[PP-129]
Resistant Priapism in Hemodialysis Patient: A Rare Case Report
Mustafa Gurkan Yenice, Yusuf Arıkan, Kami̇l Gökhan Seker, Yunus Colakoglu, Mithat Eksi, Osman Ozdemir, Emre Sam, Abdulmuttalip Simsek, Feyzi Arda Atar, Volkan TugcuIndoduction:
Priapism is a penis erection that lasts longer than 4 hours without sexual stimulation and is a urological emergency that requires immediate treatment.Priapism can be seen rarely after hemodialysis.
CASE:
A 47- year- old man who underwent hemodialysis for two months due to end-stage renal disease admitted to the emergency department due to priapism.There was no history of trauma, sickle cell anemia, illegal drug use, nitrate use, sexual intercourse, any psychostimulant use, vasoactive agent or phosphodiesterase inhibitors use. The penis was painful and rigid.Laboratory examinations showed BUN: 89 mg/dL, Cr: 6.23 mg/dL, Hb: 10.8 g/dL, blood gas from corpus cavernosum were pH:7.3, pCO2:49.1 mmHg, pO2:51 mmHg. The patient was diagnosed with ischemic priapism.. Then, the patient had undergone a failed conservative management which involved multiple corporal aspiration with a 16 G butterfly needle (The corporal aspiration was tried 2 times with a 30 minute interval) and performed intracavernous injection of sympathomimetic phenylephrine with the patient under local anesthesia (penile block) Despite the removal of approximately 150 cc venous blood with in 30 minutes, no detumescence was achieved. Then, the operation decision was taken to the patient. We decided to perform a T-shunt combined with corporal tunneling. In the follow-up visits, the patient who was not able to have detumescence was informed and planned to have an early implantation of penile prosthesis due to necrosis, fibrosis, permanent loss of erection.
Conlusion:
Mechanism of priapism in hemodialysis patient is accused of inadequate heparinization and dialysis-induced hypoxemia and acidosis. Early penile prosthesis implantation may be considered in resistant cases with no response to medical and surgical treatment.However, there is a need for more advanced studies due to lack of sufficient cases. We aimed to present the patient with resistant priapism who underwent hemodialysis.
priapizm yönetimi
)