Bristol Urological Institute | Education

Bristol Urological Institute | Improving care by advancing knowledge

Education - Case Histories
Erectile Dysfunction - Priapism

C Gingell and T Porter

A 53-year old male was admitted with a painful priapism of 72 hours duration. No medication was involved: the patient had previously suffered with prolonged erections, lasting for a few hours. No predisposing factors for priapism have been identified. Corporal aspiration and aramine was unsuccessful in achieving decompression, therefore an Ebbehoj or modified Winter shunt was performed. This was temporarily successful, but the erection returned. A right cavernoso-spongiosus shunt was performed, which again was partially successful, the patient was catheterised post-operatively. The procedure was complicated by a brief post-operative infection and the patient developed a discharge from his urethra.

After his operation the patient was discharged with a catheter in place with arrangements to come back into hospital after one week for a trial without catheter, and then again one week after that for flows as an outpatient.

The patient returned to hospital and had his catheter removed. The penis was indurated and still partially tumescent. A trial without catheter (TWOC) was successful but there was some terminal haematuria.
A month later he was seen for review. A lot of purulent urine was still coming from the penis when squeezed so an ascending urethrogram was requested.
Ten days later the patient had an ascending urethrogram. A catheter (12 Foley) was inserted into the top of the urethra and contrast medium introduced (Niopam 200). The contrast medium filled the penile urethra and the bulbar urethra but did not reflux through the membranous or prostatic urethras into the bladder (Figure 1). In the proximal penile urethra there is a communication with a cavity on the dorsal side of the urethra (approximately 3 cm diameter) and this cavity filled preferentially to the urethra (Figure 2). No urethral strictures were demonstrated although only the anterior urethra was demonstrated. Multiple small lucencies were noted incidentally projected over the substance of the penis, dorsal to the distal penile urethra.

Are these an expected post-operative appearance?


Figure 1. Urethrogram showing cavity	Figure 2. Post void showing cavity extent

Comments

Clinically the patient has an infection, probably at the site of his corporo-spongiosal shunt, and is collecting urine there. On squeezing the penis a large amount of purulent discharge came out through the urethra. The penis is also still swollen but not woody hard and probably has quite considerable preservation of erectile tissue. The patient is on Trimethoprim (prescribed by his GP) and has been advised to bathe twice daily and to squeeze and express the penis after every act of micturition.

What is the best treatment? Should a catheter be inserted and, if so, urethral or suprapubic?

Feedback
Any comments, ideas or answers? Email edu@bui.ac.uk

^ Go to Top

< Return to Case Histories

Page Last Updated 11 October, 2009