0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57
1208 Priapism➣Supplement with hydration, alkalinization, and hypertransfu-
sion
➣Recurrent cases treated with gonadotropin-releasing hormone
agonist or antiandrogen
■Lymphoma and Leukemia
➣Treatment of primary disease with chemotherapy or radiother-
apy
■Pelvic malignancy/metastatic lesions
➣Indicative of advanced and incurable disease
➣Secondary to compression or obstruction of venous drainage of
the penis
➣Treated symptomatically
■Intermittent or stuttering ischemic priapism
➣Associated with spinal trauma or stenosis and sickle cell disease
➣Treated with LHRH agonist or antiandrogen
■Severe recalcitrant ischemic priapism requires surgical shunt
procedures:
➣Initial therapy: distal (glans-cavernosum) shunt
Surgical blade to create communication between the glans and
corpus cavernosum
Decompress corpora cavernosa
➣If distal shunt fails, proceed with proximal shunt procedures:
Cavernosal-spongiosal shunt
Cavernosal-penile dorsal vein shunt
Cavernosal-saphenous vein shuntfollow-up
■Each 3–6 months to assess erectile function
■Patients with mild erectile dysfunction treated medically
➣Phosphodiesterase-5 inhibitor (sildenafil, vardenafil, tadalafil)
➣Vacuum constriction device
➣Intracavernous injection therapy
■Patients with severe erectile dysfunction given penile prosthesis
complications and prognosis
■Permanent erectile dysfunction is most severe complication
➣Associated with ischemic priapism lasting >24 hours
➣Penile fibrosis and damage increase as duration of ischemic pri-
apism increases.
■Severe fibrosis of penile corporal tissue
➣Unresponsive to medications for erectile function
➣Difficulty with placement of penile prosthesis
➣Decrease in penile size