title: Homocysteinemia: A rare cause of priapism.
abstract: Priaprism is a persistent painful erection that continuous beyond or is unrelated to sexual stimulation. Majority of cases are idiopathic (46%), alcohol and drug related (21%), perineal trauma (12%), sickle cell anemia and hypercoagualable state related (11%). We report case of priapism caused by hyperhomocysteinemia with favorable outcome with only few cases so far reported in the literature to the best of our knowledge. A 31 year-old male referred to our institution with non resolving priaprism for the last 6 days. Immediate distal shunt (Al-ghorab) was created but it could not achieve the detumescence. The penile Doppler showed no flow into the corpora, so a proximal shunt (Quackels) was made which achieved satisfactory detumescence. On thorough evaluation for the cause of priaprism, only homocysteine level was found to be significantly raised (40.46 µmol/L), being the unusual and rare cause for priaprism. The patient was discharged on homocheck. In the follow-up the patient is on vacuum assisted device for the erectile dysfunction and has been advised for the penile implant. Priaprism being a urological emergency should be thoroughly evaluated even for the rare causes and should be timely intervened to avoid the unavoidable consequences of permanent erectile dysfunction.
authors.affiliation: Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
authors.forename: Jaisukh
authors.initials: J
authors.lastname: Kalathia
authors.affiliation: Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
authors.forename: Santosh
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
authors.forename: Saurabh Sudhir
authors.initials: SS
authors.lastname: Chipde
authors.affiliation: Department of Urology and Kidney Transplantation, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Agrawal
keywords: Homocystenemia; priapism; shunt
references.citation: Am J Clin Nutr. 1994 May;59(5):1033-9
references.pmid: 8172087
references.citation: J Urol. 2009 Apr;181(4):1699-705
references.pmid: 19233430
references.citation: J Pediatr Surg. 2008 Nov;43(11):2082-6
references.pmid: 18970944
references.citation: Expert Opin Pharmacother. 2001 Sep;2(9):1449-60
references.pmid: 11585023
references.citation: Invest Urol. 1964 Mar;1:509-13
references.pmid: 14130594
references.citation: J Urol. 1981 Feb;125(2):210-1
references.pmid: 7206057
references.citation: Urology. 1976 Oct;8(4):389-91
references.pmid: 973296
references.citation: J Neurol Neurosurg Psychiatry. 2007 Apr;78(4):334-41
references.pmid: 17369588
references.citation: J Urol. 2003 Oct;170(4 Pt 1):1318-24
references.pmid: 14501756
references.citation: Adv Exp Med Biol. 2009;643:415-22
references.pmid: 19239173
references.citation: Blood. 2000 Jan 1;95(1):78-82
references.pmid: 10607688
references.citation: Urology. 2005 Jul;66(1):194
references.pmid: 15921728
references.citation: Urology. 1976 May;7(5):519-20
references.pmid: 1274013
references.citation: Scand J Plast Reconstr Surg. 1974;8(3):241-2
references.pmid: 4458048
references.citation: Urologe A. 2008 Jun;47(6):748-52
references.pmid: 18299814