Priapisme (Dimi bɛ mɛn sen na) ani Sickle Cell Urological Emergency¶

Priapisme ye cɛya wulicogo dafalen ye min bɛ to senna, min man ɲi, min bɛ to sen na fo ka tɛmɛ lɛri 4 kan (walima a bɛ kɛ siɲɛ caman dimi bɛ kɛ sanga 1 fo lɛri 3 kɔnɔ "sɔgɔsɔgɔninjɛ" waatiw la) o tɛ tali kɛ fewu walima a bɛ taa ɲɛ waati jan cɛnimusoya lawulili bannen kɔfɛ. Priapisme banabagatɔw bɛɛ kɛmɛsarada la 95 ni kɔ ye Ischemic (Low-Flow walima Veno-Occlusive) Priapism ye, o ye **cɛya cɛya banakisɛ lakika ye. Priapisme ischemique (ischemique priapisme) la, joli bɛ siri cɛya silinda belebele fila kɔnɔ (corpora cavernosa) ni oksizɛni kura tɛ don joli siraw la ani joli siraw joli bɛ bɔ. Ni joli min sirilen don, o bɛ oksizɛni bɔnɛ (hypoxia), ka kɛ asidi ye (asidɔsi), ani ka sukaro ban (glucopenie), farikolojidɛsɛ nɔgɔlenw bɛ daminɛ ka sa lɛrɛ 4 fo lɛri 6 kɔnɔ, o bɛ na ni farikolo fibrose (joli) ye min tɛ se ka kɔsegin, ani cɛya wulibaliya banbali, a si bɛɛ la fo ka se kɛmɛsarada la 50 fo 90 ma bana minnu ma furakɛ ka tɛmɛ lɛri 12 fo lɛri 24 kan.

Aw ka teliya ka kunkanbaaraw ni cɛya kuntaalajan, dimi bɛ a la, o ye ka cɛya wulicogo o cɛya bɛ gɛrɛ walima min bɛ tɛmɛ lɛri 4 kan, o furakɛ i n’a fɔ kɛnɛyaso lajɛ min bɛ kɛ waati gɛlɛn na, ka dimi, farakurun gɛlɛn ischemic (low-flow) priapism (yɔrɔ min na cɛya kunsigi ka gɛlɛn ani ka tɔɔrɔ k’a sɔrɔ cɛya kunkolo/ɲɛnajɛ bɛ to ka nɔgɔya) ni dimi tɛ min na post-traumatic non-ischemic (high-flow) priapism, aw bɛ fɛɛrɛw tigɛ joona minnu tɛ mɔgɔ tɔɔrɔ, aw bɛ olu kɛ dɔrɔn lɛrɛ 1 fo lɛri 2 fɔlɔw (i n’a fɔ koli, ka jisuma kɛ walima ka aw ko a kɔnɔ bana min bɛ wele ko sikilibana, ji min, ani ɛrɛzɛnsun jiginni farikoloɲɛnajɛ nɔgɔman walasa ka joli bolicogo wɛrɛ bila cɛya la), aw bɛ jisumamuguw kɛ mɔgɔ o mɔgɔ la min bɛ ni sɔgɔsɔgɔninjɛ ye walima ni sɔgɔsɔgɔninjɛ taamasiɲɛ bɛ a la, ani ka se dɔgɔtɔrɔso la kɔrɔtɔko yɔrɔ la sani lɛrɛ 4 ka se ka kɛ ka farikolo yɔrɔw kisi ka se ka fenilɛfirini pikiri kɛ kɔkolo kɔnɔ ani ka joli sama.

