膀胱癌陰莖轉移繼發性持續勃起
林士勛，王弘仁1
高雄長庚紀念醫院外科部 泌尿科1
Priapism secondary to penile metastasis of bladder cancer
Shih-Hsun Lin，Hung-Jen Wang
Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Introduction
Malignant priapism secondary to penile metastases is a rare condition. The first three primary tumor sites are prostate, bladder and recto-sigmoid. Clinical manifestations of penile metastases vary widely, including penile nodules, cutaneous findings, or priapism. We describe an interesting case of priapism secondary to penile metastasis of bladder cancer and a brief review of literature.
Case report
A 52-year-old male patient with history of schizophrenia was admitted to our clinic with penile erection and urine retention with voiding difficulty. Fifteen months earlier, he underwent transurethral resection of bladder tumor(TURBT). Postoperative pathology report revealed infiltrating urothelial carcinoma, large nested variant with detrusor muscle invasion. Radical cystectomy was advised but patient refused. Few months earlier, recurrence of bladder cancer was detected and TURBT was done. One month earlier, penile erection with focal pain and urine retention developed
Physical examination showed no palpable hard nodules or visible skin lesions over penile shaft. Patient also denied taking medications or injecting drug (Ex: PGE1) to penis.
We first performed intracorporal blood aspiration for blood gas sampling. The data revealed no acidosis or hypercapnia (pH:7.425, HCO3:24.5 mmol/L, pO2:52.6 mmHg). Further penile echo showed patency of bilateral cavernosal arterial blood flow (Fig.1). Ischemia type of priapism was excluded. Therefore, epinephrine was diluted with N/S to concentration of 200mg/ml and was injected into corpora cavernosa. Patient got mild improved but regain rigid penis in the following day.
Due to persistent priapism, we performed surgery of Quackel shunt (Cavernous-spongiosum shunt). But the result seemed limited. Follow-up penile echo revealed no cavernosal arterial high flow (Fig. II) Unfortunately, surgical wound over penile root became infectious with pus formation (Fig. III). Furthermore, fever developed. Therefore, we performed wound debridement and partial penectomy (Fig. IV). Postoperative pathology report revealed metastatic urothelial carcinoma, high grade with unclear surgical margin. The priapism got mild resolved postoperatively. The patient was then transferred to oncology department for further intravenous systemic chemotherapy treatment.