Priapism all important things in urology make a ppt 15/20 pages
Reading File
Reading File
Reading File
Finding Sources
Finding Sources
Reading File
Reading File
Reading File
Reading File
Reading File
Reading File
Running Command
ls -la /home/daytona/workspace/ && mkdir -p /home/daytona/workspace/priapism-ppt
Running Command
mkdir -p /home/daytona/priapism-ppt && ls /home/daytona/
Writing File
/home/daytona/priapism-ppt/priapism.js
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pres.title = "Priapism - A Urological Emergency";
pres.author = "Urology";
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
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// ══════════════════════════════════════════════════════════════════════════
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{ text: "A prolonged, persistent penile erection unrelated to sexual interest or stimulation lasting ", options: { color: WHITE } },
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{ text: " — constituting a urological emergency", options: { color: WHITE } }
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{ text: "• Tumescence restricted primarily to the corpora cavernosa\n", options: { breakLine: true } },
{ text: "• Corpus spongiosum and glans penis typically NOT involved\n", options: { breakLine: true } },
{ text: "• Named after Priapus, Greek/Roman god of fertility\n", options: { breakLine: true } },
{ text: "• Incidence: up to 5.34 per 100,000 men per year (ischemic type)\n", options: { breakLine: true } },
{ text: "• Idiopathic in ~60% of cases; remaining 40% have identifiable cause\n", options: { breakLine: true } },
{ text: "• Most frequently affects men in 3rd-4th decade; also seen in pediatric sickle cell patients", options: {} }
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — CLASSIFICATION (3 types)
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{ x: 0.2, label: "1. ISCHEMIC", sub: "(Low-Flow / Veno-Occlusive)", color: "8B0000", pts: ["Most common type","Venous outflow obstruction","Stagnant, hypoxic blood","Painful, rigid corpora","EMERGENCY — time sensitive","Cavernous blood: low O₂, high CO₂, acidotic"] },
{ x: 3.55, label: "2. NON-ISCHEMIC", sub: "(High-Flow / Arterial)", color: MID_BLUE, pts: ["Less common","Cavernosal artery fistula","Unregulated arterial inflow","Painless, partially rigid","NOT a medical emergency","High-O₂ bright red blood on aspiration"] },
{ x: 6.9, label: "3. STUTTERING", sub: "(Recurrent / Intermittent)", color: "4A235A", pts: ["Recurrent ischemic episodes","Short-lived, self-limiting","Common in sickle cell disease","Precursor to fulminant priapism","PDE5 dysregulation implicated","Painful episodes with detumescence"] }
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — ETIOLOGY / CAUSES
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{ label: "Hematologic", color: "6E2C00", items: ["Sickle cell disease (most common in children)","Leukemia / lymphoma","Thalassemia","G6PD deficiency","Polycythemia"] },
{ label: "Medications", color: "145A32", items: ["Intracavernous injections (papaverine, PGE1)","Trazodone (antidepressant)","Chlorpromazine / antipsychotics","Prazosin / α-blockers","Heparin, warfarin"] },
{ label: "Neurological", color: "154360", items: ["Spinal cord injury","Cauda equina compression","Autonomic neuropathy","Cerebrovascular accident","Multiple sclerosis"] },
{ label: "Other Causes", color: "4A235A", items: ["Perineal / penile trauma (high-flow)","Pelvic tumors / metastases","Pelvic infections","Idiopathic (60%)","Recreational drugs (cocaine, alcohol)"] }
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — PATHOPHYSIOLOGY
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{ text: "Tissue hypoxia + acidosis + hypercapnia\n", options: { breakLine: true } },
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{ text: "Endothelial & smooth muscle damage\n", options: { breakLine: true } },
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{ text: "Perineal/penile trauma → Cavernosal artery injury\n", options: { breakLine: true } },
{ text: "↓\n", options: { breakLine: true, color: GOLD, bold: true } },