Aw bɛ o kɛ sisan¶

1. Aw bɛ taa dɔgɔtɔrɔso la joona joona ni cɛya kuntaalajan dɔ sera lɛri 4 ma (walima lɛri 2 fo lɛri 3 ni dimi jugumanba bɛ a la): Aw kana a to maloya ka dɔgɔtɔrɔso ladonni bila kɔfɛ. Ischemic priapism ye sanga 4 kɔrɔtɔko ye min ni testicular torsion (banakisɛfagalan) torsion walima compartiment syndrome (banakisɛ min bɛ wele ko compartiment syndrome).: ni a furakɛra kɔrɔtɔko la lɛrɛ 4 fo lɛri 6 kɔnɔ, cɛya baara bɛ mara banabagatɔ kɛmɛsarada la 100 ɲɔgɔn na ; lɛrɛ 24 fo lɛri 36 kɔfɛ, farikolojidɛsɛ banbali ni cɛyabaliya si bɛɛ bɛ se ka bali.
2. Aw bɛ dɔgɔtɔrɔso kɔrɔtɔlenw wele joona ni priapisme kɛra kɔkolo/kɔkolo jogin kɔfɛ walima ni sikilibana jugumanba dɔ kɛrɛfɛ: Aw bɛ aw ka sigida kɔrɔtɔko nimɔrɔ wele (911 Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri, 000 Ɔsitarali) walima aw ye an ka gafe ɲɛbilasɛbɛn lajɛ kɔrɔtɔko nimɔrɔw ni cɛya barikama bɔra binkanni, jikuru kasaara kɔfɛ, walima mobili tiɲɛni kɔfɛ dɔrɔn ("neurogenic priapism" ka bɔ acute la kɔkolo joginni), walima ni banabagatɔ min bɛ ** .bana min bɛ wele ko sikilibana** a bɛ priapisme sɔrɔ disidimi kɛrɛfɛ, ninakilidegun (syndrome acute chest), sumaya, walima kirinni taamasiɲɛw.
3. Ni cɛya ma mɛn ka tɛmɛ lɛri 2 kan (a daminɛ na walima "sɔgɔsɔgɔninjɛ" waati), aw bɛ nin dɛmɛ fɔlɔ fɛɛrɛ minnu tɛ mɔgɔ tɔɔrɔ miniti 15 kɔnɔ, aw bɛ olu lajɛ ka aw labɛn ka taa dɔgɔtɔrɔso la:
4. Aw bɛ sugunɛ lankolonya (ka sugunɛ): Sugunɛ falen bɛ ɲɛgɛnɛsiralabanaw lawuli ni hakilijagabɔ ye minnu bɛ cɛya sɔgɔsɔgɔninjɛ sabati; koli teliya la, o bɛ dɛmɛ ka basibɔn lafiya.
5. Aw bɛ farikolo duguma farikoloɲɛnajɛ kunkurunnin kɛ ("The Thigh Steal Phenomenon"): Ni banabagatɔ kɛnɛyara ani ni disi dimi jugumanba tɛ a la walima ni joginda tɛ a la, ka yele ɛrɛzɛnsunw kan teliya la, ka farikolo girinya 20 fo 30 kɛ, walima ka taama u nɔ na, o bɛ cɛya ni kɔkolo joli sira belebelebaw bonya (iliac steal), o bɛ simpatiki baara kɛlɛ-walima-boli-nɛrɛ minnu bɛ dɛmɛ ka cɛya ji bɔ.
6. Aw bɛ ji mililitiri 500 min ka dimimadafura minnu sɛbɛnnen don so kɔnɔ, aw bɛ olu ta (ni aw bɛ lɛri 1 fo lɛri 2 fɔlɔw la; ni aw taara kɛnɛyaso la ka tɛmɛ lɛri 3 kan, aw bɛ aw bila foyi la da fɛ ni opereli ka kan ka kɛ ka shunting kɛ).
7. SISIKƐLI SARIYA KƆRƆBƆLI: Aw kana jisuma walima ji nɛnɛ kɛ mɔgɔ si cɛya walima a kɔkili la abada, Sikilibana walima Sikilibana bɛ mɔgɔ min na: Sikilibana bɛ banabagatɔ min na, farigan bɛ kɛ sababu ye ka joli siraw gɛlɛya joona ani ka joli kuru bilenmanw bila cɛya kɔnɔ ka sikili, ka kurukuru, ka polimɛri kɛ joona, o bɛ kɛ sababu ye ka joli misɛnninw datugu kudayi da tugu. O nɔ na, ​​sikilibanabagatɔw ka kan ka jisuma kɛ walima ka jisuma kɛ ani ka to funteni na.
8. Ni priapisme min tɛ sikili ye (i n’a fɔ cɛya pikiri kɔfɛ), komɛsi nɛnɛman min sirilen don fini na, o bɛ se ka kɛ waati kunkurunnin kɔnɔ sɔgɔsɔgɔninjɛ/kɔnɔna na lɛri 1 fo lɛri 2 fɔlɔ kɔnɔ dɔrɔn: Aw kana jisuma jɛlen kɛ abada cɛya fari la k’a ɲɛsin cɛya fari ma (o bɛ kɛ sababu ye ka nɛnɛ bila mɔgɔ la), ani aw kana mɛn abada ka taa kɔrɔtɔko yɔrɔ la ka tɛmɛ sanga 3 fo sanga 4 kan taamasiyɛn kɛ ka nɛnɛ pake makɔnɔ a ka baara kɛ.
9. Aw bɛ na ni fura buteli tigitigi ye, pikirijikɛlan, walima furakisɛw foroko kɔrɔtɔlen na: A kɛra a daminɛna ni cɛya pikiri ye min sɛbɛnnen don (alprostadil / Trimix / Bimix), sunɔgɔ/degunfura da la (trazodone), hakiliɲagamifura, walima "gasi-station male enhancement" min tɔgɔ ma sɛbɛn furakisɛ," na ni buteli ye walasa dɔgɔtɔrɔw ka furakɛlicogo tigitigi dɔn.

