Priapism and Secondary Cavernitis Associated with Advanced Bladder Cancer - Step-by-step treatment approach

D. AC Souza, A. B Albuquerque, G. TL Junior, J. S Costa, G. TS Maia, F. TL Neto

Priapism, Urinary Bladder Neoplasms, Palliative Care

We report a case of priapism resulting from direct invasion of the corpora cavernosa by advanced urothelial carcinoma of the bladder. A 65-year-old male presented with painful penile tumescence during prolonged hospitalization for the treatment of urinary tract infection. The patient was under non-exclusive palliative care and experienced severe pain, which prompted the decision for surgical intervention. Urological evaluation revealed cavernous infiltration, and initial therapeutic attempts including aspiration and intracavernosal vasoconstrictor injections proved unsuccessful. Given the purulent drainage encountered, the decision was made to proceed with open decompression rather than attempt irrigation. Multiple surgical approaches were subsequently employed, including T-shunt placement and Burnett "Snake" maneuver with transglandular approach. Despite these comprehensive surgical efforts, complete detumescence was not achieved. Intraoperative findings and preoperative magnetic resonance imaging confirmed extensive tumor infiltration at the penile base, explaining the failure of venous return and lack of response to surgical decompression. However, the patient experienced significant pain improvement and partial resolution of tumescence following the procedure. Given the extent of tumor involvement and clinical deterioration, a multidisciplinary team transitioned the patient to exclusive palliative care. The patient died approximately one and a half months after the surgical procedure. This case underscores the significant challenges in managing malignant priapism in the context of advanced oncological disease.

Professor Fernando Figueira Integral Medicine Institute (IMIP)

None. 

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