{ text: "Arterio-sinusoidal fistula formation\n", options: { breakLine: true } },
{ text: "↓\n", options: { breakLine: true, color: GOLD, bold: true } },
{ text: "Unregulated arterial inflow\n", options: { breakLine: true } },
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{ text: "• Microvascular occlusion by sickled RBCs\n", options: { breakLine: true } },
{ text: "• PDE5 dysregulation → ↑cGMP signaling\n", options: { breakLine: true } },
{ text: "• Abnormal nitric oxide (NO) regulation\n", options: { breakLine: true } },
{ text: "• Hypoxia during sleep (mild hypoventilatory acidosis)\n", options: { breakLine: true } },
{ text: "• Recurring episodes → eventual fulminant priapism", options: {} }
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════════════
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"Clinical Features",
"ISCHEMIC (Low-Flow)",
[
{ text: "• Painful, rigid erection >4 hours\n", options: { breakLine: true } },
{ text: "• Corpora cavernosa: tense, tender\n", options: { breakLine: true } },
{ text: "• Glans & corpus spongiosum: SOFT\n", options: { breakLine: true } },
{ text: "• Progressive pain intensity\n", options: { breakLine: true } },
{ text: "• Skin may become ischemic/dusky\n", options: { breakLine: true } },
{ text: "• No sexual desire/stimulation\n", options: { breakLine: true } },
{ text: "• Cavernous blood: dark, deoxygenated\n", options: { breakLine: true } },
{ text: "• May progress to penile necrosis if untreated", options: {} }
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{ text: "• Can last days to weeks\n", options: { breakLine: true } },
{ text: "• Cavernous blood: bright red, oxygenated\n", options: { breakLine: true } },
{ text: "• Pulsatile flow may be palpable\n", options: { breakLine: true } },
{ text: "• No associated ischemia\n", options: { breakLine: true } },
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{ text: "• Erectile function usually preserved", options: {} }
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}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — DIAGNOSTIC EVALUATION
// ══════════════════════════════════════════════════════════════════════════
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{ n: "01", t: "History", d: "Duration, pain level, trauma, medications (intracavernous therapy, trazodone), sickle cell disease, prior episodes" },
{ n: "02", t: "Physical Examination", d: "Assess rigidity, tenderness, glans softness; perineal trauma signs; lymphadenopathy; abdominal mass" },
{ n: "03", t: "Corporal Blood Gas", d: "Gold standard: aspirate with 21G needle. Ischemic: pO₂ <30 mmHg, pCO₂ >60 mmHg, pH <7.25. Non-ischemic: normal/high pO₂" },
{ n: "04", t: "Color Doppler Ultrasound", d: "Ischemic: absent/minimal arterial flow. Non-ischemic: high-velocity turbulent arterial flow, visible fistula" },
{ n: "05", t: "Lab Tests", d: "CBC (sickle cell screen, leukocytosis), coagulation profile, urine/serum toxicology, G6PD level if indicated" },
{ n: "06", t: "Angiography/MRI", d: "Pudendal arteriography for non-ischemic: localizes fistula for embolization. MRI evaluates corporal fibrosis if chronic" }
];
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — CAVERNOUS BLOOD GAS TABLE
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[
{ text: "Parameter", options: { bold: true, color: WHITE, align: "center" } },
{ text: "Normal Arterial", options: { bold: true, color: WHITE, align: "center" } },
{ text: "Ischemic Priapism", options: { bold: true, color: WHITE, align: "center" } },
{ text: "Non-Ischemic Priapism", options: { bold: true, color: WHITE, align: "center" } }
],
[
{ text: "pO₂", options: { bold: true, align: "center" } },
{ text: ">90 mmHg", options: { align: "center" } },
{ text: "<30 mmHg ⚠", options: { color: "C0392B", bold: true, align: "center" } },
{ text: ">90 mmHg", options: { color: "1A7A40", align: "center" } }
],
[
{ text: "pCO₂", options: { bold: true, align: "center" } },
{ text: "<40 mmHg", options: { align: "center" } },
{ text: ">60 mmHg ⚠", options: { color: "C0392B", bold: true, align: "center" } },
{ text: "<40 mmHg", options: { color: "1A7A40", align: "center" } }
],
[
{ text: "pH", options: { bold: true, align: "center" } },