flowchart TD
    Start["Kɔrɔya sabatili min man ɲi, o ni cɛnimusoya nege tɛ kelen ye"] --> CheckTrauma{"1. Yala o kɛra kɔ/kɔkolo jogin kɔfɛ yɛrɛ (Kɔnɔbara joginni) WAALIMA ni Sikili dimi/Stroke/Fever ye wa?"}
    CheckTrauma -->|Yes| CallEMS["Aw bɛ kɔrɔtɔko baarada wele (911 / 112 / 999) teliya la: Aw kana kɔkolo lamaga ni joginda bɛ aw la"]
    CheckTrauma -->|No| CheckType{"2. Aw bɛ a gɛlɛya ni dimi lajɛ: Yala a sɔgɔlen ka gɛlɛn i n’a fɔ fara ani a bɛ dimi ka a sɔrɔ a kun (Glans) ka nɔgɔn wa?"}
    CheckType -->|Yes: Ischemic Low-Flow Priapism| CheckTime{"3. Kɔrɔya bɛ mɛn sen na fo waati joli?"}
    CheckType -->|Painless, Semi-Soft After Groin/Straddle Injury| HighFlow["Suspect Non-Ischemic High-Flow (Arterial) Priapism: Aw bɛ Urology Doppler Ultrasound Evaluation kɔrɔtɔlen labɛn"]
    CheckTime -->|3 to 4+ Hours (Or Severe Pain)| UrgentED["Aw bɛ taa dɔgɔtɔrɔso la joona joona (Lɛrɛ 4 Tissue-Salvage Window for Aspiration & Phenylephrine)"]
    CheckTime -->|Under 2 Hours (Early / Stuttering)| EarlySteps{"4. Yala banabagatɔ bɛ ni sɔgɔsɔgɔninjɛ bana ye wa walima sɔgɔsɔgɔninjɛ jogo wa?"}
    EarlySteps -->|Yes: Sickle Cell| SickleAid["Aw kana baara kɛ ni jisuma ye abada: Aw bɛ aw ko/aw bɛ aw ko ni funteni ye, ka sugunɛ kɛ, ka ji bɔ a la, ka taa ni dimimadafura ye so; Aw bɛ taa ED la ni A ma taa ni Lɛrɛ 2 fo 3 ye"]
    EarlySteps -->|No: Medication / ED Injection| MedAid["Koli, ka Eskalanin/Squat Exercise nɔgɔman kɛ (Thigh Steal), Optional Brief Cool Compress; Aw bɛ taa ED la joona ni a bɛ Gɛrɛ Lɛrɛ 3 fo Lɛrɛ 4 la"]

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Priapisme ischemique (Flow-Flow) ni Priapisme non Ischemique (Flow-High-Flow) ye¶

Sani u ka maga priapisme la walima k’a furakɛ, sugunɛbilennikɛlaw ni kɔrɔtɔko dɔgɔtɔrɔw bɛ bana bɛɛ tila jolilabana suguya fila ye minnu tɛ kelen ye pewu ka da laadilikanw kan minnu bɔra Ameriki sugunɛbilenni jɛkulu (AUA) ani Erɔpu sugunɛbilenni jɛkulu (EAU) ka laadilikanw na:

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Lɛrɛ ni lɛrɛ mikroskɔpi waati jateminɛ : Mun na sanga 4 waati bɛ cɛya kɛcogo jira a si bɛɛ la¶

Ni joli sirilen don corpora cavernosa datugulen kɔnɔ ischemic priapism waati la, ɛlektrɔniki mikroskɔpi sɛgɛsɛgɛliw bɛ farikolo yɔrɔw tiɲɛni jatebɔ kɛ min tɛ ban, min bɛ se ka fɔ ka ɲɛ:

