Priapism
Penis
Penile Erection
Etilefrine
Penile Prosthesis
Anemia, Sickle Cell
Erectile Dysfunction
Outpatient penile aspiration and epinephrine irrigation for young patients with sickle cell anemia and prolonged priapism. (1/83)
The optimal management of prolonged priapism for patients with sickle cell anemia (SCA) has not been established. We prospectively studied in an outpatient setting the efficacy and safety of a procedure that employs aspiration of blood from the corpora cavernosa and irrigation with a dilute epinephrine solution under local anesthesia to relieve priapism in young patients with SCA. If hydration and analgesics failed to produce detumescence or if priapism had lasted >4 hours, the protocol was activated in the emergency room or clinic. Fifteen patients with homozygous SCA (Hb SS) were treated on 39 occasions; 10 patients were treated once, 1 patient twice, 2 patients 3 times, 1 patient 6 times, and 1 patient 15 times. Median age of patients at first treatment was 14.3 years (range, 3.9-18.3 years). The procedure was successful in producing immediate detumescence on 37 of 39 occasions (95% efficacy, 95% confidence intervals (CI): 81%-99%). No serious immediate or long-term side effects were observed. None of the patients who demonstrated detumescence required hospitalization. The 2 patients whose priapism persisted after aspiration and irrigation presented with episodes lasting >24 hours. All evaluable patients whose priapism resolved after aspiration and irrigation self-reported normal erectile function at a median of 40 months (range, 3-58 months) after the last procedure. Thus, aspiration of the corpora cavernosa followed by irrigation with dilute epinephrine is effective in producing immediate and sustained detumescence and should be the initial therapy employed for patients with SCA and prolonged priapism. (Blood, 2000; 95:78-82) (+info)Traumatic priapism: an unusual cycling injury. (2/83)
A case is reported of a 35 year old man who sustained an injury to the perineum in a cycling accident which resulted in a traumatic priapism. After confirmation of the diagnosis by Doppler sonography and angiography, therapeutic selective arterial embolisation was followed by successful detumescence of the penis and subsequent return of normal erectile function. It is suggested that percutaneous embolisation of the lacerated cavernosal artery is a safe and effective minimally invasive treatment for this uncommon condition. (+info)Bilateral superselective arterial microcoil embolisation in delayed post-traumatic high flow priapism. (3/83)
High flow arteriogenic priapism is uncommon and usually occurs after trauma to the genitoperineal area. The onset of prolonged erection can be delayed and is often relatively pain free. Arteriography in this case illustrated the causative bilateral arteriocavernosal fistulae and pseudoaneurysms. Treatment consisted of staged bilateral superselective metallic microcoil embolisations, resulting in prompt detumescence. There were no complications. The patient had normal erectile function six months later. Recent concerns about erectile dysfunction with the bilateral use of permanent metallic coils appear to be unfounded. (+info)Intracavernosal adrenalin injection in priapism. (4/83)
Prolonged erection is a rare problem in urology but it must be treated effectively. The most common etiological factor is intracavernosal vasoactive agent injection for diagnosis or treatment of erectile dysfunction. The aim of this study was to evaluate the efficacy of intracavernosal adrenalin injection alone in the treatment of priapism. Nineteen patients with prolonged erection were evaluated. Seventeen out of the 19 prolonged erections were due to intracavernosal vasoactive agent injection and the remaining two were idiopathic. In all cases 2 ml adrenalin (1/100 000) was injected in each cavernosal body. In the patients who did not respond to the first injection, repeated adrenalin injections were performed at 20 min intervals. Blood pressure and heart rate were monitored during the injections. Detumescence was achieved in ten (53%) patients after the first injection. Repeated adrenalin injections (2-5 injections) were required in nine patients and eight (42%) of them achieved detumescence. Only one (5%) patient who had 26-h prolonged erection could not achieve detumescence. There was no significant difference in blood pressure and heart rate during the monitoring of the patients when compared to the initial values. No standard treatment method has yet been described for prolonged erection. Repeated aspirations and irrigations for treatment of prolonged erection are problematical applications both for patients and urologist. Intracavernosal adrenalin injection alone can be used with high efficacy and safety for the treatment of prolonged erection especially in patients with a short duration of erection. (+info)Management of sickle cell priapism with etilefrine. (5/83)
Intracavernous injections of etilefrine were effective in seven children with acute sickle cell priapism, and stuttering priapism resolved in five children after one to seven months of oral etilefrine. Compared with our previous reports in adults, etilefrine appears to be more effective in childhood. (+info)Report of the American Foundation for Urologic Disease (AFUD) Thought Leader Panel for evaluation and treatment of priapism. (6/83)
