Zuclopenthixol Induced Ischemic Priapism: Case Report and Review of Literature
,
Abstract
Objective: Present a case of zuclopenthixol associated priapism, literature review and focus on the stuttering priapism entity as a potential serious complication as well as providing information about possible preventive treatments.
Case report: A 44 year-old male patient with history of cocaine abuse with associated priapism presents with acute painful erection after starting zuclopenthixol for treatment of a psychotic episode. This episode was later followed by many other similar episodes defined as stuttering priapism.
Conclusion: Acute ischemic priapism is a potential serious side effect of antipsychotics that physicians especially psychiatrists needs to be aware of especially if the patient has previous episodes in order to prevent reoccurrence.
1. Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, Nehra A, Sharlip ID; Members of the Erectile Dysfunction Guideline Update Panel; Americal Urological Association. American Urological Association guideline on the management of priapism. J Urol. 2003;170(4 Pt 1):1318-24.
2. Bruno S, Bonaccio M, Bettati S, Rivetti C, Viappiani C, Abbruzzetti S, Mozzarelli A. High and low oxygen affinity conformations of T state hemoglobin. Protein Sci. 2001;10(11):2401-7.
3. Bivalacqua TJ, Musicki B, Hsu LL, Gladwin MT, Burnett AL, Champion HC. Establishment of a transgenic sickle-cell mouse model to study the pathophysiology of priapism. J Sex Med. 2009;6(9):2494-504.
4. Bivalacqua TJ, Liu T, Musicki B, Champion HC, Burnett AL. Endothelial nitric oxide synthase keeps erection regulatory function balance in the penis. Eur Urol. 2007;51(6):1732-40.
5. Callewaert P, Stockx L, Bogaert G, Baert L. Post-traumatic high-flow priapism in a 6-year-old boy: management by percutaneous placement of bilateral vascular coils. Urology. 1998;52(1):134-7.
6. Ramos CE, Park JS, Ritchey ML, Benson GS. High flow priapism associated with sickle cell disease.
J Urol. 1995;153(5):1619-21.
7. Volkmer, B. G., Nesslauer, T., Kraemer, S. C., Goerich, J., Basche, S., & Gottfried, H. W. (2001). Prepubertal high flow priapism: incidence, diagnosis and treatment. J. Urol., 166(3), 1018–1023.
8. Kuefer R, Bartsch G Jr, Herkommer K, Krämer SC, Kleinschmidt K, Volkmer BG. Changing diagnostic and therapeutic concepts in high-flow priapism. Int
J Impot Res. 2005;17(2):109-13.
9. Doufik J, Otheman Y, Khalili L, Ghanmi J, Ouanass A. Priapisme sous antipsychotiques et défis de prise en charge: à propos d'un cas [Antipsychotic-induced priapism and management challenges: a case report]. Encephale. 2014;40(6):518-21. French.
10. Hwang T, Shah T, Sadeghi-Nejad H. A Review of Antipsychotics and Priapism. Sex Med Rev. 2021;9(3):464-471.
11. Rezaee ME, Gross MS. Are We Overstating the Risk of Priapism With Oral Phosphodiesterase Type 5 Inhibitors? J Sex Med. 2020;17(8):1579-1582.
12. El-Bahnasawy MS, Dawood A, Farouk A. Low-flow priapism: risk factors for erectile dysfunction. BJU Int. 2002;89(3):285-90.
13. Zacharakis E, Garaffa G, Raheem AA, Christopher AN, Muneer A, Ralph DJ. Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation. BJU Int. 2014;114(4):576-81.
14. Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, Shamloul R. Priapism: pathogenesis, epidemiology, and management. J Sex Med. 2010;
7(1 Pt 2):476-500.
15. Ateyah A, Rahman El-Nashar A, Zohdy W, Arafa M, Saad El-Den H. Intracavernosal irrigation by cold saline as a simple method of treating iatrogenic prolonged erection. J Sex Med. 2005;2(2):248-53.
