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Arthur L Burnett - One of the best experts on this subject based on the ideXlab platform.
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men with sickle cell disease experience greater sexual dysfunction when compared with men without sickle cell disease
Blood Advances, 2020Co-Authors: Ibrahim M Idris, Arthur L Burnett, Akib Abba, Jamil Galadanci, Sharfuddeen Abbas Mashi, Nafiu Hussaini, Sagir Ahmed Gumel, Michael R DebaunAbstract:Recurrent ischemic Priapism is a common complication of sickle cell disease (SCD). We assessed the burden, characteristics, and types of Priapism, including sexual dysfunction, in a cohort of men with and those without SCD, to test the hypothesis that sexual dysfunction is more prevalent in men with SCD. In Kano, Nigeria, we conducted a comparative cross-sectional survey that included 500 and 250 men 18 to 40 years of age, with and without SCD, respectively. The survey used the Priapism Questionnaire and the International Index of Erectile Function for sexual function assessment. All eligible participants approached for the study gave informed consent and were enrolled. Stuttering and major Priapism were defined based on the average duration of Priapism experiences that lasted ≤4 and >4 hours, respectively. The prevalence of Priapism was significantly higher in men with SCD than in those without it (32.6% vs 2%; P < .001). Stuttering Priapism accounted for 73.6% of the Priapism episodes in men with SCD. Nearly 50% of the participants with SCD-related Priapism had never sought medical attention for this complication. The majority of the men with SCD-related Priapism used exercise as a coping mechanism. Priapism affected the self-image of the men with SCD, causing sadness, embarrassment, and fear. The percentage of the men with SCD who had erectile dysfunction was more than twofold higher than that of those without SCD who had erectile dysfunction (P = .01). The men with SCD had a higher prevalence of Priapism and sexual dysfunction than the men without SCD.
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management of Priapism
2016Co-Authors: Arthur L BurnettAbstract:Priapism is a pathological condition characterized by prolonged erection and is a potential urologic emergency. This chapter outlines the management approach to evaluating, diagnosing, and treating Priapism. Key components of the evaluation include expeditious and correct classification of Priapism and implementation of appropriate therapies in a timely fashion. If ischemic Priapism is the etiology, then stepwise therapeutic maneuvers should be implemented to correct the compartment syndrome, reestablish blood flow, and relieve pain. Medical and surgical management options are reviewed.
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Priapism impact profile questionnaire development and initial validation
Urology, 2015Co-Authors: Arthur L Burnett, Uzoma A Anele, Leonard R DerogatisAbstract:Objective To create and evaluate a psychometric instrument that measures the impact of experiencing Priapism from the patient perspective. Methods The research protocol consisted of several phases as follows: (1) generating items, (2) composing a patient questionnaire, (3) administering the questionnaire to patients with both active and remitted (≥1 year without Priapism episodes) histories of Priapism, (4) performing internal consistency and criterion-oriented validity analyses in correlation with clinical histories and erectile function assessment tools, and (5) ascertaining psychometric properties of the instrument. Results The final instrument comprised a 12-item Priapism Impact Profile (PIP) questionnaire, representing the following 3 domains adversely impacted by Priapism: quality of life (QoL), sexual function (SF), and physical wellness (PW), with higher scores indicating inferior experience in respective domains. Internal consistency reliability coefficients for the total PIP score and the 3 domain scores were >0.75. Fifty-four patients (mean age, 31.7 ± 11.4 years) completed the questionnaire. Patients with active Priapism (n = 42) had higher total, QoL, SF, and PW scores than those with Priapism remission (n = 8; P P P = .09, and P 2 hours in duration had higher total, QoL, SF, and PW scores than those with "very minor" Priapism recurrences (≤2 hours in duration; P P P P P P = .14, P P = .25, respectively). Conclusion The PIP questionnaire is a novel psychometric instrument that offers a means to quantify the adverse health impact of the patient's experience with Priapism.
