American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2020, 8(8), 237-239
DOI: 10.12691/ajmcr-8-8-6
Open AccessCase Report

A Rare Case of Recurrent Idiopathic Low-flow Priapism that Developed into a High-flow Priapism

Obed Agyei1, , Sakshi Joshi2, Jeffrey Nalesnik MD3, Arman Froush DO4 and Everardo Cobos MD5

1Department of Internal Medicine Cone Health Teaching Affiliate UNC Chapel Hill Medical Center, Greensboro, USA

2Department of Family Medicine, UCSF-Fresno, Fresno, CA

3Department of Urology, UCLA-Kern Medical, Bakersfield, CA

4Department of Radiology, UCLA-Kern Medical, Bakersfield, CA

5Department of Internal Medicine, UCLA-Kern Medical, Bakersfield, CA

Pub. Date: May 11, 2020

Cite this paper:
Obed Agyei, Sakshi Joshi, Jeffrey Nalesnik MD, Arman Froush DO and Everardo Cobos MD. A Rare Case of Recurrent Idiopathic Low-flow Priapism that Developed into a High-flow Priapism. American Journal of Medical Case Reports. 2020; 8(8):237-239. doi: 10.12691/ajmcr-8-8-6

Abstract

Priapism, according to the American Urological Association is defined as a persistent penile erection that continues hours beyond sexual stimulation; typically, greater than 4 hours. Although priapism is a rare condition and has an unpredictable course in most presentation, it affects 5.36 per 100,000 male subjects per year [1]. Priapism is a urological emergency and delay in treatment or refractory cases can result in cavernous smooth muscle necrosis, fibrosis and penile shortening [2]. There are 2 categories of priapism-namely low-flow (ischemia, veno-occlusive) and high-flow (non-ischemic, arterial) [3,4]. There is a subset of ischemic priapism known as stuttering priapism which presents with recurrent incidences of ischemic priapism varying in length and is usually self-limiting [4]. Low-flow priapism occurs when an occlusive process inhibits the relaxation of the corpus cavernosum, thus the outflow of blood is impaired. The conditions associated with low-flow/ischemic priapism are as follows: sickle cell disease, vasoactive drugs, neoplastic diseases of the penis, urethra, prostate, bladder, kidney, gastrointestinal tract, leukemia, polycythemia, traumatic injury, hyperlipidemic parenteral nutrition, hemodialysis, heparin treatment, Fabry disease and neurologic conditions [3]. On the other hand, high-flow priapism occurs when there is increased arterial blood flow or pooling of blood. Conditions associated with high-flow priapism include traumatic arterio-cavernous fistula, vasoactive drugs, penile revascularization surgery, and neurologic conditions [3]. The mechanism of penile erection is a multifocal phenomenon that involves the nervous system, molecules (nitric oxide, cGMP, calcium), enzymes, and blood vessels. We present an interesting case of a patient with a history of recurrent priapism who converted from a low-flow priapism to a high-flow priapism, thought to be secondary to an arterio-cavernous fistula. Upon further review of PubMed and NIH database, there has been only few of such cases reported. We discuss the diagnostic process and management of high-flow priapism in this report.

Keywords:
priapism low-flow high-flow ischemia non-ischemic

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References:

[1]  Roghmann, Florian, and Andreas Becker et. al. “Incidence of Priapism in Emergency Departments in the United States.” THE JOURNAL OF UROLOGY, vol. 190, Oct. 2013, pp. 1275-1280.
 
[2]  Salem, Emad A et al. “Management of Ischemic Priapism by Penile Prosthesis Insertion: Prevention of Distal Erosion.” THE JOURNAL OF UROLOGY, vol. 183, June 2010, pp. 2300-2303.
 
[3]  Burnet, AL. “Priapism Pathophysiology: Clues to Prevention.” International Journal of Impotence Research, no. 0955, ser. 9930, 2003, pp. 80-85. 9930.
 
[4]  Kousournas,, Georgios, et al. “Contemporary Best Practice in the Evaluation and Management of Stuttering Priapism.” Therapeutic Advances in Urology, vol. 9, no. 9, ser. 10, 28 Dec. 2016, pp. 227-238. 10.
 
[5]  Lutz,, Austin, and Stephen LaCour et al. “Conversion of Low-Flow to High-Flow Priapism: A Case Report and Review.” Continuing Medical Education, vol. 9, 2012, pp. 951-954.
 
[6]  Cahn et. al. “Case Report: Conversion of a Low-Flow to High-Flow Priapism.” Current Urology, 10 July 2015, pp. 8-103.
 
[7]  Mistry et. al. “Conversion of Low-Flow Priapism to High-Flow State Using T-Shunt with Tunneling.” Case Reports in Urology, 26 Feb. 2017, pp. 2-4.
 
[8]  Wallis et al;. “Recurrent Idiopathic High-Flow Priapism Treated with Selective Arterial Embolization after Repeated Initial Treatments for Low-Flow Priapism.” Canadian Urological Association, vol. 3, no. 1, 2009, pp. 60-63.
 
[9]  McMahon CG. High flow priapism due to arterial-lacunar fistula complicating initial veno-occulsive priapism. Int J Impot Res. 2002; 14: 195-6.
 
[10]  American Urological Association guideline on the management of priapism. Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, Nehra A, Sharlip ID, Members of the Erectile Dysfunction Guideline Update Panel, American Urological Association J Urol. 2003; 170(4 Pt 1): 1318.
 
[11]  Priapism: new concepts in medical and surgical management. Burnett AL, Bivalacqua TJ Urol Clin North Am. 2011 May; 38(2):185-94.
 
[12]  Fitzgerald et. Al. “Color Doppler Sonography in the Evaluation of Erectile Dysfunction.” RadioGraphics, vol. 12, 1992, pp. 3-17.
 
[13]  Kyung et. al. “Treatment of High-Flow Priapism with Superselective Transcatheter Embolization in 27 Patients: A Multicenter Study.” Journal of Vascular and Interventional Radiology, vol. 18, no. 10, 2007, pp. 1222-1226.
 
[14]  Zhao et. Al,. “Therapeutic Embolization of High-Flow Priapism 1 Year Follow Up with Color Doppler Sonography.” European Journal of Radiology, 2014, p. 2.