PURPOSE: Patients with priapism often develop permanent erectile dysfunction and personal sexual distress. This report is intended to help educate the public by reviewing the varied definitions and classifications of priapism and limited literature reports of pathophysiology, diagnosis and treatment outcomes of priapism. The AUA priapism guidelines committee is responsible for creating consensus as to appropriate individual patient management of priapism by physicians. MATERIALS AND METHODS: A multidisciplinary panel, consisting of 19 thought leaders in priapism, was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease to address pertinent issues concerning the role of the urologist, primary care providers and other health care professionals in the education of the public regarding management of men with priapism. The panel utilized a modified Delphi method and built upon the peer review literature on priapism. RESULTS: The Thought Leader Panel recommended adoption of the definition of priapism as a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is stressed to be an important medical condition that requires evaluation and may require emergency management. The classification system is categorized into ischemic and non-ischemic priapism. Essential elements of the ischemic classification are the inclusion of: (i) clinical characteristics of pain and rigidity; (ii) diagnostic characteristics of absence of cavernosal arterial blood flow; (iii) pathophysiological characteristics of a closed compartment syndrome; (iv) a time limit of 4 h prior to emergent medical care; and (v) a description of the potential consequences of delayed treatment. Essential elements of the non-ischemic classification are the inclusion of: (i) clinical characteristics of absence of pain and presence of partial rigidity; (ii) diagnostic and pathophysiological characteristics of unregulated cavernosal arterial inflow; and (iii) the need for evaluation but emphasizing the lack of a medical emergency. The panel recommended adoption of a rational management algorithm for the assessment and treatment of priapism where the cornerstone of initial assessment includes a careful clinical history, a focused physical examination and selected laboratory and/or radiologic tests. The panel recommended that specific criteria and clinical profiles requiring specialist referral should be identified. The panel further recommended that patient (and partner) needs and education concerning priapism should be addressed prior to therapeutic intervention, however only in the case of chronic management or post acute presentation evaluation should this delay intervention. Treatment goals to be discussed include management of the priapism with concomitant prevention of permanent and irreversible erectile dysfunction and associated psychosocial consequences. The panel recommended that when specific therapies for priapism are required, a step-care treatment approach based upon reversibility and invasiveness should be followed. CONCLUSIONS: The Thought Leader Panel calls for research to expand our understanding of the prevalence and diagnosis of priapism and education to create awareness among the public of the potential urgency of this condition. Critical areas to be addressed include the multiple pathophysiologies of priapism as well as multi-institutional trials to objectively assess safety and efficacy in the various treatment modalities. (+info)Epidural analgesia in a child with sickle cell disease complicated by acute abdominal pain and priapism. (7/83)
We describe a case of a 9-yr-old child with sickle cell disease complicated by abdominal vaso-occlusive crisis and priapism. Both complications were successfully treated with a combination of epidural local anesthetics and morphine. (+info)High flow priapism due to an arterial-lacunar fistula complicating initial veno-occlusive priapism. (8/83)
High flow or arterial priapism is rare, caused by unregulated arterial blood flow from a lacerated cavernous artery or branch entering directly into lacunar spaces, bypassing the protective, high resistance helicine arterioles and resulting in an arterial-lacunar fistula (ALF) and usually occurs following direct blunt or penetrating perineal trauma. Clinical features include delayed onset of a constant, painless, nontender erection of incomplete rigidity with potential for full rigidity with sexual stimulation. Colour duplex Doppler ultrasonography (CDU) is reliable in the diagnosis of arterial priapism. Treatment by arterial ligation, super-selective embolisation with autologous clot, gelatin sponge or microcoil, duplex guided compression, systemic or intracavernous administration of a variety of alpha-adrenergic agents or methylene blue, mechanical compression/ice packs or expectant management has been reported. (+info)Priapism is defined as a persistent and painful erection of the penis that lasts for more than four hours and occurs without sexual stimulation. It's a serious medical condition that requires immediate attention, as it can lead to permanent damage to the penis if left untreated.