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molecular pathophysiology of Priapism emerging targets
Current Drug Targets, 2014Co-Authors: Uzoma A Anele, Belinda F. Morrison, Arthur L BurnettAbstract:Priapism is an erectile disorder involving uncontrolled, prolonged penile erection without sexual purpose, which can lead to erectile dysfunction. Ischemic Priapism, the most common of the variants, occurs with high prevalence in patients with sickle cell disease. Despite the potentially devastating complications of this condition, management of recurrent Priapism episodes historically has commonly involved reactive treatments rather than preventative strategies. Recently, increasing elucidation of the complex molecular mechanisms underlying this disorder, principally involving dysregulation of nitric oxide signaling, has allowed for greater insights and exploration into potential therapeutic targets. In this review, we discuss the multiple molecular regulatory pathways implicated in the pathophysiology of Priapism. We also identify the roles and mechanisms of molecular effectors in providing the basis for potential future therapies.
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randomized controlled trial of sildenafil for preventing recurrent ischemic Priapism in sickle cell disease
The American Journal of Medicine, 2014Co-Authors: Arthur L Burnett, Uzoma A Anele, Irene N Trueheart, John J Strouse, James F CasellaAbstract:Abstract Background Successful preventive therapy for ischemic Priapism, a disorder of penile erection with major physical and psychologic consequences, is limited. We conducted a randomized, double-blind, placebo-controlled clinical trial to assess the efficacy and safety of sildenafil by a systematic dosing protocol to prevent recurrent ischemic Priapism associated with sickle cell disease. Methods Thirteen patients with sickle cell disease reporting Priapism recurrences at least twice weekly were randomized to receive sildenafil 50 mg or placebo daily, unassociated with sleep or sexual activity, for 8 weeks, followed by open-label use of this sildenafil regimen for an additional 8 weeks. Results Priapism frequency reduction by 50% did not differ between sildenafil and placebo groups by intention-to-treat or per protocol analyses (P = 1.0). However, during open-label assessment, 5 of 8 patients (62.5%) by intention-to-treat analysis and 2 of 3 patients (66.7%) by per protocol analysis met this primary efficacy outcome. No significant differences were found between study groups in rates of adverse effects, although major Priapism episodes were decreased 4-fold in patients monitored "on-treatment." Conclusions Sildenafil use by systematic dosing may offer a strategy to prevent recurrent ischemic Priapism in patients with sickle cell disease.
Biljana Musicki - One of the best experts on this subject based on the ideXlab platform.
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molecular analysis of erection regulatory factors in sickle cell disease associated Priapism in the human penis
The Journal of Urology, 2013Co-Authors: Gwen A Lagoda, Biljana Musicki, Sena F Sezen, Marcelo R Cabrini, Arthur L BurnettAbstract:Purpose: Priapism is a vasculopathy that occurs in approximately 40% of patients with sickle cell disease. Mouse models suggest that dysregulated nitric oxide synthase and RhoA/ROCK signaling as well as increased oxidative stress may contribute to the mechanisms of sickle cell disease associated Priapism. We examined changes in the protein expression of nitric oxide synthase and ROCK signaling pathways, and a source of oxidative stress, NADPH oxidase, in penile erectile tissue from patients with a Priapism history etiologically related and unrelated to sickle cell disease.Materials and Methods: Human penile erectile tissue was obtained from 5 patients with sickle cell disease associated Priapism and from 6 with Priapism of other etiologies during nonemergent penile prosthesis surgery for erectile dysfunction or Priapism management and urethroplasty. Tissue was also obtained from 5 control patients without a Priapism history during penectomy for penile cancer. Samples were collected, immediately placed in ...
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new insights into the pathophysiology of sickle cell disease associated Priapism
The Journal of Sexual Medicine, 2012Co-Authors: Trinity J Bivalacqua, Biljana Musicki, Omer Kutlu, Arthur L BurnettAbstract:ABSTRACT Introduction Priapism is defined as an erectile disorder, in which erection persists uncontrollably without sexual purpose. The precise mechanisms involved in the development of sickle cell disease‐associated Priapism are ill defined. Aim To summarize the recent developments that increase our understanding of the molecular mechanisms of Priapism. Methods This article reviews the literature (Medline search 2000–2010) that relates the key molecular signaling pathways that contribute to the development of Priapism associated with sickle‐cell disease. It focuses on basic science investigations using multiple animal models. Main Outcome Measures The reader will be informed of the most current research regarding the role of endothelial nitric oxide synthase, phosphodiesterase type 5 (PDE5), adenosine, RhoA/Rho‐kinase (ROCK), and opiorphins in the pathophysiology of Priapism. Results New concepts in the field of Priapism research suggest that Priapism often results from altered vascular homeostatic actions in the penis and is associated with deficient erection control mechanisms on a molecular level. A leading proposal in this regard is the notion of aberrant signaling of the endothelium‐derived nitric oxide and PDE5 signal transduction pathway in the penis. Additionally, dysfunctional regulatory control of signal transduction systems which interact with this pathway such as adenosine and RhoA/Rho‐kinase may contribute to the development of Priapism. Recent investigations of opiorphins also demonstrate a role in regulating corporal smooth muscle tone and thereby dysregulation of erection physiology in Priapism. These advances have paved the way for understanding this disorder as having a molecular pathogenesis. Conclusions As the science underlying Priapism further emerges, increasingly effective therapeutics for sickle cell disease‐associated Priapism is certain to follow. Bivalacqua TJ, Musicki B, Kutlu O, and Burnett AL. New insights into the pathophysiology of sickle cell disease‐associated Priapism. J Sex Med 2012;9:79–87.
