title: Case report: Avoidance of palpable corporal fibrosis due to priapism with upregulators of nitric oxide.
abstract: BACKGROUND
  Recent evidence suggests that blocking inducible nitric oxide (NO) synthase in the penis may exacerbate fibrotic processes and that application of medications known to increase NO in tissues may prevent fibrosis.
  
  
  OBJECTIVE
  To report the use of an antifibrotic regimen consisting of medications known to upregulate NO production in two patients with refractory priapism.
  
  
  METHODS
  Two patients presented with priapism of greater than 48-hour duration. After corporal aspiration/irrigation and shunting procedures failed, both were prescribed a daily antifibrotic regimen comprising the phosphodiesterase inhibitors pentoxifylline and sildenafil, and the NO precursor, L-arginine.
  
  
  RESULTS
  At 1 year, both patients were found to have supple corpora without evidence of corporal fibrosis.
  
  
  CONCLUSIONS
  An antifibrotic regimen consisting of upregulators of NO production may ameliorate the corporal fibrosis associated with recalcitrant priapism.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1738, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Rajfer
authors.forename: John L
authors.initials: JL
authors.lastname: Gore
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kaufman
authors.forename: Nestor
authors.initials: N
authors.lastname: Gonzalez-Cadavid
mesh_terms: D001120:Arginine / Q000008:administration & dosage; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005355:Fibrosis / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism; D019001:Nitric Oxide Synthase / Q000187:drug effects* / Q000378:metabolism; D010413:Penis / Q000187:drug effects / Q000473:pathology*; D010431:Pentoxifylline / Q000008:administration & dosage; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000008:administration & dosage; D011317:Priapism / Q000188:drug therapy* / Q000378:metabolism; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones; D016896:Treatment Outcome
chemical_list: D004791:Enzyme Inhibitors; D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D009569:Nitric Oxide; D001120:Arginine; D000068677:Sildenafil Citrate; D019001:Nitric Oxide Synthase; D010431:Pentoxifylline