• Lɛrɛ 0 ka se 4 ma (Reversible Physiological Trapping): Joli min sirilen bɛ kɔdingɛw kɔnɔ, o bɛ bɔ oksizɛni na dɔɔni dɔɔni lamini selilɛriw fɛ. Tiɲɛni banbali si ma kɛ a jɔcogo la fɔlɔ, wa farikolo nɔgɔlen bɛ balo la hali bi ani a bɛ se ka sɔgɔsɔgɔ ni alfa-adrénergique fura (i n’a fɔ fenilefirini) pikirila dɔrɔn.
• Lɛrɛ 4 ka se 6 ma (Ischemic Pain Threshold and Interstitial Edema): Oksizɛni tansiyɔn (pO2) bɛ jigin 30 mmHg duguma ani pH bɛ jigin 7,25 duguma. Dimi jugumanba min bɛ kɛ ni sɔgɔsɔgɔninjɛ ye, o bɛ daminɛ. Nafa min nafa ka bon kosɛbɛ, ni asidɔni jugumanba (pH < 7,10) ni sukaro dɔgɔyali (sukaro zeru) kɛra, kavernosal muscle smooth muscle tɛ se ka sɔgɔsɔgɔ ka ɲɛ ka kɛɲɛ ni alfa-adrénergique furaw ye, o de kama kɔrɔtɔko dɔgɔtɔrɔw ka kan ka ** fɔlɔ ka asidi joli kɔrɔ bɔ ni pikirijikɛlan ye** walasa joli kura oksizɛni bɛ se ka don sani a pikiri kɛ fenilefirini bɛ se ka baara kɛ ka ɲɛ.
• Lɛrɛ 12 ka se 24 ma (Trabecular Smooth Muscle Necrosis and Platelet Clotting): Endothéliale cellules minnu bɛ joli yɔrɔw datugu, olu bɛ bɔ, ka duguma yɔrɔw jira minnu bɛ joli segin furakisɛw fara ɲɔgɔn kan ani joli kurulenw. Trabecular smooth muscle cellules bɛ coagulative necrosis (cell death) kɛ min tɛ se ka wuli, ka wuli ka kɛ fibroblaste ɲɔgɔnna seliluw ye minnu bɛ joginda dilan.
• Lɛrɛ 24 fo 48 kɔfɛ (Fibrose permanente corporale et défaillance de l’erectile): Banabagatɔ kɛmɛsarada la 90 ni kɔ minnu ka ischemie priapisme bɛ mɛn ka tɛmɛ sanga 24 fo 36 kan, olu bɛ cɛya wulicogo dafalen bɔnɛ banbali, barisa cɛya sogo minnu bɛ i n’a fɔ sɔgɔsɔgɔninjɛ, olu bɛ bila u nɔ na ni sɔgɔsɔgɔninjɛ ye min ka gɛlɛn, min tɛ wuli ka bɔ a nɔ na (a ka c’a la, a bɛ kɛ joona opereli kɛli cɛya la min bɛ se ka fiyɛ ka sɔrɔ ka cɛya sɔgɔsɔgɔ ani ka cɛya surunya).

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Priapisme ischemie (ischemie priapisme) sababu minnu ka teli ka kɛ: Fura, pikiri, sikilibana ani hakiliɲagami¶

Balikuw ka ischemie priapisme banaw tilancɛ fila ɲɔgɔn bɛ sɔrɔ furaw fɛ walima cɛya pikiriw fɛ minnu bɛ kɛ ka ɲɛgɛnɛsira kɔnɔ, ka sɔrɔ sikilibana de ye a sababuba ye denmisɛnw, funankɛninw ani kamalenninw na minnu bɔra Afiriki, Mediterane, cɛmancɛ kɔrɔnfɛla, walima Ɛnduw la:

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Kɛrɛnkɛrɛnnenya la: Sickle Cell Priapism ani mun na ICE BANNA DƆN KOJUGU¶

Ni aw walima aw den ye ** .bana min bɛ wele ko sikilibana**, priapisme bɛ sariya kɛrɛnkɛrɛnnen dɔ de wajibiya, min sinsinnen bɛ daliluw kan, Ameriki jolilabanaw ka tɔnba (ASH) ani jamana dusukun, fogonfogon ani joli baarada (NHLBI) ye min sinsin:

1. Mun na aw man kan ka jisuma pake bila sikili banabagatɔ cɛya la abada¶

Teri minnu ŋaniya ka ɲi, lakɔli infirɛriw, walima ɛntɛrinɛti barokun kɔrɔlenw, tuma dɔw la, olu b’a fɔ ko i ka jikuru dɔ bila cɛya la min man ɲi. Sikilibana na, ni aw ye jisuma walima nɛnɛ pakew kɛ, o ye filiba ye:

• Nɛnɛ bɛ kɛ sababu ye ka farikolo ni kɔkolo jugumanba jolisiraw sɔgɔsɔgɔ kosɛbɛ, ka joli-sira-funu waati sumaya, ka joli-sira-funu caya.
• Hypoxic corpora cavernosa kɔnɔ, nɛnɛ bɛ kɛ sababu ye ka Hémoglobine S (HbS) mɔlikulu minnu tɛ oksizɛni sɔrɔ, olu ka polimɛri kɛ ka kɛ bere gɛlɛnw ye joona, o bɛ sɔgɔsɔgɔninjɛ min bɛ se ka segin kɔ, o tigɛli ka kɛ farakuru gɛlɛn ye, min bɛ kurukuru priapisme ischemique belebele min tɛ se ka fiɲɛ sama.
• Min ka kan ka kɛ o nɔ na sikilibanabagatɔ fɛ sanga 1 fo 2 fɔlɔ kɔnɔ so kɔnɔ:
• Aw bɛ koli kɛ joona walasa ka sugunɛ lankolonya.
• Aw bɛ ji sumalen walima ji sumalen mililitiri 500 fo 1000 (taji 2 fo 4) min walasa ka joli kuru dɔgɔya.
• Aw bɛ aw ko ni aw bɛ aw ko ni aw bɛ aw ko ni funteni ye (walima aw bɛ fɛn dɔ kɛ a la min bɛ kɛ ni degun ye) walasa ka joli siraw bonya ani ka sikiliw dɛmɛ u ka ko ka bɔ wuluwuluw kɔnɔ.
• Aw bɛ dimimadafura ta min sɛbɛnnen don so kɔnɔ (walima pseudoephedrine/etilefrine da la min sɛbɛnnen don ni banabagatɔ ka jolidɔgɔtɔrɔ ye min sɔnna a ma, o waleya bolodalen dɔ don).
• Dɔgɔtɔrɔso sariya gɛlɛn min bɛ kɛ lɛri 2 fo lɛri 3 kɔnɔ: Ni sikilila priapism ma ban pewu lɛrɛ 2 fo lɛri 3 kɔnɔ so ladonni daminɛ kɔfɛ (o la aw bɛ se dɔgɔtɔrɔso la kosɛbɛ ka kɔn lɛri 4 taamasiɲɛ ɲɛ), aw bɛ taa teliya la kɛnɛyaso la.

2. Mun na dɔgɔtɔrɔsow TƐ sigida cɛya filili bila kɔfɛ walasa ka joli kuru bilenmanw cili makɔnɔ¶

Fɔlɔ la, dɔgɔtɔrɔso dɔw tun bɛ fili ka sikɛli priapisme furakɛ ni jolisira fɛ ji, oksizɛni ani joli kuru bilenmanw ɲɔgɔn falen-falen dɔrɔn ye k’a sɔrɔ u tun bɛ lɛri 12 fo lɛri 24 makɔnɔ walasa k’a dɔn ni cɛya jiginni jigira. Bi AUA ni ASH ka laadilikanw bɛ sigida sugunɛ furakɛli bila kɔfɛ:

• Hali ni joli seginni ni dimi kunbɛnni bɛ daminɛ joona sikilibanabagatɔ la, joli tali sigida la kɔkolo kɔnɔ ani fenilefirini ji mintalen don, o WAJABA ka kɛ o yɔrɔnin bɛɛ la (lɛrɛ 4 taamasiɲɛ na) i n’a fɔ a bɛ kɛ cogo min na ischemie priapisme tɔw bɛɛ la.
• Sugunɛbilenni laadilikanw fana b’a jira ko teliya la joli kuru bilenmanw ɲɔgɔn falenfalen kɔrɔtɔlen kɛrɛnkɛrɛnnenya la priapisme kama, o farati sɛbɛnnen bɛ ASPEN Syndrome (Association of Sickle cell disease, Priapism, Exchange transfusion, and Neurological events) la, o yɔrɔ la, joli sɔgɔsɔgɔninjɛ ni joli seginni teliya la, o bɛ kɛ sababu ye ka kunsɛmɛnasumaya, kungolodimi jugumanba, kirinni, ani sɔgɔsɔgɔninjɛ.

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Fɛn min bɛ kɛ kɔrɔtɔko yɔrɔ la: Dimi tɛ farikolojidɛsɛ la, fiɲɛ bilali, ani fenilefirini kisi¶

Cɛ caman bɛ taa kɔfɛ kɛnɛyaso la ni priapisme ye bawo u bɛ siran dɔgɔtɔrɔso taabolo ɲɛ walima u bɛ maloya k’o fɔ triage infirɛri ye. Ni aw b’a dɔn tigitigi min bɛ kɛ kɛnɛyaso kɔnɔ, o bɛ o siran bɔ yen:

Taabolo fɔlɔ : Mɔgɔ kelen-kelen ka so, kɔkolo cɛya nɛrɛmuguma, ani dimimadafura sitɛmu¶

• Ni aw y’a fɔ dɔrɔn ko "Ne ye cɛya janya min bɛ mɛn sanga 3 fo sanga 4 kɔnɔ (siga bɛ a la ko priapisme)" triage waati, aw bɛ bila sɛgɛsɛgɛlikɛyɔrɔ kɛrɛnkɛrɛnnen dɔ la barisa priapisme bɛ triage kɛ i n’a fɔ high-priority organ-salvage emergency.
• Aw bɛ sɔgɔsɔgɔ kosɛbɛ SANI pikirijikɛlan si ka maga cɛya la: Kɔrɔtɔko dɔgɔtɔrɔ walima sugunɛbaralabana bɛ fɔlɔ ka Dorsal Penile Nerve Block walima Circumferential Penile Ring Block kɛ ni lidocaine walima bupivacaine local anesthetic gansan ye (a pikiri kɛ ni pikirijikɛlan fitinin ye min bonya bɛ se inisɔndi ma cɛya da la, ka fara sistɛmu kan Dimimadafura min bɛ kɛ IV la ni a mago bɛ a la). Miniti 3 kɔnɔ, cɛya dawolo bɛɛ bɛ sɔgɔ pewu.