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feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent Priapism
The Journal of Sexual Medicine, 2006Co-Authors: Arthur L Burnett, Trinity J Bivalacqua, Hunter C Champion, Biljana MusickiAbstract:ABSTRACT Introduction Recurrent ischemic Priapism is an enigmatic erectile disorder in need of improved clinical interventions to avert its known, potentially serious complications. Aim To evaluate the use of a long‐term, continuous phosphodiesterase type 5 (PDE5) inhibitor therapeutic regimen in controlling recurrent ischemic Priapism and its feasibility in a clinical management program for the disorder. Main Outcome Measures The main outcome measure was reduction in frequency or duration of Priapism episodes. A secondary outcome measure was preservation of erectile ability. Methods We retrospectively evaluated the clinical progress of seven patients (age 22–37 years) with sickle cell disease‐associated “stuttering” Priapism (N = 4) and idiopathic recurrent Priapism (N = 3), who were counseled and consented to the “off‐label” use of the PDE5 inhibitors sildenafil citrate and tadalafil. The medications were administered according to a specified therapeutic regimen based on scientific evidence that chronic PDE5 inhibitor administration in Priapism contexts effectively reconditions PDE5 regulatory function in the penis. The duration of clinical follow‐up extended through 2 years. Results All seven patients were confirmed to have recurrent ischemic Priapism without identifiable pharmacologic, traumatic, or neoplastic disease associations based on clinical history, physical examination, laboratory testing, and penile diagnostics. PDE5 inhibitor treatment was successful in alleviating or resolving Priapism recurrences in six of the seven patients. Erectile function was unchanged in six patients and improved in one patient at last follow‐up compared with baseline status. All the patients reported that PDE5 inhibitor therapy was well tolerated and did not cause any adverse effects limiting their continued use of the medication. Conclusions Because of their efficacy, safety, and tolerability as shown in this case series, PDE5 inhibitors would appear to have a possible role in a rigorously implemented clinical management program to control recurrent Priapism. However, completion of a controlled clinical trial is necessary to confirm the utility of this treatment. Burnett AL, Bivalacqua TJ, Champion HC, and Musicki B. Feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent Priapism. J Sex Med 2006;3:1077–1084.
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long term oral phosphodiesterase 5 inhibitor therapy alleviates recurrent Priapism
Urology, 2006Co-Authors: Arthur L Burnett, Trinity J Bivalacqua, Hunter C Champion, Biljana MusickiAbstract:Abstract Objectives Recurrent ischemic Priapism describes a disorder of repeated episodes of prolonged penile erection that frequently leads to devastating complications of erectile tissue damage and erectile dysfunction. A mechanistic role for dysregulated phosphodiesterase 5 (PDE5) in the deranged smooth muscle response of the corpus cavernosum of the penis offers new understanding about the pathogenesis of the disorder and suggests that PDE5 may serve as a molecular target for its treatment and prevention. We explored the use of PDE5 inhibitors to treat recurrent Priapism, based on the hypothesis that the erection regulatory function of PDE5 would be regularized by this treatment and protect against further episodes. Methods We administered PDE5 inhibitors using a long-term therapeutic regimen to 3 men with sickle cell disease-associated Priapism recurrences and 1 man with idiopathic Priapism recurrences. Results Long-term PDE5 inhibitor treatment alleviated Priapism recurrences. Conclusions These observations support the hypothesis that PDE5 dysregulation exerts a pathogenic role for Priapism associated with hematologic dyscrasias, as well as idiopathic Priapism. Although these preliminary findings suggest that continuous, long-term PDE5 inhibitor therapy may be useful as a preventative strategy for Priapism, additional evaluation in the form of a controlled clinical trial is needed.
