Topic: Priapism

Priapism: A Management Enigma

Michael Coburn, MD, FACS, Professor and Russell and Mary Hugh Scott Chair of the Department of Urology at Baylor College of Medicine, discusses priapism and the American Urological Association’s (AUA) guidelines on managing the illness. He gives an overview of priapism, outlining differences between ischemic, non-ischemic, recurrent, primary, and secondary priapism, and discusses a range of contributing risk factors. Next, Dr. Coburn reviews study data on the different qualities of ischemic and non-ischemic priapism, explaining that the latter often is chronic and characterized by less rigidity in the penis, while ischemic priapism tends to be characterized by a fully rigid, very painful erection which contains abnormal cavernous gases. He then discusses treatment recommendations for various forms of the disease, ranging from oral medication for intracavernosal-caused priapism to complex specialty treatment for priapism related to underlying medical conditions. Dr. Coburn concludes by recommending that physicians use the AUA guidelines to create a treatment algorithm for priapism, making sure that if a deviation is made that it is well documented and explained.

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Evidence-Based Guideline for Management of Priapism: Perspectives from AUA/EAU Guideline Panel

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at Johns Hopkins Medicine, discusses potential solutions to the issues with bacillus Calmette-Guérin (BCG) as a treatment for high-risk non-muscle invasive bladder cancer (NMIBC). Intravesical BCG is more effective than chemotherapy for NMIBC, but approximately ⅓ of high-risk patients are BCG-unresponsive, and there is also a BCG shortage. Dr. Bivalacqua lists potential solutions to both these problems, including early cystectomy, increasing the availability of BCG by using alternative strains, and enhancing immunotherapy. He concludes by discussing research intended to characterize immune cell expression among patients with NMIBC treated with BCG which found that immune checkpoint inhibition with BCG may be beneficial in a subset of patients who experience tumor recurrence after BCG.

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Priaprism Through a New Prism: Alternative Perspectives on the AUA Guidelines

Tobias S. Kohler MD, MPH, discuss the current AUA guidelines regarding priapism, covering proper diagnosis, sympathomimetic injections, phenylephrine use, shunt techniques, and oral medications. He then suggests changes to these guidelines, such as including proper patient counseling, minimizing proximal shunts, and early penile prosthesis. Furthermore, he proposes a new algorithm for the management of this condition.

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