Treatment of Priapism: A Single Center Experience

Öz

Background: The aim of this study was to evaluate patients in our region who applied to the emergency department or urology outpatient clinic due to priapism, regarding the parameters such as the duration of priapism, treatment, age, and treatment outcomes.
Materials and Methods: Thirty-nine male patients who presented with priapism between January 2010 and May 2018 were included in the study. We reviewed all data in patients’ files and recorded patients’ data including age, date of first episode of priapism, duration as well as the clinical coarse of priapism, presence of accompanying conditions associated with priapism, history of intracavernosal injections use, administration of intracavernosal injections (self-administration or by a doctor), treatment method and outcomes
Results: A total of 43 episodes of priapism were recorded in 39 patients. The mean age of the patients was 46.6 (27-70) years. It was observed that priapism developed following intracavernosal injections use in all patients. In 9 (23%) patients (10 episodes), priapism developed after intracavernosal injection, which was used for treatment due to erectile dysfunction and in 30 (77%) (33 episodes) patients following penile Doppler ultrasound with intracavernosal injections. 30 patients (32 episodes) were successfully treated with drainage only, while 9 patients (11 episodes) required drainage + sympathomimetic therapy, and two of these had distal shunt due to persistent priapism.
Conclusions: Drainage is enough in the majority of priapism patients. However, drainage is not sufficient with the prolongation of the patient application period. In this regard, patients should be informed about potential risks before starting an ICI therapy.

Key Words: Priapism, Urological emergency, Papaverine, Pain

Anahtar Kelimeler

• Priapism
• urological emergency
• papaverine
• pain

Priapizm Tedavisi: Tek Merkez Sonuçları

Öz

Amaç: Bu çalışmada amacımız bölgemizde priapizm nedeniyle acil servise veya üroloji kliniğine başvuran hastaların priapizm süresi, uygulanan tedavi, hastaların yaşı ve tedavi sonuçlarını değerlendirmektir.
Materyal ve Metod: Ocak 2010 ile Mayıs 2018 tarihleri arasında priapizm nedeniyle başvuran 39 hasta çalışmaya dahil edildi. Tüm hastaların yaşı, priapizm tarihi, klinik öyküsü, priapizm nedenleri, intrakavernoz ilaç kullanımı, hastaneye başvuru süresi priapizm için yapılan tedavi ve sonuçları hasta dosyasından alındı.
Bulgular: Toplam 39 hastada 43 priapizm epizodu görüldü. Hastaların yaş ortalaması 46,6 (27-70) yıl olarak tespit edildi. Hastaların tamamında intrakavernozal enjeksiyon kullanımı sonrasında priapizm geliştiği görüldü. Hastalar ortalama 22,6 (6-92) saat sonra tedavi için başvurduğu görüldü. Hastaların 9 (%23)’unda (10 epizod) erektil disfonksiyon şikayeti nedeniyle tedavi amaçlı kullanılan intrakavernozal enjeksiyon sonrası priapizm gelişti. 30 (%77) hasta da (33 epizod) ise penil dopler ultrason için yapılan intrakavernozal enjeksiyon sonrasında priapizm gelişti. 30 hasta (33 epizod) sadece drenaj ile tedaviden fayda görürken, 6 hastaya (9 epizod) drenaj+sempatomimetik uygulandı. Bu hastalardan ikisine priapizmin devam etmesi nedeniyle distal şant uygulanmıştır.
Sonuç: Priapizm hastalarının çoğunluğunda drenaj yeterli olmaktadır. Ancak hasta başvuru süresinin uzaması ile drenaj yeterli olmamaktadır. Bu nedenle hastalar priapizm konusunda bilgilendirilmeli ve olası sonuçları paylaşılmalıdır.

Anahtar kelimeler: Priapizm, Ürolojik Acil, Papaverin, Ağrı.

Anahtar Kelimeler

• Priapizm
• ürolojik acil
• papaverin
• ağrı

Kaynakça

1. 1- Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, Shamloul R. Priapism: pathogenesis, epidemiology, and management . J Sex Med 2010;7:476-500.
2. 2- Burnett AL, Bivalacqua TJ. Priapism: new concepts in medical and surgical management . U rol Clin North Am 2011;38:185-94.
3. 3- Shigehara K, Namiki M. Clinical management of priapism: a review. World J Mens Health 2016;34:1-8.
4. 4- Cherian J, Rao AR, Thwaini A, Kapasi F, Shergill IS, Samman R. Medical and surgical management of priapism. Postgrad Med J 2006;82:89-94.
5. 5- Porst H. The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. J Urol 1996;155:802-15.
6. 6- Habous M, Elkhouly M, Abdelwahab O, et al. Noninvasive treatments for iatrogenic priapism: Do they really work? A prospective multicenter study. Urol Ann 2016;8:193-6.
7. 7- Kızılay F, Karamazak S, Semerci B. Priapism and penis fracture from andrologic emergencies. Androloji Bülteni 2016;18:83-91.
8. 8- Lomas GM, Jarow JP. Risk factors for papaverine-induced priapism. J Urol 1992;147:1280-1.

9. 9- Tay YK, Spernat D, Rzetelski-West K, Appu S, Love C. Acute management of priapism in men. BJU Int 2012;109:15-21.
10. 10- Yenice MG, Şeker KG, Şam E, et al: Kılavuzlar Eşliğinde Priapizm Hastalarının Yonetimine İlişkin Deneyimlerimiz. J Reconstr Urol 2017;7:90-6.
11. 11- Walsh PC, Retik AB, Vaughan ED, Wein AJ, Kavoussi AR, Novick AC, eds. Campbell’s Urology. 8th ed. Philadelphia: W.B. Saunders; 2002:1619-71.
12. 12- Welford C, Spies SM, Green D. Priapism in primary thrombocythemia. Arch Intern Med 1981;141:807-8.
13. 13- Raven JL. Haemoglobinopathies in Australia. Med J Aust 1972;2:726-9.
14. 14- De Siati M, Chierigo P, Contin F, Lazzarotto M, Rahmati M, Franzolin N. Priapism as a complication of heparin therapy. Arch Ital Urol Androl 1999;71:201-2.
15. 15- Burke BJ, Scott GL, Smith PJ, Wakerley GR. Heparin associated priapism. Postgrad Med J 1983;59:332-3.
16. 16- Zimbelman J, Lefkowitz J, Schaeffer C, et al. Unusual complications of warfarin therapy: skin necrosis and priapism. J Pediatr 2000;137:266-8.
17. 17- Routledge PA, Shetty HG, White JP, Collins P. Case studies in therapeutics: warfarin resistance and inefficacy in a man with recurrent thromboembolism, and anticoagulant-associated priapism. Br J Clin Pharmacol 1998;46:343-6.
18. 18- Brindley GS. New treatment for priapism. Lancet 1984;2:220-1.
19. 19- Lue TF, Hellstrom WJ, McAninch JW, Tanagho EA. Priapism: a refined approach to diagnosis and treatment. J Urol 1986;136:104-8.
20. 20- Levine JF, Saenz de Tejada I, Payton TR, Goldstein I. Recurrent prolonged erections and priapism as a sequela of priapism: pathophysiology and management. J Urol 1991;145:764-7.
21. 21- de Holl JD, Shin PA, Angle JF, Steers WD. Alternative approaches to the management of priapism. Int J Impot Res 1998;10:11-4.