Taabolo 2nan : Furakɛcogo Aspiration ani saline Irrigation (Ka bana min bɛ wele ko « Syndrome de compartiment ») .¶

• Ni cɛya sɔgɔra ka ban, dɔgɔtɔrɔ bɛ 19-gauge walima 21-gauge butterfly needle dɔ don kɛrɛfɛla la ka don jiribolo kɛrɛ fɛ (nɛgɛ 3 walima 9 waati, ka a yɛrɛ tanga nɛrɛmuguma ni joli siraw ma minnu bɛ sanfɛ nɛgɛ kanɲɛ 12 waati, ka sugunɛbaralabana kɛ duguma nɛgɛ kanɲɛ 6 waati).
• Ikomi corpora cavernosa fila bɛ ɲɔgɔn cɛ kɔnɔna na ni cɛmancɛ kogo dɔ ye min dabɔlen don (midline septum dafabali), fan kelen dɔrɔn de ka kan ka don walasa ka ji bɔ fan fila bɛɛ la.
• Pikirijikɛlan mililitiri 10 walima mililitiri 20 bɛ joli min sirilen don, a dibi don, a ka bon, o bɔ dɔɔni dɔɔni (a bɛ mililitiri 1 fɔlɔ ci joli gazi sɛgɛsɛgɛlikɛlan ma walasa ka a jira ko pO2 < 30 mmHg ani pH < 7,25) ka sɔrɔ ka so kɔnɔna ko dɔɔni dɔɔni ni saline sterili 0,9% normal ye fo joli ka kɛ oksizɛni bilenman jɛlen ye ani kɔnɔna na compartiment tansiyɔn bɛ jigin. A daminɛ na, fo ka se kɛmɛsarada la 30 ma, aspirasi dɔrɔn bɛ priapisme (priapisme) ɲɛnabɔ pewu.

Taabolo 3nan : Fenilefirini pikiri kɛli kɔkolo kɔnɔ (The Chemical Off-Switch) .¶

• Ni cɛya tora asidi joli kɔrɔ fiyɛlen kɔfɛ, dɔgɔtɔrɔ bɛ Phenylephrine (alpha-1 adrénergique agoniste saniyalen min b’a fɔ k’a ɲɛsin kɔkolo joli siraw ma u ka gɛlɛya ani ka trabeculaire muscle smooth ka sɔgɔsɔgɔ, ka joli siraw bɔli da wuli) pikiri kɛ.
• Baliku hakɛ dantɛmɛnen ye mikɔrɔgaramu 100 fo 500 ye mililitiri kelen na, ka mililitiri 1 pikiri kɛ miniti 3 fo miniti 5 o miniti 5 (a bɛ se ka kɛ mikrogaramu 1000 ye lɛri 1 kɔnɔ) ka sɔrɔ ka banabagatɔ tansiyɔn ni dusukun tantanni kɔlɔsi dusukun jateminɛnan na (ni fenilefirini fɛn o fɛn donna farikolo la, ka tansiyɔn jiginni kɛ waati kunkurunnin kɔnɔ walima ka dusukun tansiyɔn jiginni kɛ dɔɔni dɔɔni hakɛ).
• Ni a kɛra lɛrɛ 4 fo lɛri 12 kɔnɔ a daminɛ kɔfɛ, fiɲɛ bilali ka fara fenilefirini kan min bɛ kɛ kɔkolo kɔnɔ, o bɛ schemie priapisme bana kɛmɛsarada la 85 fo 95 ni kɔ ɲɛnabɔ miniti 15 fo 30 kɔnɔ k’a sɔrɔ opereli si ma kɛ.

Taabolo 4nan : Opereli yɔrɔjan (Distal Surgical Shunting) (Ni minnu bɛ kɛ kɔfɛ dɔrɔn, minnu tɛ se ka fiɲɛ sama ani ka fenilefirini kɛ) .¶

• Ni banabagatɔ ye makɔnɔni kɛ ka tɛmɛ lɛri 12 fo lɛri 24+ kan walasa farikolojidɛsɛbanakisɛ ka kɛ asidi ye kojugu ani ka funu kojugu walasa a ka se ka fenilefirini jaabi, sugunɛbilennikɛla bɛ Distal Cavernoglandular Shunt (i n’a fɔ Winter, Ebbehoj, Al-Ghorab, walima T-shunt kɛcogo) kɛ dɔrɔn. O bɛ kɔnɔna tɛmɛsira fitinin dɔ Dabɔ kɔ̀rɔbalen kùncɛ la ka Dòn glans (cɛya kunkolo) la min ka nɔgɔn, min ji bɛ Bɔ ka ɲɛ, o b’a To joli min sirilen dòn, o bɛ Se ka Bɔ ka Bɔ kɔ̀rɔbalen sɔgɔsɔgɔninjɛ fɛ lafiya la.