16. Burnett AL, Sharlip ID. Standard operating procedures for priapism. J Sex Med. 2013;10(1):180-94.
17. Bodner DR, Lindan R, Leffler E, Kursh ED, Resnick MI. The application of intracavernous injection of vasoactive medications for erection in men with spinal cord injury. J Urol. 1987;138(2):310-1.
18. Roberts JR, Price C, Mazzeo T. Intracavernous epinephrine: a minimally invasive treatment for priapism in the emergency department. J Emerg Med. 2009 Apr;36(3):285-9.
19. Lagoda G, Sezen SF, Cabrini MR, Musicki B, Burnett AL. Molecular analysis of erection regulatory factors in sickle cell disease associated priapism in the human penis. J Urol. 2013 Feb;189(2):762-8.
20. Levey HR, Kutlu O, Bivalacqua TJ. Medical management of ischemic stuttering priapism: a contemporary review of the literature. Asian J Androl. 2012;14(1):156-63.
21. Morrison BF, Burnett AL. Stuttering priapism: insights into pathogenesis and management. Curr Urol Rep. 2012;13(4):268-76.
22. Roizenblatt M, Figueiredo MS, Cançado RD, Pollack-Filho F, de Almeida Santos Arruda MM, Vicari P, Sato JR, Tufik S, Roizenblatt S. Priapism is associated with sleep hypoxemia in sickle cell disease. J Urol. 2012;188(4):1245-51.
23. Champion HC, Bivalacqua TJ, Takimoto E, Kass DA, Burnett AL. Phosphodiesterase-5A dysregulation in penile erectile tissue is a mechanism of priapism. Proc Natl Acad Sci U S A. 2005;102(5):1661-6.
24. Bivalacqua TJ, Musicki B, Kutlu O, Burnett AL. New insights into the pathophysiology of sickle cell disease-associated priapism. J Sex Med. 2012;9(1):79-87.
25. Hou LT, Burnett AL. Regimented Phosphodiesterase Type 5 Inhibitor Use Reduces Emergency Department Visits for Recurrent Ischemic Priapism. J Urol. 2021 Feb;205(2):545-553.
2. Bruno S, Bonaccio M, Bettati S, Rivetti C, Viappiani C, Abbruzzetti S, Mozzarelli A. High and low oxygen affinity conformations of T state hemoglobin. Protein Sci. 2001;10(11):2401-7.
3. Bivalacqua TJ, Musicki B, Hsu LL, Gladwin MT, Burnett AL, Champion HC. Establishment of a transgenic sickle-cell mouse model to study the pathophysiology of priapism. J Sex Med. 2009;6(9):2494-504.
4. Bivalacqua TJ, Liu T, Musicki B, Champion HC, Burnett AL. Endothelial nitric oxide synthase keeps erection regulatory function balance in the penis. Eur Urol. 2007;51(6):1732-40.
5. Callewaert P, Stockx L, Bogaert G, Baert L. Post-traumatic high-flow priapism in a 6-year-old boy: management by percutaneous placement of bilateral vascular coils. Urology. 1998;52(1):134-7.
6. Ramos CE, Park JS, Ritchey ML, Benson GS. High flow priapism associated with sickle cell disease.
J Urol. 1995;153(5):1619-21.
7. Volkmer, B. G., Nesslauer, T., Kraemer, S. C., Goerich, J., Basche, S., & Gottfried, H. W. (2001). Prepubertal high flow priapism: incidence, diagnosis and treatment. J. Urol., 166(3), 1018–1023.
8. Kuefer R, Bartsch G Jr, Herkommer K, Krämer SC, Kleinschmidt K, Volkmer BG. Changing diagnostic and therapeutic concepts in high-flow priapism. Int
J Impot Res. 2005;17(2):109-13.
