Priapism recurrent

A 57-year-old man with erectile impotence, who had previously been treated with intracorporeal injections of papaverine and alprostadil, resulting in recurrent episodes of priapism necessitating aspiration, decided to try intraurethral alprostadil (MUSE). The dose needed to achieve a full erection in the clinic was titrated to 1 ig, but after 5 months this was found to be inadequate unless supplemented by a hot bath before MUSE administration. The patient stated that with MUSE alone the erection lasted for 5-10 minutes but on the two previous occasions when he had had a hot bath for 20 minutes and then used MUSE, the erection had lasted 3-4 hours. However, on the third occasion, priapism lasted 20 hours and necessitated corporeal aspiration for detumescence. 

Priapism was associated with co-administration of lithium, oxcarbazepine, and aripiprazole in a 16 year-old boy (605). It started soon after oxcarbazepine 300 mg bd had been added to lithium 1200 mg/day and resolved without recurrence after oxcarbazepine was withdrawn. 

Identical twin brothers, aged 37 years, had both suffered from bipolar disorder since their early twenties and had been treated with chlorpromazine, haloperidol, lithium, and carbamazepine before developing priapism. One of them developed priapism after taking trazodone 400 mg/day, and in the 2 years after the initial episode he suffered recurrent painless erections. Initially they occurred daily and lasted 4-5 hours. During a relapse of mania at age 37, he was given oral zuclopenthixol 40 mg/day. On the tenth day he presented with priapism of 4 days duration, which persisted despite zuclopenthixol withdrawal, needle aspiration, and phenylephrine instillation, but subsided 2 weeks later with conservative management. The... 

A 27-year-old man had taken olanzapine 15 mg at bedtime for 12 days for hallucinations and then developed priapism (238). Partial detumescence was followed by recurrence, and he required an operation to insert a glandular shunt. He subsequently required mechanical support to achieve an erection. 

Recurrent priapism during clozapine and then olanzapine therapy occurred in a 43-year-old man (239). 

Compton MT, Saldivia A, Berry SA. Recurrent priapism during treatment with clozapine and olanzapine. Am J Psychiatry 2000 157(4) 659. 

Brown JA, Nehra A. Erythropoietin-induced recurrent veno-occlusive priapism associated with end-stage renal disease. Urology 1998 52(2) 328-30. 

Some clinicians transfuse patients to maintain an HbS level less than 30% to prevent recurrent priapism. Duration of such regimens should be limited to 6 to 12 months. 

Modalities to prevent priapism are limited and not well studied. Pseudoephedrine (30 or 60 mg/day given orally at bedtime) and leuprolide, a gonadotropin-releasing hormone, have been used to decrease the number of recurrent episodes of priapism. Hydroxyurea therapy may also be useful. Recently, low-doses of an antiandrogen, bicalutamide, have been used in two patients with SCD and one patient with spinal cord injury for treatment of recurrent and refractory priapism without major side effects. " " ... 

The etiology of priapism has been traditionally divided into primary or idiopatic and secondary to some other condition or disease process. However, in accordance with Pryor (2004), for the purposes of clinical management, it is appropriate to distinguish between high-flow, low-flow, and recurrent or stuttering priapism. 

Routledge PA, Shetty HG, White JP, Collins P (1998) Case studies in therapeutics warfarin resistance and inefficacy in a man with recurrent thromboembolism, and anticoagulant-associated priapism. Br J Clin Pharmacol 46 343-346... 

Recently, recurrent or stuttering priapism has been described as a poorly understood condition that may present clinically with low-flow or, more frequently, with high-flow episodes, alternatively (Pautler and Brock 2001 Pryor et al. 2004). 

During the follow-up of patients with high-llow priapism, we recommend color Doppler ultrasound 1-2 months after embolization to confirm the absence of recurrent fistula. Recanalization of the em-bolized cavernosal artery can be observed also when non-reabsorbable embolization material has been used (Savoca et al. 2004). In patients with erectile dysfunction, the study should be performed after in-tracavernosal prostaglandin injection to determine whether the functional impairment is caused by insufficient penile blood flow or not. 

Deficiencies of anticoagulant proteins can increase the risk of skin necrosis due to warfarin. In a 19-year-old man with protein C deficiency, recurrent (stuttering) priapism attributed to warfarin was complicated by skin necrosis, presumably because of paradoxical hypercoagulability [30" ]. Activated protein C concentrate can be used to treat such cases [31" ]. In another case, skin necrosis occurred on the pinna of an 82-year-old man with protein S deficiency after warfarin therapy for 2 weeks [32 ]. 

A case of a 21-year-old male with no prior history who developed priapism 3 days after being reintiated on oral risperidone is reported [266 ]. He was successfully treated with terbutaline and switched to asenapine with no recurrence. 

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