Trinity J Bivalacqua - One of the best experts on this subject based on the ideXlab platform.
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Management of Priapism: an update for clinicians
SAGE Publishing, 2014Co-Authors: Helen R. Levey, Robert L. Segal, Trinity J BivalacquaAbstract:Priapism is a prolonged erection that persists beyond or is unrelated to sexual stimulation. It is associated with significant morbidity: psychological, socioeconomic, and physical, including pain and potentially irreversible compromise of erectile function. There are three major types of Priapism: ischemic, nonischemic, and stuttering. Establishing the type of Priapism is paramount to safely and effectively treating these episodes. Ischemic Priapism represents a urological emergency. Its treatment may involve aspiration/irrigation with sympathomimetic injections, surgical shunts, and as a last resort, penile prosthesis implantation. Nonischemic Priapism results from continuous flow of arterial blood into the penis, most commonly related to penile trauma. This is not an emergency and may be managed conservatively initially, as most of these episodes are self-limiting. Stuttering Priapism involves recurrent self-limiting episodes of ischemic Priapism. The primary goal of therapy is prevention, but acute episodes should be managed in accordance with guidelines for ischemic Priapism. In this paper we review the diagnosis and treatment of the three Priapism variants, as well as discuss future targets of therapy and novel targets on the horizon
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new insights into the pathophysiology of sickle cell disease associated Priapism
The Journal of Sexual Medicine, 2012Co-Authors: Trinity J Bivalacqua, Biljana Musicki, Omer Kutlu, Arthur L BurnettAbstract:ABSTRACT Introduction Priapism is defined as an erectile disorder, in which erection persists uncontrollably without sexual purpose. The precise mechanisms involved in the development of sickle cell disease‐associated Priapism are ill defined. Aim To summarize the recent developments that increase our understanding of the molecular mechanisms of Priapism. Methods This article reviews the literature (Medline search 2000–2010) that relates the key molecular signaling pathways that contribute to the development of Priapism associated with sickle‐cell disease. It focuses on basic science investigations using multiple animal models. Main Outcome Measures The reader will be informed of the most current research regarding the role of endothelial nitric oxide synthase, phosphodiesterase type 5 (PDE5), adenosine, RhoA/Rho‐kinase (ROCK), and opiorphins in the pathophysiology of Priapism. Results New concepts in the field of Priapism research suggest that Priapism often results from altered vascular homeostatic actions in the penis and is associated with deficient erection control mechanisms on a molecular level. A leading proposal in this regard is the notion of aberrant signaling of the endothelium‐derived nitric oxide and PDE5 signal transduction pathway in the penis. Additionally, dysfunctional regulatory control of signal transduction systems which interact with this pathway such as adenosine and RhoA/Rho‐kinase may contribute to the development of Priapism. Recent investigations of opiorphins also demonstrate a role in regulating corporal smooth muscle tone and thereby dysregulation of erection physiology in Priapism. These advances have paved the way for understanding this disorder as having a molecular pathogenesis. Conclusions As the science underlying Priapism further emerges, increasingly effective therapeutics for sickle cell disease‐associated Priapism is certain to follow. Bivalacqua TJ, Musicki B, Kutlu O, and Burnett AL. New insights into the pathophysiology of sickle cell disease‐associated Priapism. J Sex Med 2012;9:79–87.
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medical management of ischemic stuttering Priapism a contemporary review of the literature
Asian Journal of Andrology, 2012Co-Authors: Helen R. Levey, Omer Kutlu, Trinity J BivalacquaAbstract:Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process with little information on the pathophysiology of this erectile disorder. Complications from this disorder are devastating due to the irreversible erectile damage and resultant erectile dysfunction (ED). Stuttering Priapism, though relatively rare, affects a high prevalence of men with sickle-cell disease (SCD) and presents a challenging problem with guidelines for treatment lacking or resulting in permanent ED. The mechanisms involved in the development of Priapism in this cohort are poorly characterized; therefore, medical management of Priapism represents a therapeutic challenge to urologists. Additional research is warranted, so we can effectively target treatments for these patients with prevention as the goal. This review gives an introduction to stuttering Priapism and its clinical significance, specifically with regards to the patient with SCD. Additionally, the proposed mechanisms behind its pathophysiology and a summary of the current and future targets for medical management are discussed.