Priapism can be classified into two types: ischemic (or low-flow) priapism and nonischemic (or high-flow) priapism. Ischemic priapism is the more common form, and it occurs when blood flow to the penis is obstructed, leading to the accumulation of deoxygenated blood in the corpora cavernosa. Nonischemic priapism, on the other hand, is usually caused by unregulated arterial blood flow into the corpora cavernosa, often as a result of trauma or surgery.
The causes of priapism can vary, but some common underlying conditions include sickle cell disease, leukemia, spinal cord injuries, and certain medications such as antidepressants and drugs used to treat erectile dysfunction. Treatment for priapism depends on the type and cause of the condition, and may involve medication, aspiration of blood from the penis, or surgical intervention.
The penis is a part of the male reproductive and urinary systems. It has three parts: the root, the body, and the glans. The root attaches to the pelvic bone and the body makes up the majority of the free-hanging portion. The glans is the cone-shaped end that protects the urethra, the tube inside the penis that carries urine from the bladder and semen from the testicles.
The penis has a dual function - it acts as a conduit for both urine and semen. During sexual arousal, the penis becomes erect when blood fills two chambers inside its shaft. This process is facilitated by the relaxation of the smooth muscles in the arterial walls and the trappping of blood in the corpora cavernosa. The stiffness of the penis enables sexual intercourse. After ejaculation, or when the sexual arousal passes, the muscles contract and the blood flows out of the penis back into the body, causing it to become flaccid again.
The foreskin, a layer of skin that covers the glans, is sometimes removed in a procedure called circumcision. Circumcision is often performed for religious or cultural reasons, or as a matter of family custom. In some countries, it's also done for medical reasons, such as to treat conditions like phimosis (an inability to retract the foreskin) or balanitis (inflammation of the glans).
It's important to note that any changes in appearance, size, or function of the penis should be evaluated by a healthcare professional, as they could indicate an underlying medical condition.
Penile erection is a physiological response that involves the engagement of the corpus cavernosum and spongiosum (erectile tissue) of the penis with blood, leading to its stiffness and rigidity. This process is primarily regulated by the autonomic nervous system and is influenced by factors such as sexual arousal, emotional state, and certain medications or medical conditions. A penile erection may also occur in non-sexual situations, such as during sleep (nocturnal penile tumescence) or due to other physical stimuli.
Etilefrine is a synthetic, sympathomimetic amine drug that acts as a direct-acting adrenergic agonist. It primarily stimulates alpha-1 and beta-1 adrenergic receptors, leading to increased heart rate, cardiac contractility, and blood pressure. Etilefrine is used clinically as a vasopressor agent to treat hypotension (low blood pressure) in certain conditions, such as shock or during surgical procedures. It should be administered under the supervision of a healthcare professional due to its potential serious side effects, including cardiac arrhythmias and hypertension.
A penile prosthesis is a medical device that is implanted inside the penis to treat erectile dysfunction. It consists of a pair of inflatable or semi-rigid rods, which are surgically placed into the corpora cavernosa (the two sponge-like areas inside the penis that fill with blood to create an erection). The implant allows the person with ED to have a controlled and manual erection suitable for sexual intercourse. This is usually considered as a last resort when other treatments, such as medications or vacuum devices, have failed.
