Introduction:
High-flow priapism is rare, uncontrolled arterial inflow, preceded by penile or perineal trauma and arterial-lacunar fistula. There are several ways to treat high-flow priapism,, i.e., conservative management, use of ice packs, mechanical decompression, surgery, and super-selective arterial embolization. Embolization is currently widely accepted in patients who fail from conservative management. This study aimed to report using gel foam and microcoil embolization in high-flow priapism recurrent to PVA embolization.
Case Study:
A 36-year-old man complained of prolonged erection. The erection occurred three days before admission while waking up in the morning, not accompanied by either sexual stimulation or pain. There was a history of fall four days ago in the afternoon, with the patients groin hitting a rocky ground. Physical examination revealed an erect penis which felt warm, with an EHS of 4. Blood gas analysis of the corpus cavernosum showed bright red blood with pH of 7.47, pCO2 23.6, pO2 145, HCO3 17.3, BE -6, and SaO2 99%. Doppler ultrasound examination of the penis showed high-flow priapism. Embolization with PVA was performed and there were decreased complaints. A few hours later erection occurred. Reevaluation was then performed and continued with embolization using gelfoam and microcoil. There were immediate successful results (EHS 3) accompanied by a decrease in symptoms. Long-term follow-up has shown a return to normal erectile function six months following the injury.
Conclusion :
Priapism may happen from various etiologies. Differentiating high-flow and low-flow is paramount during the acute phase because of different treatment strategies. Conservative management may be applied to high-flow priapism. If conservative management fails, embolization may be attempted. The choice of embolization agent must be taken into account.
Objective: To presents a case series of three patients who received PCNL during 2020 and 2021. Case(s) Presentation: We reported three cases of two females and one male, aged 54, 63, and 48. All patients were diagnosed for having the staghorn stones in the kidney. We performed the “Single Site Multipuncture Supine (SMS) PCNL” technique on these patients. Discussion: Percutaneous Nephrolithotripsy (PCNL) is the preferred surgical technique for treating staghorn or other complicated kidney stones. There are many techniques and modified positions available for PCNL. This technique removes complex kidney stones by making a one cm skin incision to accommodate multiple punctures to access all kidney poles. The highest reduction in hemoglobin was only 1.54 g/dL in the patient who got four punctures, no blood transfusion was needed during post-operative recovery, and no complications occurred during the follow-up period. All patients were stone-free post-operatively without any need for additional procedures. The mean time of overall surgery was 130 minutes. Conclusion: This single-site multi-punctures supine PCNL technique could give the advantage to cosmetics due to less tissue injury.
Keywords: Multi punctures, PCNL, staghorn stones.
Objective: Overactive bladder (OAB) is a chronic medical condition that has a tremendous impact on the quality of life for both men and women. Urgency is a primary symptom in diagnosing OAB and is closely related to the urge to urinate frequently during the day. Material & Methods : A retrospective study was conducted from January 2018 until December 2020 by using medical records database in our institution. There were 562 patients. Inclusion criteria used in this study are patients with OAB symptoms with any etiology who have undergone conservative, moderate, or future or postoperative measures in the study period. The patient who cannot be cooperative in filling out the International Prostate Symptom Score (IPSS) questionnaire or the patient who refuses were excluded from this study. Statistical analysis was performed using Pearson correlation and linear regression. Results: From the results, linear regression, obtained significance (p <0.05) on the variables of frequency, urgency and nocturia. A linear regression value of y= -0.005 + 0.987X was obtained which illustrates that the higher the frequency, urgency and nocturia variables, the higher the possibility of Lower urinary tract symptoms (LUTS) that can be correlated with OAB. Conclusion: Frequency, nocturia, and urgency are factors that influence the significance of the IPSS variable on the total IPSS score. Questionnaire items on overactive bladder symptoms score (OABSS) have a significant correlation with IPSS scores.
