|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 3 | Page : 248-249
Paediatric priapism in emergency medicine
Emanuele Baldassarre1, Ilaria Prosperi Porta2, Lorna Spagnol3
1 Department of Andrology and Paediatric Urology, ASL Valle d'Aosta, Rome, Italy
2 Emergency Medicine, ASL Valle d'Aosta, Rome, Italy
3 Department of Paediatric Andrology, Bambino Gesù Children's Research Hospital, Rome, Italy
|Date of Submission||13-May-2020|
|Date of Decision||21-May-2020|
|Date of Acceptance||23-May-2020|
|Date of Web Publication||17-Jul-2020|
Dr. Emanuele Baldassarre
Department of Andrology and Paediatric Urology, Umberto Parini Hospital, Viale Ginevra 3 11100 Aosta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Baldassarre E, Porta IP, Spagnol L. Paediatric priapism in emergency medicine. Niger Postgrad Med J 2020;27:248-9
We read with interest the stimulating article recently published in your journal by Abolarinwa et al. The higher incidence of haemoglobinopathies makes paediatric priapism more common in such environments. With respect to the low incidence of priapism in Italy, it is very impressive that the authors had 37 cases in a 5-year period at their hospital alone. According to the authors, there is an ubiquitous need for subspecialisation in paediatric urology to treat specific pathologies such as priapism, an emergency, poorly described in literature and generally not sufficiently managed during the urologic postgraduate training.
Herein, we report two cases of priapism in the paediatric age group, which occurred in our department that may represent a great challenge for non-experienced doctors. In both cases, the diagnosis was made later and the presence of a paediatric andrologist was the determinant for a correct approach.
The first patient, a 16-year-old boy, presented with priapism for 4 days, unrecognised by the general practitioner. From the anamnesis, there was a similar episode 3 weeks before, which lasted for 2 hours and spontaneously regressed. Physical examination revealed a modest splenomegaly and widespread lymphadenopathy. The laboratory findings revealed 320,000 white blood count (blasts 50%). An urgent bilateral glandulo-cavernous shunt was done. He was transferred to a paediatric oncology centre, with a clinical suspicion of a leukaemia. No follow-up data are present.
The second child, 12 years old, was referred by the paediatrician for a modest persistent and moderately painful erection, of about 48 h duration. A direct scrotal trauma from a straddle injury on a gate, which occurred a week ago, emerged from the anamnesis.
Physical examination showed a modest scrotal hematoma associated with a modestly turgid penis. The Doppler appeared difficult to interpret, therefore an urgent arteriography was done. The examination showed an important arteriovenous fistula at the level of the pudendal vessels. We decided embolisation, with rapid resolution of the clinical complaint. At 1-month and 3-month follow-up, the Doppler showed the persistence of normal blood flow and complete regression of the symptoms. At 8-year follow-up, the boy has normal erections.
While a low-flow priapism is more common and caused by a venous obstruction, is generally painful and always presents as a surgical emergency, a high-flow priapism is a rare disease in children and is due to the formation of an arteriovenous fistula usually following perineal trauma.
Paediatric priapism represents a rare pathology in Europe, but the low-flow variant generally is not rare in the sub-Saharan Africa, due to the higher incidence of haemoglobinopathies. However, the high-flow type is rare even in the adult population. In low-flow priapism, the shunt represents the accepted emergency procedure, whereas in the high-flow type, it remains controversial whether to perform embolisation of the fistula or stick to a conservative treatment. The general practitioner, the paediatrician and the emergency medicine trainer should be aware of the problem, suspect it and refer the patient for early treatment to avoid permanent damage of erectile function, especially in the paediatric age group.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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