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Ko kɛrɛnkɛrɛnnenw: Denmisɛnw ka priapisme, den kuraw ka priapisme, ani Priapisme malignant¶

Fura ni balikuw ka sikilibana kɔfɛ, priapisme jiracogo saba minnu bɛ kɛnɛyaso la, olu bɛ jateminɛ kɛrɛnkɛrɛnnenw de wajibiya:

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Mun bɛ kɛ kɛnɛyaso kɔrɔtɔlen furakɛli kɔfɛ? (Ka a dɔn ko sɔgɔsɔgɔninjɛ min bɛ kɛ furakɛli kɔfɛ ni a seginni tiɲɛnen ye)¶

Banabagatɔ min ye a ka priapisme (priapisme) ji bɔ ka ɲɛ sisan kɛnɛyaso la, o waati minnu bɛ degun kosɛbɛ, olu dɔ la kelen bɛ kɛ lɛrɛ 2 fo lɛri 12 a seginnen kɔ so, o waati la cɛya bɛ i n’a fɔ a fununen don ani a tilalen don a tilancɛ la tuguni. Ni aw ye danfara faamuya hiperemie/édéma réactive post-procédure harmless ni priapisme ischemique récurrent lakika cɛ, o bɛ siran kunntan kisi ka sɔrɔ ka seginkanni lakikaw minɛ joona:

• Furu min bɛ makɔnɔn fiɲɛ bilali kɔfɛ ani jolidɛsɛ min bɛ se ka kɛ ("Post-Ischemic Reperfusion"):
• Lɛrɛ caman kɛlen kɔ ka joli segin joli-sira-funu na ani ka pikirijikɛlan fiyɛ, ni joli kura bɛ segin ka don corpora cavernosa kɔnɔ (reperfusion), cɛya kɛnɛma fari bɛ kurukuru (ecchymose) ani kɔnɔna sponge bɛ funu ni ji ye (interstitial edema).
• O de kosɔn, cɛya ka teli ka kɛ i n'a fɔ a ka bon, a kurulen don, ani kɛmɛsarada la 50 fo 70 "semi-erect" (partial tumescence) tile damadɔ kɔnɔ.
• A dɔnni cogo min na ko funu seginni farati tɛ: Ni aw ye sɔgɔsɔgɔninjɛ kɛrɛw digidigi dɔɔni dɔɔni bolokɔni fila ni ɲɔgɔn cɛ, a bɛ kɛ i n’a fɔ a bɛ se ka digidigi, ka kɛ mugu ye, walima ka sɔgɔsɔgɔ (a tɛ gɛlɛya i n’a fɔ fara i n’a fɔ jiri), ani sɔgɔsɔgɔninjɛ jugumanba min bɛ kɛ ni sɔgɔsɔgɔninjɛ ye, o tɛ ban (a bɛ bila a nɔ na ni kurukuru dimi nɔgɔman dɔrɔn ye pikirijikɛlan yɔrɔ la).
• Priapisme ischemique récurrent lakika ka darapo bilenmanw (Aw bɛ segin Kɔrɔtɔko ɲɛmɔgɔso la joona):
• A jiribolo bɛ kɛ fara-gɛlɛn ye min tɛ jɔ ani a bɛ gɛlɛya i n’a fɔ kolo walima jiri tugun.
• Dimi jugumanba, jugumanba, sɔgɔsɔgɔninjɛ bɛ segin ka kɛ ka juguya.
• Ni siga bɛ aw la, aw bɛ segin kɛnɛyaso kɔrɔtɔlen na walima sugunɛbaralabana dɔgɔtɔrɔso la, yɔrɔ min na Color Duplex Doppler Ultrasound walima joli gazi misɛnnin minnu bɛ kɛ kɔ kɔnɔ, olu sɛgɛsɛgɛli sekɔndi 60 kɔnɔ, o bɛ a jira o yɔrɔnin bɛɛ la ni joli siraw joli bɛ woyo ka bɔ a la (reperfusion safe) walima ni a jɔlen don tuguni (ischemie recurrente).

