A quick overview of malignant priapism which is a rare complication secondary to penile metastasis of malignant tumours.

1. Malignant PriapismMalignant Priapism
A Quick Overview
Shady Nafie
Senior Clinical Fellow Urology
Lister Hospital

2. Priapism
๏ Priapism is a persistent, prolonged (more than 6
hours) and painful erection not associated with
sexual stimulation.
๏ First described in 1824.
๏ Named after greek god of fertility, Priapus.

3. ๏ Idiopathic.
๏ Haematological (Sickle cell, Leukaemia,
Lymphoma).
๏ Neurological (Spinal cord injury).
๏ Traumatic (Genital, Perineal)
๏ Iatrogenic (Intra-cavernous injections).
๏ Infection (Malaria, Rabies, Scorpion sting).
๏ Penile Metastasis of Malignant Tumours.
Priapism
Aetiology

4. Penile Metastasis.
๏ Uncommon condition.
๏ First described by Eberth in 1870.
๏ 460 cases are reported since.
๏ Manifestations include: indurated nodules,
penile mass, diffuse penile swelling,
ulceration and priapism (in 40% of cases
and is referred to as “Malignant Priapism”).

5. ๏ Metastatic tumours of the penis represent
evidence of a more widespread malignant
disease with a poor prognosis, and the
majority of patients die within 1 year.
Penile Metastasis.

6. Mechanism of spread
๏ Retrograde venous spread (most
common).
๏ Retrograde lymphatic spread.
๏ Tumour implantation via arteries.
๏ Direct invasion.
๏ Implantation of tumour cells during
instrumentation and damage to the
urethral mucosa.
Penile Metastasis.

7. Malignant Priapism
๏ Persistent, painful, nonsexual erections
caused by invasion of malignant cells into
the cavernosal sinuses and their
associated venous systems.
๏ Term is first used by Peacock in 1938.
๏ 88 cases are reported since.
๏ Occurred in 40% of cases of Tumour Penile
Metastasis.

8. Origin of primary Tumour
Malignant Priapism
๏ Based upon the 88 reported
cases.

9. ๏ Tumour infiltration of the corpora
cavernosa leads to:
๏ Stasis or thrombosis of the venous sinuses,
blocking the venous drainage. Remaining
patent cavernous sinuses become
distended, leading to Erection (priapism).
๏ Irritation of the neural pathways, causing
Pain.
๏ The arterial supply is usually not affected.
Malignant Priapism
Pathogenesis

10. ๏ Core-Needle biopsy (confirms diagnosis).
๏ Corporeal aspiration (confirms diagnosis).
๏ MRI (reliable alternative for confirming the
diagnosis and assessing the extension of the
disease).
๏ Doppler ultrasound (differentiate between High
flow and Low flow priapism).
Malignant Priapism
Investigations

11. Management
๏ Tailored according to the case, it includes:
๏ Conservative (have a short life expectancy,
conservative treatment can be a reasonable
choice).
๏ Excision of corpora cavernosa (effective in treating
pain).
๏ Total penectomy.
๏ Radiotherapy.
๏ Chemotherapy.
Malignant Priapism

12. Case Report
๏ 64 years old male.
๏ Presented with:
๏ Weight loss (3 stones), lethargy, generalised bone
pains (for 3 months).
๏ Constipation (for 1 week)
๏ Painful erection (for 1 month).
Presentation

13. Case Report
๏ Passing urine.
๏ No haematuria.
๏ DRE showed benign feeling prostate.
๏ PSA was 1.4
๏ Had a painful erection for 1 month with soft
glans penis.
Presentation

14. Case Report
๏ CT Chest/Abdo/Pelvis, showed:
๏ Enlarged Hilar, Mediastinal, Para-aortic Lymph Nodes.
๏ Enlarged necrotic inguinal Lymph Nodes.
๏ Large left adrenal mass.
๏ L3 vertebral body collapse.
Investigation

15. Case Report
๏ Biopsy from inguinal lymph nodes, showed
poorly differentiated squamous cell carcinoma.
๏ Patient refused any further investigations or
treatment and died in 2 weeks.
Investigation

16. Thank You.