Correction of Priapism – Spongiosum-Cavernosum
- What is Correction Of Priapism – Spongiosum-Cavernosum
- Effects of Correction Of Priapism – Spongiosum-Cavernosum
- Candidates for Correction Of Priapism – Spongiosum-Cavernosum
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- The Correction Of Priapism – Spongiosum-Cavernosum Procedure
What is CORRECTION OF PRIAPISM – Spongiosum-cavernosum?
Effects of CORRECTION OF PRIAPISM – Spongiosum-cavernosum
Candidates for CORRECTION OF PRIAPISM – Spongiosum-cavernosum
Priapism can occur in persons of any age group, with peaks at age 5-10 years and 20-50 years. Patients with priapism report a persistent erection. The symptoms depend on the type of priapism and the duration of engorgement.
Recommended basic laboratory testing in the routine evaluation of the patient with priapism includes complete blood count, white blood cell differential and platelet count. These tests are relevant for the determination of the existence of acute infections or hematologic abnormalities. Reticulocyte count and hemoglobin electrophoresis offer additional usefulness to identify the presence of sickle cell disease or trait, as well as of other hemoglobinopathies. Screening for psychoactive drugs and urine toxicology to evaluate for overdoses of legal and illegal drugs can also be performed.
The CORRECTION OF PRIAPISM – Spongiosum-cavernosum Procedure
Surgical shunting as a means for blood drainage from the corpora cavernosa involves either distal or proximal approaches. Distal cavernoglanular (corporoglanular) shunting is usually performed first because it is less invasive and carries a lower risk of complications than proximal shunting. Distal shunting techniques include placing a large biopsy needle (Winter shunt) or scalpel (Ebbehoj shunt) percutaneously through the glans, or excising the tunica albuginea at the tip of the corpus cavernosum (El-Ghorab shunt). If distal shunting fails, proximal cavernospongiosal (corporospongiosal) shunting can be used. This involves the creation of a window between the respective corporal bodies (Quackels or Sacher shunt), or an anastomosis of a saphenous vein to one of the corpora cavernosa (Grayhack shunt).
Post-operative infection should be prevented by broad spectrum prophylactic antibiotics. Antibiotics should be given especially when aspirations and surgical procedures are contemplated.
Complications can and do occur during and after the treatment for priapism. These complications include:
- Recurrence of priapism
- Bleeding from the holes placed in the penis as a part of the shunting procedure
- Skin necrosis
- infection of the corporal body
- Infection of the skin around it
- Damage to the urethra and the urine tube, including strictures
- Holes between the urethra and the skin
- Loss of the penis
What are the corpus spongiosum and corpora cavernosa?
The corpora cavernosa consist of empty spaces divided by partitions of tissue. The tissue consists of muscle, collagen (a fibrous protein), and elastic fibre. The corpora cavernosa are termed erectile tissue, because during sexual excitation, their fibrous tissue is expanded by blood that flows into and fills their empty spaces. The blood is temporarily trapped in the penis by the constriction of blood vessels that would normally allow it to flow out. The penis becomes enlarged, hardened, and erect as a result of this increased blood pressure. The corpus spongiosum is also considered erectile tissue. This area, however, does not become as enlarged as the other two during erection, for it contains more fibrous tissue and less space; unlike the corpora cavernosa, the corpus spongiosum has a constant blood flow during erection.
The corpora cavernosa and corpus spongiosum are enclosed by a circular layer of elastic tissue. This in turn is covered by a thin layer of skin. The skin, which is slightly darker in colour than the rest of the body, is loose and folded while the penis is in a flaccid state. At the beginning of the glans penis, a circular fold of skin, commonly called the foreskin (or prepuce), extends forward to cover the glans.
What is priapism?
Priapism is the pathologically prolonged painful erection of the penis. It is a urological emergency that requires immediate treatment to prevent complications, for example, difficulty with urination, urinary retention, impotence, cavernosa fibrosis, and gangrene.
What causes priapism?
The cause of priapism remains unclear in 50% of cases. Known causes of priapism include blood dyscrasias (sickle cell disease, leukemia, nephrotic syndrome, multiple myeloma, hyperviscosity states); solid tumors; trauma; spinal-cord injuries; and stroke. Drug-induced priapism accounts for 15% to 41% of all cases,l most often associated with two classes of drugs, neuroleptics and antihypertensives. Neuroleptic-induced priapism has been reported for phenothiazines, butyrophenones, risperidone, and clozapine.
What is a Winter shunt?
The Winter shunt is the most common procedure. With this technique a fistula is created between the glans penis and the corpora cavernosa. Possible post-operative complications are infection of the corpora cavernosa with abscess formation, urethral injury leading to stricture or urethrocutaneous fistula and penile hematoma with or without penile thrombosis resulting in erectile dysfunction.