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CORRECTION OF PRIAPISM -
Spongiosum-cavernosum
What is
CORRECTION OF PRIAPISM - Spongiosum-cavernosum?
Priapism is the occurrence of any persistent
erection for more than four hours duration in
the absence of sexual stimulation.
Spongiosum-cavernosum involves treatment for
priapism.
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Effects
of CORRECTION OF PRIAPISM -
Spongiosum-cavernosum
The
goals of management are to assist with emptying
the corpora cavernosa, relieve the patient's
pain, and, if possible, prevent impotence.
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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.
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Your Consultation
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.
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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).
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Recovery
Post-operative infection should be prevented by
broad spectrum prophylactic antibiotics.
Antibiotics should be given especially when
aspirations and surgical procedures are
contemplated.
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Risks
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
. infections
. 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
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Frequently Asked Questions
Q:
What are the corpus spongiosum and corpora
cavernosa?
A:
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.
Q:
What is priapism?
A:
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.
Q:
What causes priapism?
A:
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.
Q:
What is a Winter shunt?
A:
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.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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