{ text: "7.35 – 7.45", options: { align: "center" } },
{ text: "<7.25 ⚠", options: { color: "C0392B", bold: true, align: "center" } },
{ text: "Normal (7.35-7.45)", options: { color: "1A7A40", align: "center" } }
],
[
{ text: "Blood Color", options: { bold: true, align: "center" } },
{ text: "Bright red", options: { align: "center" } },
{ text: "Dark, deoxygenated", options: { color: "C0392B", bold: true, align: "center" } },
{ text: "Bright red, pulsatile", options: { color: "1A7A40", align: "center" } }
],
[
{ text: "Doppler Flow", options: { bold: true, align: "center" } },
{ text: "Normal", options: { align: "center" } },
{ text: "Absent / minimal", options: { color: "C0392B", bold: true, align: "center" } },
{ text: "High velocity, turbulent", options: { color: "1A7A40", align: "center" } }
]
];
slide.addTable(tableData, {
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border: { type: "solid", color: "BBBBBB", pt: 0.5 },
colW: [1.9, 2.2, 2.5, 2.8],
fill: { color: WHITE },
fontFace: "Calibri",
fontSize: 13,
rowH: 0.62,
firstRowFill: { color: DARK_NAVY }
});
}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — MANAGEMENT: ISCHEMIC (OVERVIEW)
// ══════════════════════════════════════════════════════════════════════════
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addHeader(slide, "Management: Ischemic Priapism — Step-by-Step");
// Emergency banner
slide.addShape(pres.shapes.ROUNDED_RECTANGLE, {
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fill: { color: RED_ALERT }, line: { color: RED_ALERT }, rectRadius: 0.06
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slide.addText("⚠ TIME-SENSITIVE: Prompt treatment essential to prevent penile fibrosis and permanent erectile dysfunction", {
x: 0.3, y: 0.92, w: 9.4, h: 0.38,
fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri",
align: "center", valign: "middle", margin: 0
});
const steps = [
{ num: "STEP 1", label: "Corporal Aspiration", color: "7B241C",
desc: "21-gauge butterfly needle, aspirate 20-30 mL of dark blood from corpus cavernosum. Can irrigate with normal saline. Often provides immediate relief." },
{ num: "STEP 2", label: "Intracavernous Phenylephrine", color: MID_BLUE,
desc: "Phenylephrine 500 µg (diluted) every 5 minutes — preferred α-adrenergic agent. Max: 1 mg/hour. Monitor BP and heart rate. Alternatives: epinephrine, norepinephrine." },
{ num: "STEP 3", label: "Surgical Shunting", color: "145A32",
desc: "If aspiration/medication fails or episode >24-48h. Distal shunts first (Winter, Ebbehoj, T-shunt, Al-Ghorab). Progress to proximal only if needed (Quackels, Barry)." },
{ num: "STEP 4", label: "Tunneling / Prosthesis", color: "4A235A",
desc: "For ischemia >48h: Lue tunneling through T-shunt. Penile prosthesis implantation if refractory — ideally within 4 weeks of ischemic episode to reduce complications." }
];
steps.forEach((s, i) => {
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fill: { color: s.color }, line: { color: s.color }, rectRadius: 0.08
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slide.addText(s.num, {
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fontSize: 10, bold: true, color: GOLD, fontFace: "Calibri", margin: 0
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slide.addText(s.label, {
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}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — SURGICAL SHUNTS
// ══════════════════════════════════════════════════════════════════════════
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addHeader(slide, "Surgical Shunt Procedures");
// Distal shunts
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slide.addText("DISTAL SHUNTS (1st choice)", {
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fontSize: 13.5, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0
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slide.addText([
{ text: "Corporoglanular Shunts:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Winter shunt: Tru-Cut needle through glans into corpora\n", options: { breakLine: true } },
{ text: "• Ebbehoj shunt: Scalpel blade through glans\n", options: { breakLine: true } },
