Priapism

[Michael Scally MD]

Gravel J, LeBlanc C, Varner C. Management of priapism with a trial of exercise in the emergency department. CJEM 2018:1-4. Management of priapism with a trial of exercise in the emergency department | Canadian Journal of Emergency Medicine | Cambridge Core

Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature.

Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed.

Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism.

If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.

 

[BBC3]

Begg'in forgivenance, BUT THE FASTEST THING TO SUBSIDE AND ERECTION FOR ME IS A FINGER IN THE ASS....!!

SO WHAT ARE THEY MISSING....!!!

What I appeciate greatly about the about mentions, is the ANECDOTAL ATTEMPTS. Which translates to REAL ACTION... The real POINT is that most men lack the ability to REALLY EXERCISE and summons all that blood. They simply DO NOT have the muscular capacity to redirect all that fluid/blood...! After all, it has nowhere to go if there are not pathways and PLACES for it to go..

So their bodies are for the most part STATIC...

The only excusable reason which I could imaging to have an untreatable priapism requiring CANNIBALISM, is some innocent bastard with a spinal/Neurological disorder... (And I have met folks with a spinal disorder which has precipitated priapism...)..

And STILL, ..., "SCIENCE" knows how to block NERVE SIGNALS.....

So we walk into the hospital with a GROSS GRIN on our faces MASKED with a copious amount of pain and just THINK we are in the Hand's of "MEDICAL SCIENCE". (there should be a lawsuit for each and every")...!

AND A BUNCH A DUMBASS COCK-HUNGRY R.N.'s standing around just awaiting the death of the cock UNBEWITTEDLY and they only imagine it inside themselves...

WHY IS THERE NO REAL PROTOCOL...!? Really. !?!?!?

OUR SHAME.... Indeed....

 

[Michael Scally MD]

Unintended Consequences: A Review of Pharmacologically Induced Priapism

Background - Priapism has been linked to many commonly prescribed medications, as well as recreational drugs and toxins. Although the incidence of priapism as a result of medication is small, the increasing use of antidepressants, antipsychotics, and recreational drugs may lead to more cases of pharmacologically-induced priapism in the future.

Aim - To provide a comprehensive, up-to-date review of the most common causes of pharmacologically induced priapism and discuss incidence, pathophysiology, and basic management strategies.

Methods - A review of the available literature from 1960 to 2018 was performed using PubMed with regards to pharmacologically induced priapism.

Main Outcome Measure - We reviewed publications that outlined incidence, pathophysiology, and management strategies for various pharmacologic causes of priapism: antidepressants, antipsychotics, antihypertensives, methylphenidate, cocaine, heparin, gonadotropin-releasing hormone, propofol, spider bites, and other miscellaneous causes.

Results - An understanding of the pathophysiology behind common pharmacologic causes of priapism can assist in the development of better treatment strategies and prevent future episodes of priapism.

By understanding the potential risks associated with the use of medications with α-blocking or sympathomimetic properties, physicians can reduce the likelihood of priapism in their patients, especially those with other medical conditions that put them at increased baseline risk.

Early corporal aspiration and injection of phenylephrine reduces additional complications related to priapism. In select patients, early placement of a penile prosthesis may prevent further morbidity.

Conclusion - By developing a greater understanding of common pharmacologic causes of priapism, physicians can promptly identify and manage symptoms, leading to decreased patient morbidity.

Scherzer ND, Reddy AG, Le TV, Chernobylsky D, Hellstrom WJG. Unintended Consequences: A Review of Pharmacologically Induced Priapism. Sex Med Rev 2018. https://www.sciencedirect.com/science/article/pii/S2050052118301057

 

[str8edge73]

I had high blood flow priaprism!!!!! Let me tell you it sucked and most urology and er dept. do NOT understand the difference....To different treatments totally as I learned from personal experience...Had stoooooopid urologist treat me for the ischemic type which in turn really could of screwed the rest of my sex life up but thankfully did not..My type was caused by blunt force trauma to perianal area from a fall on to my bike, which in turn kept blood flowing to my dingus and kept me 80% erect..Simple walking up steps would of kept erections under control but dumb ass doc told me I would lose erections if I didn't have a procedure I think it was called a winters shunt, which totally freakin sucked, look it up, pretty freaking drastic, but I was able to rebound sexually after 2-3 months where as this procedure has a erictile dysfunction at almost 60%

 

[The Terminator]

I had priapism twice, both times 1.5 years ago and a couple weeks apart. Woke up erect and it wouldn’t go down, started getting painful actually. 4 hours + however long while asleep. Took some aspirin and Benadryl, after 30-60 min I pee’d. As soon as the pee came out it finally went down. 2nd time wasn’t so bad but did the same thing to get rid of it. Not sure why sex or jacking off didn’t come to mind lol. Had my T tested within a month or so of it and it was 240 and had not taken any ED pills around the time. Total mystery.