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Banabagatɔ minnu bɛ ED pikiri, trazodone, walima priapisme sɔgɔsɔgɔninjɛ furakɛ, olu kunbɛnni¶

• Aw kana dɔ fara aw ka pikiri kɛlen kan abada kɔkolo kɔnɔ (Trimix / Bimix / Alprostadil) aw yɛrɛ ma, ani aw kana pikiri kɛ abada ka tɛmɛ siɲɛ kelen kan sanga 24 kɔnɔ: Pikiri kɛcogo kɔrɔtɔlen minnu bɛ sɔrɔ pikiri fɛ, olu fanba bɛ kɛ ni banabagatɔ ye pikiri filanan kɛ fɔlɔ kɔfɛ, a kɛra i n’a fɔ a bɛ baara kɛ dɔɔnin dɔɔnin, walima ni a ye Trimix vial fanga caman sɔrɔ min ma jateminɛ biro kɔnɔ sɛgɛsɛgɛli hakɛ.
• Aw kana pikiri minnu bɛ kɛ kɔkolo kɔnɔ (Alprostadil/Trimix) ni PDE5 furakisɛ da la (sildenafil/Viagra, tadalafil/Cialis, vardenafil) fara ɲɔgɔn kan abada fo ni a ɲɛfɔra k’a jɛya ani ni sugunɛbaralabana dɔgɔtɔrɔ ye u titre: Ni aw ye o fɛɛrɛ fila bɛɛ fara ɲɔgɔn kan, o bɛ farikolo lafiyali jɛ-ka-baara kɛ ni a hakɛ cayalenba ye >lɛrɛ 4 kɔnɔ priapisme (priapisme (priapisme)) ye.
• Aw bɛ Trazodone ni hakiliɲagamifura lasɔmini taamasiɲɛw dɔn joona: Ni aw ye trazodone (sunɔgɔ walima degun kama) walima hakiliɲagamifura tali daminɛ ani ka a kɔlɔsi ko aw ka sɔgɔmadafɛla wulicogo bɛ ka kɛ dimi ye walima ka mɛn miniti 30 fo miniti 60 kununni kɔfɛ, aw bɛ fura in dabila ka aw ka dɔgɔtɔrɔ wele joona walasa ka wuli ka taa a fɛɛrɛ wɛrɛ min tɛ alfa-blocking ye sani priapisme dafalen ka kɛ sanga 4 kɔnɔ.
• Aw ye Stuttering Priapism Action Plan sigi sen kan ni sɔgɔsɔgɔninjɛ bana bɛ aw la: Cɛw ni cɛdenw minnu bɛ ni sɔgɔsɔgɔninjɛ ye, ni u bɛ segin-ka-bɔ su fɛ waati kunkurunnin kɔnɔ, olu ka kan ka baara kɛ n’u ka jolidɔgɔtɔrɔ ni u ka sugunɛ furakɛla ye banakunbɛn furakɛli la (i n’a fɔ hydroxyurea, sufɛ PDE5 inhibitor paradoxical receptor resetting, walima a tata hakɛ dɔgɔman anti-androgène/alpha-agoniste protocoles) minnu bɛ sɔgɔsɔgɔninjɛ waatiw bali ka bonya ka kɛ kɔrɔtɔkobaw ye.

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Ɲininkali minnu bɛ kɛ tuma caman na¶

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Sosow sɛgɛsɛgɛra¶

• Amerika ka sugunɛbilenni jɛkulu (AUA) ani Ameriki woroduguyanfan ka cɛnimusoya furakɛli jɛkulu (SMSNA, Ameriki): Acute Ischemic Priapism: an AUA/SMSNA Guideline (2021/2022 Update).
• Erɔpu ka sugunɛbilenni jɛkulu (EAU): EAU ka laadilikanw cɛnimusoya ni bangekɔlɔsi kɛnɛyako kan: Priapisme ischemique, non-ischemique ani stuttering furakɛli (2024 Update).
• Amerika jolilabanaw ka tɔnba (ASH) ani jamana dusukun, fogonfogon ani joli baarada (NHLBI, Ameriki): Sikilibana furakɛli min sinsinnen bɛ daliluw kan: Priapisme acute protocoles ani ASPEN Syndrome kunbɛnni.
• British Association of Urological Surgeons (BAUS, Angletɛri): BAUS ka bɛnkansɛbɛn min bɛ cɛw ka cɛya ni musoya kɔrɔtɔlenw ɲɛnabɔ: Priapisme.
• Montague D. K., Jarow J., Broderick G. A., ani mɔgɔ wɛrɛw. (Journal of Urology): Amerika ka sugunɛbaralabana jɛkulu ka laadilikan priapisme furakɛli kan.

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Gafe minnu bɛ tali kɛ o ko la¶

• Sikilila gɛlɛya, joli siraw datugucogo, ani disi jugumanba
• Kɔnɔbara basigilen, kɔnɔbara basigilen, ani basibɔn dimi jugumanba
• Kɔkolo joginw ani kɔkolo kɔkolo jɔli
• Crush injury ani compartiment syndrome dɛmɛ fɔlɔ
• Scorpion, centipede ani arthropod bagalenw ka sɔgɔsɔgɔninjɛ
• Kɔrɔtɔko nimɔrɔw ka kɛɲɛ ni jamana ye