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Haemostasis and Thrombosis
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Association with priapism (See Chapter 21)The prevalence of priapism in SCD is up to 48%.>95% ischaemic type priapism.Altered vascular homeostatic actions in the penis and deficient erection control mechanisms.Possible molecular mechanisms:Aberrant signalling of the endothelium-derived nitric oxide and PDE5 signal transduction pathway in the penis.Dysfunctional signal transduction systems involving adenosine and RhoA/Rho-kinase.Opiorphins also demonstrate a role in regulating corporal smooth muscle tone and, thereby, dysregulation of erection physiology in priapism.
The Reproductive System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
Priapism is a persistent and painful erection of the penis in the absence of sexual arousal, and it may be caused by diseases and injuries to the spinal cord or secondary to obstruction of the outflow of blood from the penis.
Reproductive system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Priapism is a prolonged penile erection, which may be related to trauma, underlying medical conditions or some pharmaceuticals, among other causative factors. It is painful or at least uncomfortable and is considered a medical emergency requiring immediate treatment to avoid long-term dysfunction and irreversible infarction. Figure 8.42c shows infarction of the penis post-priapism. The blue arrows outline a region of echo-dark change within the corpora cavernosa, and no blood flow detected using colourflow Doppler.
An overview of emergency pharmacotherapy for priapism
Published in Expert Opinion on Pharmacotherapy, 2022
Graham A. Bobo, Wael Almajed, Jack Conlon, Rohan A. Morenas, Wayne J.G Hellstrom
Other areas of interest to consider in the management of priapism could include any genetic components that may predispose patients to priapism or to recurrent ischemic priapism. Among the sparse literature that discusses genetic associations with priapism, one study investigated the clinical and genetic factors associated with priapism in patients with sickle cell disease [70]. This study demonstrated that those with homozygous genotypes in sickle cell disease were at higher risk in developing priapism as well as those who were older. This sole study indicates that if we could identify patients more likely to develop priapism, we could potentially prevent future episodes of the disease state via prophylactic therapeutics and therefore the sequalae of associated side effects. This could provide a more individualized approach to the treatment and follow-up of these patients who suffer from priapism. Though prevention and genetic associations could drive future research in the treatment of priapism, given the current state of the literature and guidelines published, it is our opinion that intracavernosal phenylephrine is superior in the treatment of priapism in the emergent setting due to its limited systemic side effects and demonstrated efficacy when compared to various other therapies.
Pharmacological strategies for sexual recovery in men undergoing antipsychotic treatment
Published in Expert Opinion on Pharmacotherapy, 2022
Tommaso B. Jannini, Andrea Sansone, Rodolfo Rossi, Giorgio Di Lorenzo, Massimiliano Toscano, Alberto Siracusano, Emmanuele A. Jannini
The interaction of antipsychotic agents and sexual response extends beyond the central level, with peripheral actions being also reported. Adrenergic antagonism, involving both the α1 and α2 receptors, has been associated with priapism [71,77]. Priapism is a prolonged, painful erection that can result in persistent fibrotic/ischemic damage in the corpora cavernosa, ultimately impairing erectile function if not treated as an emergency. While priapism is not common following antipsychotic treatment [78,79], several drugs, including risperidone, clozapine, and quetiapine, have a high affinity for the adrenergic receptor and are therefore more likely to result in the onset of priapism. Additionally, despite being a condition generally reported by adult men, cases of priapism have been reported in children as well [80,81], and at least one case of clitoral priapism following olanzapine treatment has been described [82], despite the fact that olanzapine is among the antipsychotics with the lowest affinity for adrenergic receptors. Histamine improves smooth muscle relaxation in the corpora cavernosa [83]: H1 antagonism leads to impaired sexual function, possibly due to effects on vascular hemodynamics or to sedation [71,84]. Overall, this raises an important point: investigating sexual side effects of antipsychotics cannot be reduced to the mere measurement of serum Prl, but on the other hand the choice should be directed towards pharmacological agents with the ‘best’ profiles in terms of receptor affinity and agonist/antagonist behavior.
Recurrent priapism in spinal cord injury: A case report
Published in The Journal of Spinal Cord Medicine, 2021
Engin Koyuncu, Özlem Taşoğlu, Ali Orhan, Sibel Özbudak Demir, Neşe Özgirgin
Chronic priapism represents a challenging therapeutic dilemma. Inadequate or deferred treatment can result in impaired quality of life, and permanent erectile dysfunction.8 Recurrent priapism's episodes usually start after the spinal shock is over in patients with SCI. Although the erections are self-limited, the frequency and duration usually increase in time leaving the patient in a very difficult situation.2–4 The loss of sympathetic outflow to the penile vasculature leads to increased parasympathetic effect resulting in uncontrolled arterial inflow into the penile sinusoidal spaces.3 In the literature, priapism is reported only in complete SCI and most of the patients had cervical lesions. The frequency of priapism in SCI or why priapism occurs only in some SCI patients are not known.3 There are a number of conservative agents used in the treatment of recurrent priapism. The most commonly used one in SCI is oral baclofen. Intrathecal baclofen can also be used when the oral form fails. Baclofen is a Gamma Aminobutyric Acid (GABA) agonist which can inhibit erection and ejaculation through GABA activity.1,5 It is presumed that baclofen relaxes the ischiocavernosus and bulbospongiosus muscles, which are involved in penile erection.9