{ text: "• T-shunt: Bilateral scalpel incision + optional tunneling (Lue)\n", options: { breakLine: true } },
{ text: "• Al-Ghorab shunt: Open excision of distal tunica albuginea\n\n", options: { breakLine: true } },
{ text: "Principle:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "Create fistula between corpus cavernosum and glans penis to drain trapped blood\n\n", options: { breakLine: true } },
{ text: "Post-op anticoagulation:\n", options: { bold: true, color: GOLD, breakLine: true } },
{ text: "Heparin 5000 U SQ + Aspirin 325 mg PO perioperatively\nAspirin 325 mg + Clopidogrel 75 mg for ≥5 days post-op", options: {} }
], {
x: 0.3, y: 1.48, w: 4.4, h: 3.75,
fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4
});
// Proximal shunts
slide.addShape(pres.shapes.ROUNDED_RECTANGLE, {
x: 5.2, y: 1.0, w: 4.6, h: 4.35,
fill: { color: MID_BLUE }, line: { color: MID_BLUE }, rectRadius: 0.1
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slide.addText("PROXIMAL SHUNTS (2nd choice)", {
x: 5.3, y: 1.05, w: 4.4, h: 0.38,
fontSize: 13.5, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0
});
slide.addText([
{ text: "Corporospongiosal Shunts:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Quackels shunt (1964): perineal anastomosis of corpora cavernosa to corpus spongiosum\n", options: { breakLine: true } },
{ text: "• Sacher shunt: scrotal approach\n\n", options: { breakLine: true } },
{ text: "Caverno-Venous Shunts:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Barry shunt (1976): cavernosum to dorsal vein anastomosis\n", options: { breakLine: true } },
{ text: "• Saphenous vein to corpus cavernosum shunt\n\n", options: { breakLine: true } },
{ text: "Note:\n", options: { bold: true, color: GOLD, breakLine: true } },
{ text: "These technically complex procedures have largely been replaced by tunneling (Lue) and early prosthesis implantation for refractory cases (>48h ischemia)\n\n", options: { breakLine: true } },
{ text: "Shunt failure risk: collagen exposure activates coagulation → anticoagulation mandatory", options: { color: GOLD } }
], {
x: 5.3, y: 1.48, w: 4.4, h: 3.75,
fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4
});
}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — MANAGEMENT: NON-ISCHEMIC
// ══════════════════════════════════════════════════════════════════════════
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addHeader(slide, "Management: Non-Ischemic (High-Flow) Priapism");
slide.addShape(pres.shapes.ROUNDED_RECTANGLE, {
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fill: { color: MID_BLUE }, line: { color: MID_BLUE }, rectRadius: 0.06
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slide.addText("NOT an emergency — conservative management acceptable initially", {
x: 0.3, y: 0.92, w: 9.4, h: 0.38,
fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri",
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const mgmt = [
{ step: "OBSERVATION", color: "145A32",
body: "• Spontaneous resolution in some cases\n• Perineal ice pack / compression\n• Suitable if minimally symptomatic\n• Safe period for observation: days to weeks" },
{ step: "ARTERIOGRAPHY + EMBOLIZATION", color: DARK_NAVY,
body: "• Pudendal arteriography to localize fistula\n• Selective embolization: autologous clot, coil, or Gelfoam\n• First-line definitive treatment\n• Erectile function preserved in >80% of cases\n• Repeat embolization possible if recurrence" },
{ step: "SURGICAL LIGATION", color: "7B241C",
body: "• Reserved for failed embolization\n• Direct surgical exposure and ligation of fistula\n• Higher risk of erectile dysfunction vs embolization\n• Rarely required" },
{ step: "FOLLOW-UP", color: "4A235A",
body: "• Doppler USS to confirm resolution\n• Post-embolization erectile function assessment\n• Long-term: PDE5 inhibitors if needed\n• MRI if fibrosis suspected" }
];
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const x = i % 2 === 0 ? 0.2 : 5.1;
const y = 1.42 + Math.floor(i / 2) * 2.05;
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x, y, w: 4.65, h: 1.9,
fill: { color: m.color }, line: { color: m.color }, rectRadius: 0.08