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Priapism pathogenesis epidemiology and management
The Journal of Sexual Medicine, 2010Co-Authors: Gregory A Broderick, Ates Kadioglu, Trinity J Bivalacqua, Hussein Ghanem, Ajay Nehra, Rany ShamloulAbstract:ABSTRACT Introduction Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of Priapism is a matter of urgency requiring identification of underlying hemodynamics. Aims To define the types of Priapism, address its pathogenesis and epidemiology, and develop an evidence-based guideline for effective management. Methods Six experts from four countries developed a consensus document on Priapism; this document was presented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. This report focuses on guidelines written over the past decade and reviews the Priapism literature from 2003 to 2009. Although the literature is predominantly case series, recent reports have more detailed methodology including duration of Priapism, etiology of Priapism, and erectile function outcomes. Main Outcome Measures Consensus recommendations were based on evidence-based literature, best medical practices, and bench research. Results Basic science supporting current concepts in the pathophysiology of Priapism, and clinical research supporting the most effective treatment strategies are summarized in this review. Conclusions Prompt diagnosis and appropriate management of Priapism are necessary to spare patients ineffective interventions and maximize erectile function outcomes. Future research is needed to understand corporal smooth muscle pathology associated with genetic and acquired conditions resulting in ischemic Priapism. Better understanding of molecular mechanisms involved in the pathogenesis of stuttering ischemic Priapism will offer new avenues for medical intervention. Documenting erectile function outcomes based on duration of ischemic Priapism, time to interventions, and types of interventions is needed to establish evidence-based guidance. In contrast, pathogenesis of nonischemic Priapism is understood, and largely attributable to trauma. Better documentation of onset of high-flow Priapism in relation to time of injury, and response to conservative management vs. angiogroaphic or surgical interventions is needed to establish evidence-based guidance. Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, and Shamloul R. Priapism: Pathogenesis, epidemiology and management.
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feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent Priapism
The Journal of Sexual Medicine, 2006Co-Authors: Arthur L Burnett, Trinity J Bivalacqua, Hunter C Champion, Biljana MusickiAbstract:ABSTRACT Introduction Recurrent ischemic Priapism is an enigmatic erectile disorder in need of improved clinical interventions to avert its known, potentially serious complications. Aim To evaluate the use of a long‐term, continuous phosphodiesterase type 5 (PDE5) inhibitor therapeutic regimen in controlling recurrent ischemic Priapism and its feasibility in a clinical management program for the disorder. Main Outcome Measures The main outcome measure was reduction in frequency or duration of Priapism episodes. A secondary outcome measure was preservation of erectile ability. Methods We retrospectively evaluated the clinical progress of seven patients (age 22–37 years) with sickle cell disease‐associated “stuttering” Priapism (N = 4) and idiopathic recurrent Priapism (N = 3), who were counseled and consented to the “off‐label” use of the PDE5 inhibitors sildenafil citrate and tadalafil. The medications were administered according to a specified therapeutic regimen based on scientific evidence that chronic PDE5 inhibitor administration in Priapism contexts effectively reconditions PDE5 regulatory function in the penis. The duration of clinical follow‐up extended through 2 years. Results All seven patients were confirmed to have recurrent ischemic Priapism without identifiable pharmacologic, traumatic, or neoplastic disease associations based on clinical history, physical examination, laboratory testing, and penile diagnostics. PDE5 inhibitor treatment was successful in alleviating or resolving Priapism recurrences in six of the seven patients. Erectile function was unchanged in six patients and improved in one patient at last follow‐up compared with baseline status. All the patients reported that PDE5 inhibitor therapy was well tolerated and did not cause any adverse effects limiting their continued use of the medication. Conclusions Because of their efficacy, safety, and tolerability as shown in this case series, PDE5 inhibitors would appear to have a possible role in a rigorously implemented clinical management program to control recurrent Priapism. However, completion of a controlled clinical trial is necessary to confirm the utility of this treatment. Burnett AL, Bivalacqua TJ, Champion HC, and Musicki B. Feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent Priapism. J Sex Med 2006;3:1077–1084.
