Semi-Rigid Penile Prosthesis as Salvage Management of Idiopathic Ischemic Stuttering Priapism

Priapism is the persistent erection resulting from dysfunction of the mechanisms that regulate penile swelling, stiffness, and sagging. It is a full or partial erection that persists for a period more than 4 hours beyond sexual stimulation and/or orgasm or is unrelated to sexual stimulation. Ischemic priapism should be managed in a step-by-step fashion.

To demonstrate step-by-step management of stuttering refractory ischemic priapism. We report a case of stuttering refractory ischemic priapism. Moreover, we reviewed different approaches to priapism management in the literature.

A 53-year-old male presented with a painful erection of 29 hours’ duration, probably caused by consumption of alcohol. The penile blood gas showed a pH of 7.08, PCO₂ of 75 mmHg and PO₂ of 39 mmHg. Aspiration was followed by irrigation of an α-adrenergic, Winter and T-shunt operations were preformed, and finally a semi-rigid penile prosthesis was implanted to overcome the refractory stuttering ischemic priapism.

In case of stuttering refractory ischemic priapism, immediate implantation of a penile prosthesis is a simple and effective procedure that manages both the acute episode and the inevitable erectile dysfunction that would otherwise occur, while preserving penile length.

Below:  Penoscrotal approach for semi-rigid penile prosthesis implantation with distal dilatation using Rossello dilators

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By: Amr A Faddan, Alexey V Aksenov, Carsten M Naumann, Klaus P Jünemann, and Daniar K Osmonov

Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Kiel, Germany

Correspondence: Amr A Faddan, Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str 3, Haus 18 D - 24105 Kiel, Germany

Malignant Priapism: Penile Metastasis Originating on a Primary Prostate Adenocarcinoma

Below:  Coronal sulcus inflammatory nodules

Malignant priapism is a definition invented in 1938 by Peacock, defined as a persistent erection, not related with sexual activity, caused by cavernous sinus and associated venous systems invasion with malignant cells. Penile secondary lesions are rare entities. Primary locations are usually the pelvic cavity organs, namely the prostate and the bladder as the most common ones. Priapism as a first manifestation of these kinds of lesions is even rarer. The aim was to present a 52-year-old patient harboring a penile metastasis that originated in the primary prostate adenocarcinoma, manifesting itself as a “common” priapism. The patient referred to the emergency room presenting with a priapism and nodules at the coronal sulcus, without previous similar episodes. His evolution until properly diagnosed was catastrophic with multiple lymph nodes, bone and organ involvement, and with his demise soon after from serious bleeding and congestive heart failure, almost 2 months after he first came to the emergency room. We review the literature concerning malignant priapism, diagnosis, and current treatment and survival perspectives.

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