Rare emergency in children: Priapism and stepwise treatment approach

Kılıç, Nizamettin; Ozcakir, Esra; Karagözlü Akgül, Ahsen; Uçar, Murat; Balkan, Emin

doi:10.14744/tjtes.2020.74670

Rare emergency in children: Priapism and stepwise treatment approach

Nazim Abdulkadir KANKİLİC, (Marmara Üniversitesi, Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Çocuk Ürolojisi Anabilim Dalı, İstanbul, Türkiye)

Murat UÇAR, (Akdeniz Üniversitesi, Tıp Fakültesi, Üroloji Anabilim Dalı, Çocuk Ürolojisi Anabilim Dalı, Antalya, Türkiye)

Esra OZCAKİR, (Sağlık Bilimleri Üniversitesi, Bursa Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Bursa, Türkiye)

Mehmet Emin BALKAN, (Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Çocuk Ürolojisi Anabilim Dalı, Bursa, Türkiye)

Nizamettin KİLİC (Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Cerrahisi Anabilim Dalı, Çocuk Ürolojisi Anabilim Dalı, Bursa, Türkiye)

Ulusal Travma ve Acil Cerrahi Dergisi

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Yıl: 2022 Cilt: 28 Sayı: 4 Sayfa Aralığı: 464 - 470 Metin Dili: İngilizce DOI: 10.14744/tjtes.2020.74670 İndeks Tarihi: 10-05-2023

Rare emergency in children: Priapism and stepwise treatment approach

Öz:

BACKGROUND: Priapism is a rare condition in children and the treatment algorithm is controversial in this age group. Herein, we report eight cases with low-flow priapism and our stepwise treatment approach in light of literature. METHODS: We present a simple stepwise treatment for low-flow priapism including five steps. Step 1: Cold compress and analgesia while evaluation the priapism and its etiology. Step 2: Corporal aspiration and adrenaline infusion in the ward. Step 3: Modified Winter shunt in the same place. Step 4: Ketamine application and caudal block in the operating room. Step 5: Sapheno-cavernous (Grayhack) shunt. Eight cases with low-flow priapism were reviewed retrospectively. Symptoms, duration of tumescence, the interventions, and step that provide detumescence were recorded. RESULTS: The mean age of patients was 8.5 years (1–17 y). The median time of the priapism before admission was 15 h (4–165 h). The etiological factors were sickle cell disease, hemodialysis due to chronic renal failure, and factor V Leiden mutation in three patients. Detumescence was achieved in one patient at Step 2, in two patients at Steps 3, 4, and 5, respectively. Rigidity of cavernous body was observed in one patient in long-term follow-up. CONCLUSION: Low-flow priapism is a urological emergency that may cause erectile dysfunction. Treatment options should be selected according to a protocol that prevents time loss and avoids more invasive treatment in unnecessary situations. Our algorithm with simple nature and its steps from less invasive to more invasive procedures may be an alternative for the treatment of low-flow priapism.

Anahtar Kelime:

Çocukluk çağının nadir bir acili: Priapizm ve basamaklı tedavi yaklaşımı

Öz:

AMAÇ: Priapizm çocukluk çağında çok nadir görülen bir hastalıktır. Hasta sayısının azlığı nedeniyle tedavi algoritması da halen literatürde netleşmemiştir. Bu çalışmada, priapizmli sekiz çocuk hasta ve kliniğimizde uyguladığımız basamaklı tedavi yaklaşımımız literatür ışığında sunulmaktadır. GEREÇ VE YÖNTEM: Uyguladığımız tedavi beş basamaktan oluşmaktadır: 1. basamak; etiyoloji değerlendirmesi yapılırken soğuk kompres ve analjezi uygulaması. 2. basamak; korpus kavernozuma korporal aspirasyon ve adrenalin infüzyonu. 3. basamak; Modifiye Winter şunt. 4. basamak; ameliyathanede ketamin infüzyonu ve kaudal blok uygulaması. 5. basamak; safeno-kavernöz (Grayhack) şunt. Düşük akımlı priapizmi olan sekiz hastanın verileri geriye dönük olarak ele alındı. Başvuru şekli, tumesans süresi, yaşı, yapılan müdahaleler ve hangi basamakta detumesans sağlandığı kaydedildi. BULGULAR: Yaş ortalaması 8.5 (1–17) yıl idi. Başvuru öncesindeki ortanca tumesans süresi 15 saat (4–165) idi. Üç hastada etiyolojik faktörler; orak hücreli anemi, kronik böbrek yetersizliği nedeniyle yapılan hemodiyaliz ve faktör V Leiden mutasyonu idi. Bir hastada ikinci basamakta detumesans sağlandı. 3, 4, 5. basamakalarda detumesans sağlanan 2’şer hasta oldu. Uzun dönem kontrolünde bir hastada kavernöz cisim rijiditesi görüldü. TARTIŞMA: Düşük akımlı priapizm ürolojik bir acildir ve erektil disfonksiyona neden olabilir. Tedavi seçenekleri, zaman kaybını ve gereksiz invaziv işlemleri engellemek için bir algoritma veya bir tedavi protokolü ile uygulanmalıdır. Kliniğimizde uygulanan tedavi protokolü basit ve daha az invaziv işlemden daha invaziv işleme doğru gitmektedir ve düşük akımlı priapizm tedavisinde iyi bir alternatif olabilir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Karagözlü Akgül A, Uçar M, Ozcakir E, Balkan E, Kılıç N (2022). Rare emergency in children: Priapism and stepwise treatment approach. , 464 - 470. 10.14744/tjtes.2020.74670
Chicago	Karagözlü Akgül Ahsen,Uçar Murat,Ozcakir Esra,Balkan Emin,Kılıç Nizamettin Rare emergency in children: Priapism and stepwise treatment approach. (2022): 464 - 470. 10.14744/tjtes.2020.74670
MLA	Karagözlü Akgül Ahsen,Uçar Murat,Ozcakir Esra,Balkan Emin,Kılıç Nizamettin Rare emergency in children: Priapism and stepwise treatment approach. , 2022, ss.464 - 470. 10.14744/tjtes.2020.74670
AMA	Karagözlü Akgül A,Uçar M,Ozcakir E,Balkan E,Kılıç N Rare emergency in children: Priapism and stepwise treatment approach. . 2022; 464 - 470. 10.14744/tjtes.2020.74670
Vancouver	Karagözlü Akgül A,Uçar M,Ozcakir E,Balkan E,Kılıç N Rare emergency in children: Priapism and stepwise treatment approach. . 2022; 464 - 470. 10.14744/tjtes.2020.74670
IEEE	Karagözlü Akgül A,Uçar M,Ozcakir E,Balkan E,Kılıç N "Rare emergency in children: Priapism and stepwise treatment approach." , ss.464 - 470, 2022. 10.14744/tjtes.2020.74670
ISNAD	Karagözlü Akgül, Ahsen vd. "Rare emergency in children: Priapism and stepwise treatment approach". (2022), 464-470. https://doi.org/10.14744/tjtes.2020.74670

APA	Karagözlü Akgül A, Uçar M, Ozcakir E, Balkan E, Kılıç N (2022). Rare emergency in children: Priapism and stepwise treatment approach. Ulusal Travma ve Acil Cerrahi Dergisi, 28(4), 464 - 470. 10.14744/tjtes.2020.74670
Chicago	Karagözlü Akgül Ahsen,Uçar Murat,Ozcakir Esra,Balkan Emin,Kılıç Nizamettin Rare emergency in children: Priapism and stepwise treatment approach. Ulusal Travma ve Acil Cerrahi Dergisi 28, no.4 (2022): 464 - 470. 10.14744/tjtes.2020.74670
MLA	Karagözlü Akgül Ahsen,Uçar Murat,Ozcakir Esra,Balkan Emin,Kılıç Nizamettin Rare emergency in children: Priapism and stepwise treatment approach. Ulusal Travma ve Acil Cerrahi Dergisi, vol.28, no.4, 2022, ss.464 - 470. 10.14744/tjtes.2020.74670
AMA	Karagözlü Akgül A,Uçar M,Ozcakir E,Balkan E,Kılıç N Rare emergency in children: Priapism and stepwise treatment approach. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(4): 464 - 470. 10.14744/tjtes.2020.74670
Vancouver	Karagözlü Akgül A,Uçar M,Ozcakir E,Balkan E,Kılıç N Rare emergency in children: Priapism and stepwise treatment approach. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(4): 464 - 470. 10.14744/tjtes.2020.74670
IEEE	Karagözlü Akgül A,Uçar M,Ozcakir E,Balkan E,Kılıç N "Rare emergency in children: Priapism and stepwise treatment approach." Ulusal Travma ve Acil Cerrahi Dergisi, 28, ss.464 - 470, 2022. 10.14744/tjtes.2020.74670
ISNAD	Karagözlü Akgül, Ahsen vd. "Rare emergency in children: Priapism and stepwise treatment approach". Ulusal Travma ve Acil Cerrahi Dergisi 28/4 (2022), 464-470. https://doi.org/10.14744/tjtes.2020.74670