Tom F Lue - One of the best experts on this subject based on the ideXlab platform.
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clinical outcomes of periprocedural antithrombotic therapy in ischemic Priapism management
The Journal of Sexual Medicine, 2020Co-Authors: Joris Ramstein, Tom F Lue, Alan W Shindel, Austin Lee, Andrew J Cohen, Nnenaya A Mmonu, Natalie Rios, Anthony Enriquez, Benjamin N BreyerAbstract:Abstract Background Priapism is a urologic emergency consisting of a painful erection lasting greater than 4 hours; antithrombotic therapy (ATT) have recently been recommended as an adjunct in the treatment of ischemic Priapism. Aim To determine the short- and long-term outcomes of periprocedural ATT in the management of acute ischemic Priapism. Methods A retrospective review of patients seen at the University of California, San Francisco, from 2008 to 2019 was carried out to identify those evaluated for acute Priapism. Information regarding duration of Priapism, etiology, treatment, periprocedural and postprocedural ATT type and dose, and follow-up data was collected. Outcomes ATT use was the exposure of interest; outcome variables included Priapism resolution, repeat episodes, long-term complications, and follow-up. Results 70 patients with at least 1 detailed record of an acute Priapism episode between 2008 and 2019 were identified. Of the 70 patients who underwent management for an acute episode of Priapism, 59 (84%) received intracavernous injection of phenylephrine with or without corporal aspiration. Of the 4 patients who received ATT at the same time as intracavernous injection, none had additional Priapism episodes. In the 55 patients who did not receive immediate ATT, 22 (40%) required at least 1 shunting procedure. The 9 patients who received ATT concurrently with shunting experienced less recurrence than the 13 patients who did not receive ATT (11% vs 69%, respectively P = .012). There were no significant differences in long-term erectile dysfunction (P = .627), fibrosis (P = .118), genitourinary pain (P = .474), and urinary issues (P = .158) between those who received ATT and those who did not. Clinical Implications Our findings suggest that ATT has a role in preventing Priapism recurrence; we observed that long-term repeat Priapism episodes are less frequent in those who received periprocedural ATT compared with those who did not and that ATT may especially reduce recurrence in cases when shunting was required Strengths & Limitations This is the first study looking at the clinical outcomes of periprocedural ATT in the management of ischemic Priapism. It is limited by the fact that it is a single-center study, types of ATT were heterogenous, and the exact timing of Priapism management could not be measured for everyone. Conclusion In spite of its limitations, these preliminary findings are promising and warrant further exploration of the use of ATT in the management of ischemic Priapism. Ramstein JJ, Lee A, Cohen AJ, et al. Clinical Outcomes of Periprocedural Antithrombotic Therapy in Ischemic Priapism Management. J Sex Med 2020;17:2260–2266.
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modern strategies for the surgical treatment of Priapism
2020Co-Authors: Amanda B Reedmaldonado, Tom F LueAbstract:Priapism, a prolonged penile erection unrelated to sexual stimulation, is a challenging urologic condition. Though amongst the most common urologic emergencies, Priapism is a rare condition to encounter, and its pathophysiologic mechanisms remain poorly understood. If Priapism is not diagnosed and treated appropriately and in a timely manner, there is a risk of progressive penile corporal fibrosis and eventual erectile dysfunction. In this chapter, we review the three distinct clinical presentations of Priapism (ischemic, non-ischemic, and stuttering), and we describe concise and practical treatment algorithms for each based on the most recent and best quality scientific and clinical research. We hope that reading this chapter will not only streamline intervention for Priapism but also stimulate further research into the pathophysiology of and potential therapies for Priapism.
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avoiding complications surgery for ischemic Priapism
Translational Andrology and Urology, 2017Co-Authors: Amanda B Reedmaldonado, Janet S Kim, Tom F LueAbstract:Ischemic, or low-flow, Priapism is among the most common and challenging urologic emergencies. Management of recurrent or refractory ischemic Priapism is even more challenging, with increasing levels of risk for both the patient and the urologist. The goal of this commentary is to condense a career of experience (TF Lue) in the management of ischemic Priapism into a concise, practical clinical tool for the reader. We will describe our current algorithm for the treatment of ischemic Priapism in addition to detailing how we arrived at these recommendations. We will also describe why we believe that the presented approach is the best available approach and why we have turned away from alternative procedures.
