Malignant priapism is a prolonged and painful erection not linked to sexual arousal, often resulting from metastatic cancers invading the penile tissue. It has various etiologies, including hematological, neurological, and iatrogenic causes, with poor prognosis due to the advanced nature of associated malignancies. Diagnosis involves imaging and biopsy, while management is tailored and may include conservative measures or more invasive treatments, reflecting the life expectancy and overall patient condition.

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.