The emergency treatment strategy and prognosis of priapism in a Chinese clinic
Zhang, M1; Huang, Y1; Liu, Y1; Wang, H1; Liu, W1; LU, M1
1: , China
Objective: To explore the emergency treatment principles and prognosis of priapism in a Chinese andrology clinic.
Material and Method: The medical records of 24 priapism patients in our emergency department were reviewed retrospectively. The mean age of the patients was 30.6 years (range from 18 to 48 years) with onset time from 4 h to 7 days. Among the 24 patients, twelve patients were caused by injection of vasoactive drugs, 4 patients were accompanied by hematological system diseases, 1 patient had repetitive sex intercourse, 5 patients experienced penile perineal trauma, and the rest 2 patients had no obvious causes. All patients received blood complete cells count, urine analysis, corpus cavernosum blood gas analysis and color Doppler ultrasonography, among which 18 patients were followed with a mean duration of 24 months ranging from 10 to 36 months.
Result: According to medical history, corpus cavernosum blood gas analysis and ultrasonography, 16 patients were diagnosed as ischemic priapism, 3 patients were stuttering priapism, and 5 patients were non-ischemic priapism. The venous type priapism patients received initial corpus cavernosum blood suction and α-adrenergic receptor agonist perfusion, whose corpus cavernosum was washed repetitively until its blood color returned to bright red. Ten ischemic priapism patients were recovered after corpus cavernosum blood irragation and α-adrenergic receptor agonist perfusion. The other 5 ineffective ischemic priapism patients received penile corpus cavernosum-glans shunt or penile corpus cavernosum-urethral corpus cavernosum shunt. The rest 1 ischemic priapism patient was treated by bilateral penile corpus cavernosum-great saphenous vein shunt. All 5 non-ischemic priapism patients recovered after 1 to 2 times of highly-selective internal pudendal arteriogram and embolism. Three stuttering priapism patients were received antiandrogen drugs, estrogen and PDE5 inhibitors, whose priapism frequency was ameliorated and controlled. Among the 18 patients under follow-ups, 5 non-ischemic priapism patients maintained erectile function, 10 ischemic priapism patients experienced obvious penile erectile dysfunction, of which 5 patients received penile prosthesis implantation, and 3 stuttering priapism patients maintained partial penile erection.
Conclusion: The classification of priapism patients according to medical history, corpus cavernosum blood gas analysis and penile color Doppler ultrasonography is valuable for diagnosis. Non-ischemic penile erection is able to be cured by highly-selective internal pudendal arteriogram and embolism with satisfied long-term erectile function. Although the symptoms of most ischemic priapism patients ameliorate after corpus cavernosum blood suction, drug perfusion and shunts, long-term penile erection function is unable to restore, accompanied with penile corpus cavernosum fibrosis.
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