e-ISSN:2148-1547
Uzamış İskemik Priapizmli Çocukta Tünelsiz T-Şunt Uygulaması
T-Shunt Without Tunneling For Prolonged Ischaemic Priapism in A Child
Olgu Sunumu
Başvuru: 24.05.2014
Kabul: 01.07.2014
Yayın: 25.08.2014
Oktay Üçer1, Bilal Gümüş1
1
Celal Bayar Üniversitesi Tıp Fakültesi Üroloji A.B.D.
Özet
Abstract
Priapizm cinsel istek veya uyarı olmaksızın uzamış ve
dirençli penil ereksiyon olarak tanımlanabilir. Bu durum
çocuklarda orak hücreli anemi dışında oldukça nadir
görülen bir durumdur. Biz bu makalede zeka geriliği ve
spasititesi olan ve düşük akımlı priapism şikayetiyle
başvuran bir çocuktaki tek taraflı tünelsiz T-şunt
uygulamamızı sunduk.
Priapism can be described as a “prolonged and
persistent penile erection unassociated with sexual
interest or stimulation. This condition in pediatric
population is vert rare, expect those with sickle cell
anemia. We report unilateral T-shunt without
tunneling in a child with low-flow priapism who had
spasticity and mental retardation.
Anahtar kelimeler: İskemik priapizm,
Keywords: Ischaemic priapism,
Introduction
Priapism can be described as a “prolonged and persistent penile erection unassociated with sexual interest or
stimulation” [1]. This condition occurs very infrequently in pediatrics outside of the sickle-cell population [2].
Pathophysiologically, priapism can either be high-flow (non-ischemic) priapism or low-flow (ischemic)
priapism [3]. Although the most common cause of low-flow priapism in children is sickle-cell anemia, the most
common cause in adult is medication. The most common cause of high-flow priapism is genital and pelvic
trauma [4]. Here, we report unilateral T-shunt without tunneling in a child with low-flow priapism who had
spasticity and mental retardation.
Case Report
A 11-year-old boy was admitted with painless rigid erection of 24 hours. Physical examination revealed a painless
rigid erection. There were no other urogenital pathological findings on physical examination. The peripheral
blood count showed a hemoglobin level of 12.3 g/dl, a hematocrit value of 35.4%, platelet count of 178.000/mm3
and a white blood cell count of 9.190/mm3 with normal differential. The serum biochemistry and hemoglobin
electrophoresis were normal. The rigidity of the erection decreased slightly following intracavernous
aspiration/irrigation, but complete detumescence did not occur. The cavernous blood gas testing revealed a pH of
7.03, a partial pressure of CO2 of 56,3 mmHg and a partial pressure of O2 of 20 mmHg. Intracavernous injection
of adrenaline (1/200.000) and irrigation were performed, but complete detumescence did not occur. Unilateral
(right corpus cavernosum) T-shunt without tunneling was performed and immediately penile detumescence was
observed. Penile rigidity did not recur within 15 minutes of creation of unilateral T-shunt so the procedure was
not repeated on the contralateral side. The patient was discharged from our clinic 1 day after the operation. The
patient’s parents provided written consent to use the information for the case report.
Discussion
Sorumlu Yazar: Oktay Üçer, Celal Bayar Üniversitesi Tıp Fakültesi Üroloji A.B.D.
Celal Bayar Üniversitesi Tıp Fakültesi Üroloji A.B.D.
[email protected]
The Cystoscope (207-208)
Sayfa 207
e-ISSN:2148-1547
The goal of all treatment is to make the erection go away and preserve future erectile function. In adult, treatment
options include: ice packs, surgical ligation (used in cases where an artery has been ruptured), intracavernous
injection (used for low-flow priapism), surgical shunt (used for low-flow priapism, a shunt is a passageway that is
surgically inserted into the penis to divert the blood flow and allow circulation to return to normal) and
aspiration [3]. Some authors reported that Winter shunt was safety performed on ischemic priapism in children [4,5].
On the other hand there are no children who were performed T-shunt with or without tunneling in literature.
The T-shunt is indicated in cases of ischemic priapism that are refractory to intracavernous injection of diluted α adrenergic medications. In ischemic priapism of > 3 days’ duration, tissue death and edema can obstruct blood
flow from the proximal to distal corpus cavernosum; in these cases a T-shunt alone might be insufficient to
restore penile circulation and consideration must be given to placing a bilateral T-shunt with tunneling of each
corpus cavernosum, using a rigid straight 20–24 F urethral sound or dilator [6]. The initial treatment was not
successful so we performed unilateral T-shunt without tunneling in the child and the procedure was successful.
Three-step treatment is recommended for low flow priapism in adult; if ischemia time is less than 24 hours,
evacuation of old blood and diluted α-adrenergic should be performed; if ischemia time is between 1 and 3 days,
T-shunt without tunneling will be enough for complete detumescence; if ischemia time is more than 3 days, Tshunt with tunneling needs to be performed.[6] Three-step treatment protocol can also be used in children with low
flow priapism. We suggest that unilateral T-shunt without tunneling can be safely used in pediatric priapism.
References
1. Burnett AL, Bivalacqua TJ. Priapism: Current principles and practice. Urol Clin N Am 2007;34:631-42.
2. Burnett AL. Priapism. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. CampbellWalsh Urology, 9th ed. Philedelphia: Saunders Elsevier 2007. p.839-50.
3. Keoghane SR, Sullivan ME, Miller MAV. The aetiology, pathogenesis and management of priapism. BJU
International 2002;90:149-154
4. Özçakır E, Yavaşçaoğlu B, Dönmez O, Ercan A, Balkan E, Kılıç N. Çocuklarda düşük akımlı priapizm.
Çocuk Cerrahisi Dergisi 2007;21:154-157
5. Winter CC. Cure for idiopathic priapism: new procedure for creating fistula between glans penis and
corpora cavernosa. Urology 1976;8:389-91
6. Garcia MM, Shindel AW, Lue TF. T-shunt with or without tunnelling for prolonged ischaemic priapism.
BJU Int 2008;102:1754-64.
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Uzamış İskemik Priapizmli Çocukta Tünelsiz T