15
ESSM
Today
Study cases from ISSM List
Editorial Comment
Interestingly, few weeks after reading this post I
received in my office a South American patient
with a similar history: Perineal pain after sex.
Asked deeper, the patient reported having pre-
viously had a relationship with the woman on
top and penetration in “awkward position”. He
reported having noticed a crack in the perineum
with sudden partial loss of erection.
I thought it was a fracture proximal penis
(corpora cavernosa), in this case, as in the
above-mentioned, without hematoma (partial
fracture). In my case the position of women
(on top) was clearly related, as mentioned Tuan
Le Anh.
There could be a predisposing factor as dis-
cussed in the forum. However, with the images
and complementary test (MRI, U.S. Duplex, etc.)
we found it difficult to differentiate acute lesions
of other pre-existing.
We do not know which was the clinical course
of the patient discussed in the forum. My pa-
tient had a satisfactory clinical outcome with
conservative maneuvers.
It is difficult to think of a partial priapism and
even harder to prove thrombosis in the context
of a sexual relationship.
We think it is useful to share cases like this, cer-
tainly rare to hear the views of other colleagues,
and keep in mind the different diagnostic pos-
sibilities and therapeutic options.
This post is particularly interesting because it
includes two useful references: A clinical refer-
ence on potentially similar cases, and the other
on technical details of the MRI. Very interesting.
Dr. Natalio Cruz
Raoul Alberto Belen posted:
Dear colleague,
I have seen more than 70 priapism with different etiologies, high and low flow. I’ve never seen
partial or segmental priapism of a corpus cavernosum. It’s more about the clinic is more a
cavernous fracture with four days of evolution: Pain four days after sexual intercourse, regional
dilatation of corpus cavernosum, decrease flow (may be hematoma) with segmental thrombosis
post in resonance. I ask because a segmental dilatation of the corpora cavernosa? Segmental
priapism? What would be the cause? I find no explanation.
If the diagnosis had been a fracture in the penis I would have recommended to the patient
the following:
1) Sexual abstinence
2) Anti-inflammatory drugs (surgery in case of penile fracture) in this case would be justified
if the dilatation cavernous body is aneurysma
3) Explain to the patient carefully
4) The erection should be normal by intercavernous communication
5) Do not administer tadalafil up to 30 days if necessary
Dr. Raul Alberto Belen
... and finally Richard Grunert answered:
Thanks for the replies,
I will be seeing him back in clinic tomorrow. He will be returning to South America to work in
August. Note that he has had recurrent episodes and that sexual activity in the past helped
resolved this until this time.
My plan is to re-study him with the MRI (great review article above!) in the future, and hope-
fully when he is a non-thrombosed state, to see if he has a congenital or acquired vascular
disorder that can explain this.
If this is a vascular abnormality I hopefully may be able to offer him an interventional radiology
procedure to correct this.
