Priapism: Difference between revisions
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===== Priapism refractory to shunting ===== | ===== Priapism refractory to shunting ===== | ||
*'''A vascular study (such as a PDUS) or cavernosal blood gas should be performed prior to performing additional interventions (repeat distal or proceeding to proximal shunting). <span | *'''<span style="color:#ff0000">A vascular study (such as a PDUS) or cavernosal blood gas should be performed prior to performing additional interventions (repeat distal or proceeding to proximal shunting).</span>[https://pubmed.ncbi.nlm.nih.gov/35536142/ ★]''' | ||
**Goal is to assess penile hemodynamic characteristics and extent of necrosis/fibrosis to differentiate persistent acute ischemic priapism from reactive hyperemia or conversion to non-ischemic priapism and inform secondary treatment decisions | **Goal is to assess penile hemodynamic characteristics and extent of necrosis/fibrosis to differentiate persistent acute ischemic priapism from reactive hyperemia or conversion to non-ischemic priapism and inform secondary treatment decisions | ||
***Penile corporal blood gas can help with decision making about proceeding to additional surgical procedures including placement of an immediate penile prosthesis. | ***Penile corporal blood gas can help with decision making about proceeding to additional surgical procedures including placement of an immediate penile prosthesis. | ||
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**Further surgical decisions should not be based only on exam | **Further surgical decisions should not be based only on exam | ||
**'''Evaluating the status of a patient with refractory priapism is particularly important in the event that a patient is referred from another institution and/or the clinician is seeing a patient who had been previously treated elsewhere and a complete patient history may not be available.''' | **'''Evaluating the status of a patient with refractory priapism is particularly important in the event that a patient is referred from another institution and/or the clinician is seeing a patient who had been previously treated elsewhere and a complete patient history may not be available.''' | ||
===== '''Early implantation (within 2 weeks) of penile prosthesis''' ===== | ===== '''Early implantation (within 2 weeks) of penile prosthesis''' ===== | ||
* '''May be considered in a patient with untreated acute ischemic priapism greater than 36 hours or in those who are refractory to shunting, with or without tunneling. <span style="color:#ff0000">[https://pubmed.ncbi.nlm.nih.gov/35536142/ ★]</span>''' | * '''May be considered in a patient with untreated acute ischemic priapism greater than 36 hours or in those who are refractory to shunting, with or without tunneling. <span style="color:#ff0000">[https://pubmed.ncbi.nlm.nih.gov/35536142/ ★]</span>''' | ||