9. Doufik J, Otheman Y, Khalili L, Ghanmi J, Ouanass A. Priapisme sous antipsychotiques et défis de prise en charge: à propos d'un cas [Antipsychotic-induced priapism and management challenges: a case report]. Encephale. 2014;40(6):518-21. French.
10. Hwang T, Shah T, Sadeghi-Nejad H. A Review of Antipsychotics and Priapism. Sex Med Rev. 2021;9(3):464-471.
11. Rezaee ME, Gross MS. Are We Overstating the Risk of Priapism With Oral Phosphodiesterase Type 5 Inhibitors? J Sex Med. 2020;17(8):1579-1582.
12. El-Bahnasawy MS, Dawood A, Farouk A. Low-flow priapism: risk factors for erectile dysfunction. BJU Int. 2002;89(3):285-90.
13. Zacharakis E, Garaffa G, Raheem AA, Christopher AN, Muneer A, Ralph DJ. Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation. BJU Int. 2014;114(4):576-81.
14. Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, Shamloul R. Priapism: pathogenesis, epidemiology, and management. J Sex Med. 2010;
7(1 Pt 2):476-500.
15. Ateyah A, Rahman El-Nashar A, Zohdy W, Arafa M, Saad El-Den H. Intracavernosal irrigation by cold saline as a simple method of treating iatrogenic prolonged erection. J Sex Med. 2005;2(2):248-53.
16. Burnett AL, Sharlip ID. Standard operating procedures for priapism. J Sex Med. 2013;10(1):180-94.
17. Bodner DR, Lindan R, Leffler E, Kursh ED, Resnick MI. The application of intracavernous injection of vasoactive medications for erection in men with spinal cord injury. J Urol. 1987;138(2):310-1.
18. Roberts JR, Price C, Mazzeo T. Intracavernous epinephrine: a minimally invasive treatment for priapism in the emergency department. J Emerg Med. 2009 Apr;36(3):285-9.
19. Lagoda G, Sezen SF, Cabrini MR, Musicki B, Burnett AL. Molecular analysis of erection regulatory factors in sickle cell disease associated priapism in the human penis. J Urol. 2013 Feb;189(2):762-8.
20. Levey HR, Kutlu O, Bivalacqua TJ. Medical management of ischemic stuttering priapism: a contemporary review of the literature. Asian J Androl. 2012;14(1):156-63.
21. Morrison BF, Burnett AL. Stuttering priapism: insights into pathogenesis and management. Curr Urol Rep. 2012;13(4):268-76.
22. Roizenblatt M, Figueiredo MS, Cançado RD, Pollack-Filho F, de Almeida Santos Arruda MM, Vicari P, Sato JR, Tufik S, Roizenblatt S. Priapism is associated with sleep hypoxemia in sickle cell disease. J Urol. 2012;188(4):1245-51.
23. Champion HC, Bivalacqua TJ, Takimoto E, Kass DA, Burnett AL. Phosphodiesterase-5A dysregulation in penile erectile tissue is a mechanism of priapism. Proc Natl Acad Sci U S A. 2005;102(5):1661-6.
24. Bivalacqua TJ, Musicki B, Kutlu O, Burnett AL. New insights into the pathophysiology of sickle cell disease-associated priapism. J Sex Med. 2012;9(1):79-87.
25. Hou LT, Burnett AL. Regimented Phosphodiesterase Type 5 Inhibitor Use Reduces Emergency Department Visits for Recurrent Ischemic Priapism. J Urol. 2021 Feb;205(2):545-553.
| Files | ||
| Issue | Vol 17, No 2 (June 2023) | |
| Section | Case Reports | |
| DOI | https://doi.org/10.18502/jfrh.v17i2.12875 | |
| Keywords | ||
| Zuclopenthixol Antipsychotics Priapism | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mansour E, Danaf S, Ghoussainy D, Assaf G, Ghantous I, El-Khoury F. Zuclopenthixol Induced Ischemic Priapism: Case Report and Review of Literature. J Family Reprod Health. 2023;17(2):109-112.