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advances in the understanding of Priapism
Translational Andrology and Urology, 2017Co-Authors: Matthew Hudnall, Amanda B Reedmaldonado, Tom F LueAbstract:Priapism, a persistent penile erection lasting longer than 4 hours and unrelated to sexual activity, is one of the most common emergencies treated by urologists. Priapism can be categorized as ischemic, recurrent ischemic (stuttering), and non-ischemic. Advances in understanding the pathophysiology of various types of Priapism have led to targeted management strategies. This review aims to provide an up-to-date picture of the pathophysiology and management of Priapism. A search of Medline and PubMed for relevant publications using the term “Priapism” was performed. In addition to the “classical” articles, emphasis was placed on publications from January 2013 to September 2016 to evaluate the most recent literature available. Though advances in both basic and clinical research continue and effective treatment options are available, methods for the prevention of Priapism continue to be elusive.
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a pathophysiology based approach to the management of early Priapism
Asian Journal of Andrology, 2013Co-Authors: Jason R Kovac, Siu K Mak, Maurice M Garcia, Tom F LueAbstract:Priapism is a rare condition that involves persistent penile erection for greater than 4 h. Distinct variants exist, each with unique characteristics. Ischemic Priapism is a painful medical emergency that may occur as a result of veno-occlusion leading to hypoxia and tissue death. Recurrent bouts of ischemic Priapism, or stuttering Priapism, require treatment for individual attacks as well as long-term prevention. Non-ischemic Priapism is associated with trauma and may be managed conservatively. Recent advances into the pathophysiology of Priapism have allowed the development of treatment algorithms that specifically target the mechanisms involved. In this review, we outline the basics of smooth muscle contraction and describe how derangement of these pathways results in Priapism. A pathophysiological approach to the treatment of Priapism is proposed with duration-based algorithms presented to assist in management.
Asif Muneer - One of the best experts on this subject based on the ideXlab platform.
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mean velocity and peak systolic velocity can help determine ischaemic and non ischaemic Priapism
Clinical Radiology, 2017Co-Authors: C Von Stempel, Suks Minhas, David J. Ralph, Asif Muneer, Evangelos Zacharakis, Clare Allen, Navin Ramachandran, Miles Walkden, A Freeman, Alex KirkhamAbstract:Aim To determine the threshold waveform characteristics at Doppler ultrasound (DUS) to differentiate between ischaemic and non-ischaemic Priapism. Materials and methods Fifty-two patients were categorised into “ischaemic” and “non-ischaemic” types based on clinical and blood-gas findings: 10 patients with non-ischaemic Priapism; 20 with ischaemic Priapism before surgical shunt placement and 22 with ischaemic Priapism after surgical shunt placement. DUS traces were analysed: peak systolic velocity (PSV) and mean velocity (MV) were calculated. Histological samples were obtained at the time of surgery. Three clinical outcome groups were defined: (1) normal, (2) regular use of pharmacostimulation, and (3) refractory dysfunction/penile implant. Results All non-ischaemic Priapism cases had a PSV >50 cm/s and all but one had an MV of >6.5 cm/s. In pre-surgery ischaemic cases, all men had a PSV 22 cm/s but diastolic reversal. In post-surgery ischaemic Priapism, flow parameters overlapped with the non-ischaemic group. PSV/MV did not predict clinical outcome or histology. Conclusion In the present cohort, PSV 22 cm/s, but have diastolic reversal and therefore low net perfusion. Post-shunt, DUS findings were extremely variable and did not predict histology or clinical outcome.
