case Report on Ultrasound-Guided Phenol Neurolysis

2021

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A 78-year-old man with uncontrolled diabetes, heart failure, and hemodialysis-dependent end-stage renal disease presented with intractable penile pain secondary to calciphylaxis and necrosis of his glans penis. Given pain refractory to pharmacologic management and refusal of surgery, treatment entailed an ultrasound-guided dorsal penile nerve block with 5 mL of aqueous 4% phenol bilaterally. The patient reported immediate relief and died pain-free 3 months later. While phenol nerve blocks are increasingly uncommon due to local tissue toxicity, the precision of ultrasound leverages phenol’s denaturing and axonal demyelinating properties to facilitate long-term targeted neurolysis to palliate chronic nonmalignant pain.

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Ultrasound-Guided Dorsal Penile Neurolysis for Malignant Priapism Pain Management

Cited by 3 publications

References 8 publications

Malignant priapism: case report and update on management protocols

Malignant priapism: case report and update on management protocols

Fluoroscopic-Guided Bilateral Superior Hypogastric Plexus Neurolysis in the Treatment of Intractable Neoplasm-Related Penile Pain

Palliative Nerve Block for Penile Calciphylaxis: A Case Report on Ultrasound-Guided Phenol Neurolysis

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