title: Alternative approaches to the management of priapism.
abstract: Herein we describe the use of intracavernous methylene blue (MB), a guanylate cyclase inhibitor, or internal pudendal artery embolization for the treatment of priapism. Eleven patients with priapism were treated from 1993-1996. Etiologies of priapism included PGE1/papaverine (3), trazodone (2), and sickle cell disease (1), in the other five cases the causes the cause was unknown. The average duration of priapism was 27 h for all patients (6-72 h). Five patients who failed intracavernous MB or an alpha-adrenergic agonist, underwent unilateral or bilateral pudendal artery embolization. The average duration of priapism for patients undergoing embolization was 43 h. Sixty-seven percent of the patients treated with MB responded with immediate detumescence. One-hundred percent of patients with priapism secondary to intracavernous injection therapy or trazodone responded. Of the five patients who underwent embolization, 40% achieved immediate pain relief and subsequent detumescence. The three non-responders exhibited a partial detumescence over 47-72 h. After follow-up of one year embolization available for only two patients revealed that one regained potency while the other remained impotent. These results confirmed that MB is effective for pharmacologically-induced priapism. Embolization is a less invasive option for refractory priapism, although results are less than satisfactory in men with priapism of several days duration.
authors.affiliation: Department of Urology, University of Virginia School of Medicine, Charlottesville 22908, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: deHoll
authors.forename: P A
authors.initials: PA
authors.lastname: Shin
authors.forename: J F
authors.initials: JF
authors.lastname: Angle
authors.forename: W D
authors.initials: WD
authors.lastname: Steers
mesh_terms: D000328:Adult; D000527:Alprostadil / Q000009:adverse effects; D000755:Anemia, Sickle Cell / Q000150:complications; D004621:Embolization, Therapeutic; D004791:Enzyme Inhibitors; D006162:Guanylate Cyclase / Q000037:antagonists & inhibitors*; D006801:Humans; D008297:Male; D008751:Methylene Blue / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D010208:Papaverine / Q000009:adverse effects; D011317:Priapism / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D014196:Trazodone / Q000009:adverse effects; D014665:Vasodilator Agents / Q000009:adverse effects
chemical_list: D004791:Enzyme Inhibitors; D014665:Vasodilator Agents; D010208:Papaverine; D006162:Guanylate Cyclase; D000527:Alprostadil; D008751:Methylene Blue; D014196:Trazodone