From methylene blue (methylthionine chloride) to Al-Ghorab procedure: the therapy of priapism (our experience).
OBJECTIVE
The better knowledge concerning the anatomo-physiology of erection has brought important changes to the management of priapism. We experimented with a staged therapeutic protocol forthis condition.


METHODS
17 patients, aged from 27 to 71 (mean age 43) were treated for ischemic priapism; the pathogenesis was idiopathic in 9 cases, in 4 cases secondary to intracavernous injection (IcI) of PGE1, in 2 cases to papaverine Icd, in 1 case to haemolympho-pathy and in another patient to treatement with heparin. Cavernous PO2, PCO2 and pH were checked. All patients underwent removal of 100 cc of blood, irrigation with NaHCO3 solution of the cavernous corpora and Methylen blue (MB) IcI 10 mg every 5 minutes 10 times, repeated twice.


RESULTS
From 3 to 6 hours from the beginning of therapy, detumescence was achieved in 10 cases. In 5 cases the priapism persisted and we administered adrenaline 20 pg every 5-10 minutes: 2 cases had detumescence respectively in 5 and 7 hours whereas in the patient with leukaemia the erection persisted and we desisted from further therapy; in 2 other cases the erection persisted and we did a distal cavernosum-glans shunt and the detumescence a was achieved in 30 and 58 hours respectively. In the last 2 cases, before adrenaline we administered an IcI of ethylephrine 5 mg every 5 minutes for 4-5 times but finally we had to perform a shunt. In all cases, during the treatment, and during the following 6-8 hours, we administered 200 mg of MB intravenous.


CONCLUSIONS
The introduction of oral drugs has changed the epidemiology of priapism. A better knowledge of the molecular mechanisms that govern the cavernous contraction and myorelaxation has allowed us to use adrenergic drugs and also the MB. This staged therapeutic protocol goes from a less invasive therapy (irrigation with NaHCO3, MB, ethylephrine, adrenaline) to a surgical procedure which must not be delayed and this progression could allow a reduction in the collateral effects.
Passavanti
Giandomenico
G
Department of Urology Misericordia Hospital, Grosseto, Italy. mpeppina@infinito.it
Bragaglia
Alessandro
A
Paolini
Riccardo
R
D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D004837:Epinephrine / Q000627:therapeutic use; D005039:Etilefrine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008751:Methylene Blue / Q000627:therapeutic use*; D008875:Middle Aged; D011317:Priapism / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D004791:Enzyme Inhibitors; D014662:Vasoconstrictor Agents; D017693:Sodium Bicarbonate; D008751:Methylene Blue; D004837:Epinephrine; D005039:Etilefrine