 

[jackthegripper2]

@Michael Scally MD
Brother you post the weirdest shit! Think you got WAY to much time on your hands lol

 

[Michael Scally MD]

Management of Priapism

Introduction Current management of ischemic priapism revolves around 3 principles: resolving the acute event, preserving erectile function, and reducing the risk of future recurrences.

Although more conservative management options, such as aspiration, irrigation, and surgical shunts, are effective in many patients, those who are refractory to these interventions or have prolonged priapism may benefit from placement of a penile prosthesis (PP).

Aim To provide a comprehensive overview of priapism management, highlight the current literature on the utility of penile implants for refractory priapism, and provide insight from a high-volume center on surgical decision making and technique.

Methods A complete review of the current guidelines and associated literature was performed. Associated algorithms were evaluated, and our experience was overlaid on the data present in the literature.

Main Outcome Measures The current management algorithm for priapism was evaluated. Subsequently, the data on acute and delayed PP placement were assessed. Rates of postoperative infection, erectile dysfunction, and patient satisfaction were also examined.

Results Overall, both delayed and early PP implants are associated with higher rates of failure than routine PP implants. In patients with refractory or prolonged priapism, early implantation may be technically easier, with decreased loss of penile length and associated complications.

Conclusion Patients should be evaluated on an individual basis and counseled on the risks and benefits of PP implantation in early and delayed time frames. Although there is no definitive evidence at this time regarding the ideal device or timing of implantation, there are well-established pros and cons of malleable vs inflatable prostheses and of acute vs delayed implantation.

Mishra K, Loeb A, Bukavina L, et al. Management of Priapism: A Contemporary Review. Sexual Medicine Reviews 2019. https://www.sciencedirect.com/science/article/pii/S2050052119300046

 

[Michael Scally MD]

Priapism from Recreational Intracavernosal Injections

Introduction: Recreational use of intracavernosal injections (ICIs) is a high-risk behavior that involves sharing of these agents by men without physician regulation.

Aim: To characterize the etiologies and outcomes of priapism at a Los Angeles metropolitan medical center to better understand patterns of usage of recreational ICIs and the public health implications of such practices.

Methods: With institutional review board approval, we retrospectively reviewed all cases of priapism presenting to the emergency room of a Los Angeles tertiary medical center from 2010 to 2018. We compared outcomes between patients who presented with priapism after recreational ICI and patients who presented with other etiologies.

Main outcome measure: We describe patient characteristics, etiologies, and treatments of priapism at our institution.

Results: We identified 169 priapism encounters by 143 unique patients. Recreational ICIs accounted for 82 of the 169 priapism encounters (49%). Patients who used recreational injections were younger than those who presented with other etiologies (43.5 years vs 47.5 years; P = .048) and had delayed presentations (median, 12 hours vs 8 hours; P < .0001). There was no statistical difference across groups in the proportion of patients requiring operative intervention (14.6% of recreational ICI users vs 16.1% of all other patients; P = .23). A total of 36 out of 72 patients who used recreational ICIs (50%) were HIV+.

Clinical implications: Our study adds to the relatively sparse literature on priapism outcomes. We identify and describe a high-risk population that uses recreational intracavernosal injections.

Strengths & limitations: To our knowledge, this is the largest series of priapism encounters. However, the data are retrospective from a single institution, and there is a lack of long-term follow up.

Conclusion: A large proportion of priapism visits at our institution were attributed to recreational use of ICIs. This is a high-risk patient population that may not be aware of the risks of recreational ICIs and the consequences of priapism. Further effort should be made to increase public and physician awareness of this harmful practice.

Zhao H, Berdahl C, Bresee C, et al. Priapism from Recreational Intracavernosal Injections in a High-Risk Metropolitan Community. J Sex Med. 2019;16(10):1650-1654. doi:10.1016/j.jsxm.2019.07.024 https://www.jsm.jsexmed.org/article/S1743-6095(19)31330-X/fulltext

 

[Michael Scally MD]

Medical Treatment of Recurrent Ischemic Priapism

Priapism is a medically neglected disorder for which traditional treatment is primarily aimed at resolving its acute phase. Patients with priapism recurrences, termed recurrent ischemic priapism (RIP), are commonly subjected to frequent ER visits and invasive procedures without significant improvement in the course of their condition.

Many eventually undergo radical, circumventive treatments including androgen withdrawal and IPP placement, which preclude natural sexual function. Recent research has fostered an improved understanding of the underlying molecular pathophysiology of RIP that has paved the way forward for developing new therapeutic agents.

Medications targeting neurovascular, hormonal, and hematologic mechanisms associated with RIP show great promise towards remedying this condition. A host of therapeutic agents operating across different mechanistic directions may be implemented according to a clinical management scheme to potentially optimize RIP outcomes.

Joice GA, Liu JL, Burnett AL. Medical Treatment of Recurrent Ischemic Priapism: A Review of Current Molecular Therapeutics and New Clinical Management Paradigm. BJU Int. 2021 Feb 19. doi: 10.1111/bju.15370. Epub ahead of print. PMID: 33606327. https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.15370