Sickle cell anemia is a genetic disorder that affects the hemoglobin in red blood cells. Hemoglobin is responsible for carrying oxygen throughout the body. In sickle cell anemia, the hemoglobin is abnormal and causes the red blood cells to take on a sickle shape, rather than the normal disc shape. These sickled cells are stiff and sticky, and they can block blood vessels, causing tissue damage and pain. They also die more quickly than normal red blood cells, leading to anemia.
People with sickle cell anemia often experience fatigue, chronic pain, and jaundice. They may also have a higher risk of infections and complications such as stroke, acute chest syndrome, and priapism. The disease is inherited from both parents, who must both be carriers of the sickle cell gene. It primarily affects people of African descent, but it can also affect people from other ethnic backgrounds.
There is no cure for sickle cell anemia, but treatments such as blood transfusions, medications to manage pain and prevent complications, and bone marrow transplantation can help improve quality of life for affected individuals. Regular medical care and monitoring are essential for managing the disease effectively.
Penile diseases refer to a range of medical conditions that affect the penis, including infections, inflammatory conditions, and structural abnormalities. Some common penile diseases include:
1. Balanitis: an infection or inflammation of the foreskin and/or head of the penis.
2. Balanoposthitis: an infection or inflammation of both the foreskin and the head of the penis.
3. Phimosis: a condition in which the foreskin is too tight to be pulled back over the head of the penis.
4. Paraphimosis: a medical emergency in which the foreskin becomes trapped behind the head of the penis and cannot be returned to its normal position.
5. Peyronie's disease: a condition characterized by the development of scar tissue inside the penis, leading to curvature during erections.
6. Erectile dysfunction: the inability to achieve or maintain an erection sufficient for sexual intercourse.
7. Penile cancer: a rare form of cancer that affects the skin and tissues of the penis.
These conditions can have various causes, including bacterial or fungal infections, sexually transmitted infections (STIs), skin conditions, trauma, or underlying medical conditions. Treatment for penile diseases varies depending on the specific condition and its severity, but may include medications, surgery, or lifestyle changes.
"Pausinystalia" is a genus of flowering plants in the family Rubiaceae, which includes several species that have been used in traditional medicine. Two of the most well-known species are Pausinystalia johimbe and Pausinystalia yohimbe, which are native to Central and Western Africa.
The bark of these plants contains a variety of alkaloids, including yohimbine, which has been used in traditional medicine as an aphrodisiac, stimulant, and treatment for various conditions such as erectile dysfunction and depression. However, it's important to note that the use of yohimbine and other alkaloids found in Pausinystalia species can have serious side effects and interactions with other medications, so they should only be used under the guidance of a qualified healthcare professional.
Therefore, the medical definition of "Pausinystalia" refers to a genus of plants that contain various alkaloids, including yohimbine, which have been used in traditional medicine for their stimulant and aphrodisiac effects, among others. However, the use of these substances should be approached with caution due to potential side effects and interactions.
Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It can have physical and psychological causes, such as underlying health conditions like diabetes, heart disease, obesity, and mental health issues like stress, anxiety, and depression. ED can also be a side effect of certain medications. Treatment options include lifestyle changes, medication, counseling, and in some cases, surgery.
Metaraminol is a synthetic vasoconstrictor and sympathomimetic agent, which is primarily used in clinical medicine to raise blood pressure in hypotensive states. It is a direct-acting alpha-adrenergic agonist, with some mild beta-adrenergic activity as well.
Metaraminol works by stimulating the alpha-adrenergic receptors in the smooth muscle of blood vessels, causing them to contract and narrow, leading to an increase in peripheral vascular resistance and systolic blood pressure. It also has a positive inotropic effect on the heart, increasing its contractility and stroke volume.
The drug is administered intravenously, and its effects are usually rapid in onset but short-lived, typically lasting for 5 to 10 minutes. Common side effects of metaraminol include hypertension, reflex bradycardia, arrhythmias, headache, anxiety, and tremors. It should be used with caution in patients with ischemic heart disease, hypertension, and other cardiovascular conditions.