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Distal corpus cavernosum fibrosis and erectile dysfunction secondary to non-ischaemic Priapism
PAGEPress Publications, 2015Co-Authors: Evangelos Zacharakis, David J. Ralph, Miles Walkden, Asif MuneerAbstract:Non-ischaemic Priapism is a rare type of Priapism and is associated with penile or perineal trauma. The absence of ischaemia should theoretically prevent smooth muscle necrosis and corporal fibrosis which occurs in ischaemic Priapism. The aim of this study was to first report a patient series with non-ischaemic Priapism that developed distal corpus cavernosum fibrosis and erectile dysfunction. Over a 5 year period, a cohort of 6 patients diagnosed with non-ischaemic Priapism presented to a single centre. The diagnosis was based on a clinical history, penile examination with confirmation using a combination of cavernosal blood gas analysis, colour duplex ultrasonography of the penis and angiography. Patients were followed up in clinic at regular intervals with clinical examination and repeat imaging. Following a median follow up of 4 weeks (range 2-12) the patients reported either the development of erectile dysfunction with distal penile flaccidity. Five patients required the use of PDE-5 inhibitors to achieve full tumescence. The remaining patient eventually underwent insertion of a penile prosthesis due to the failure of pharmacotherapies. Based on these findings we suggest that superselective embolisation of non-ischaemic Priapism cases occasionally should be performed after a shorter period of conservative treatment
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the efficacy of the t shunt procedure and intracavernous tunneling snake maneuver for refractory ischemic Priapism
The Journal of Urology, 2014Co-Authors: Alex Freeman, Asif Muneer, Evangelos Zacharakis, Amr Abdel Raheem, Andreas Skolarikos, Giulio Garaffa, A N Christopher, David RalphAbstract:Purpose: The current management of ischemic Priapism that is refractory to conventional medical therapy is a form of shunt procedure that diverts blood away from the corpus cavernosum. We assessed the outcome of the T-shunt and intracavernous tunneling for the management of ischemic Priapism.Materials and Methods: During a 36-month period 45 patients presented with prolonged ischemic Priapism. Patients were divided into subgroups according to the duration of Priapism. All patients had an unsuccessful primary treatment, and underwent a T-shunt and intracavernous tunneling with cavernous muscle biopsies. All patients completed an IIEF-5 (International Index of Erectile Function-5) questionnaire preoperatively and 6 months postoperatively.Results: Resolution of the Priapism using a T-shunt and snake maneuver occurred in all patients with a Priapism duration of less than 24 hours and in only 30% of those with Priapism lasting more than 48 hours. After a 6-month median followup the IIEF-5 score was significant...
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investigating the effects of high dose phenylephrine in the management of prolonged ischaemic Priapism
The Journal of Sexual Medicine, 2008Co-Authors: Suks Minhas, Alex Freeman, Asif Muneer, Pardeep Kumar, David J. RalphAbstract:ABSTRACT Introduction Acute Priapism can be managed by corporal blood aspirations and the instillation of α adrenergic agonists such as phenylephrine if patients present early. Following prolonged ischaemic Priapism, this regimen is often unsuccessful, and the use of phenylephrine is limited due to systemic cardiovascular side effects. Aim To investigate the effects of high-dose phenylephrine on human corpus cavernosal smooth muscle obtained from patients presenting with refractory ischaemic Priapism. Methods Strips of corpus cavernosum were obtained from six patients presenting with prolonged ischaemic Priapism (duration 60–240 hours), where detumescence was refractory to conventional doses of phenylephrine. The smooth muscle contractile response to high doses of phenylephrine were then compared with that of normal control corpus cavernosum obtained from four patients undergoing a penectomy for penile cancer. The tissue was then analyzed using TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling) to assess its viability. Main Outcome Measures The in vitro response to high-dose phenylephrine of corpus cavernosum smooth muscle obtained from patients with refractory Priapism compared with normal human corpus cavernosum. Results Corporal blood gas analysis confirmed hypoxia (pO 2 1.5–2.3 kPa), acidosis (pH 6.9–7.1), and glucopenia (0–0.3 mmol/L) in all six patients confirming the ischaemic nature of the Priapism. Application of high doses of phenylephrine produced a marked muscle contraction in the control tissue, but there was no contractile response at all in any of the Priapism patients. Analysis with TUNEL indicated widespread smooth muscle cell apoptosis in all the Priapism tissue. Conclusions This study has shown that patients with ischaemic Priapism that fails to respond to conventional doses of an α-agonist are unlikely to benefit from continual or high-dose phenylephrine administration, as there is usually widespread apoptosis of the cavernosal smooth muscle preventing further contraction. Muneer A, Minhas S, Freeman A, Kumar P, and Ralph DJ. Investigating the effects of high-dose phenylephrine in the management of prolonged ischaemic Priapism. J Sex Med 2008;5:2152–2159.