A 21-year-old male presented to the emergency department with sustained and painful penile erection for 36 hours.
She reported no personal history of interest or similar episodes.
However, she reported having consumed marijuana three days before the clinical picture.
On physical examination, a penis in erection was observed, with both bodies showing very induration and without involvement of the glans.
Blood count, biochemistry and coagulation were performed without findings.
Placement of tapered bodies was performed with the following values: PO2:0.6mmHg; PCO2: 124; pH: 6.79, being compatible with low flow priapism.
As a first therapeutic measure, electrocardiographic and blood pressure monitoring, puncture-aspiration of intranasal sinuses and subsequent injections with intradermal saline and phenylephrine (five injections of phenylephrine) were performed.
After 24 hours, the clinical picture recurred, demonstrating an increase in penile tumescence. Doppler ultrasound was performed, which showed a marked increase in the size of the edema of the body.
Poorly defined hypoechogenic areas appear corresponding to ischemic zones; arterial flow is not collected inside the recessed artery.
As a second therapeutic maneuver, a cavernous-spongy shunt was performed according to the Winter technique.
A cavernous-spongy shunt was performed following the Al Ghorab technique, using a transverse incision in the dorsal surface of the glans apucial groove 1cm.
We removed one portion of the albuginea from the distal portion of each stent body.
With this procedure we achieved a total detumescence.
The next day the condition recurred, so it was decided to perform a right saphenous-cavernous shunt according to Grayhack technique, with satisfactory results.
We performed a longitudinal crural incision, discovering about 15cm of the internal saphenous vein, ligate the collateral branches preserving the mouth in the femoral vein.
The lateral border of the base of the penis was established, extracting a pad of albug from the collateral vein and performing thermal-lateral anastomosis of the thermal-lateral anastomosis of the external body.
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Evolutively, four months after the intervention, the patient reports spontaneous low quality and short duration, and is waiting to resolve the erectile dysfunction he has developed.
A control Doppler ultrasound showed the permeability of the saphenous-cavernous shunt, with both bodies becoming rigid in size and echogenicity, showing a decrease in the right ventricle