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slide.addText(m.step, {
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fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", margin: 0
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slide.addText(m.body, {
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fontSize: 12, color: WHITE, fontFace: "Calibri", valign: "top", margin: 2
});
});
}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — SICKLE CELL & STUTTERING MANAGEMENT
// ══════════════════════════════════════════════════════════════════════════
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slide.addShape(pres.shapes.RECTANGLE, {
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addHeader(slide, "Sickle Cell Disease & Stuttering Priapism — Special Management");
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x: 0.2, y: 1.0, w: 4.6, h: 4.35,
fill: { color: DARK_NAVY }, line: { color: DARK_NAVY }, rectRadius: 0.1
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slide.addText("Sickle Cell Priapism", {
x: 0.3, y: 1.05, w: 4.4, h: 0.38,
fontSize: 14, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0
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slide.addText([
{ text: "Conservative First-Line:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• IV hydration\n• Supplemental oxygen\n• Systemic alkalinization\n• Adequate analgesia (opioids)\n• Exchange transfusion (reduce HbS%)\n• Hyperbaric oxygen (adjunct)\n\n", options: { breakLine: true } },
{ text: "If above fails → intracavernous phenylephrine + aspiration\n\n", options: { breakLine: true } },
{ text: "If still fails → surgical shunting\n", options: { breakLine: true } },
{ text: "(Same algorithm as idiopathic ischemic priapism)", options: { italic: true, color: LIGHT_BLUE } }
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x: 0.3, y: 1.48, w: 4.4, h: 3.78,
fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4
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slide.addShape(pres.shapes.ROUNDED_RECTANGLE, {
x: 5.2, y: 1.0, w: 4.6, h: 4.35,
fill: { color: "4A235A" }, line: { color: "4A235A" }, rectRadius: 0.1
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slide.addText("Stuttering Priapism Prevention", {
x: 5.3, y: 1.05, w: 4.4, h: 0.38,
fontSize: 14, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0
});
slide.addText([
{ text: "Oral Agents:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Pseudoephedrine (oral α-agonist) at bedtime\n• Oral terbutaline (β-agonist)\n\n", options: { breakLine: true } },
{ text: "PDE5 Inhibitors (Paradoxical use):\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Long-term low-dose sildenafil\n• Rationale: upregulate PDE5, restore cGMP homeostasis\n• RCT evidence (Burnett et al., 2014)\n\n", options: { breakLine: true } },
{ text: "Hormonal Therapy:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• GnRH agonists (leuprolide) — suppress erections\n• Anti-androgens (cyproterone, bicalutamide)\n• Limited to refractory adult cases\n\n", options: { breakLine: true } },
{ text: "Ketoconazole + hydrocortisone\nDigoxin\nBaclofen (sickle cell specific)", options: { color: LIGHT_BLUE } }
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fontSize: 12, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4
});
}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 13 — DRUG TABLE (Intracavernous agents)
// ══════════════════════════════════════════════════════════════════════════
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addHeader(slide, "Pharmacological Agents in Priapism Management");
const tableData = [
[
{ text: "Drug", options: { bold: true, color: WHITE, align: "center" } },
{ text: "Class", options: { bold: true, color: WHITE, align: "center" } },
{ text: "Dose / Route", options: { bold: true, color: WHITE, align: "center" } },
{ text: "Notes", options: { bold: true, color: WHITE, align: "center" } }
],
[
{ text: "Phenylephrine", options: { bold: true } },
{ text: "α₁-agonist (pure)", options: {} },
{ text: "500 µg IC q5min\nMax 1 mg/hr", options: {} },
{ text: "PREFERRED agent — minimal cardiac side effects", options: { color: "1A7A40", bold: true } }
],
[
{ text: "Epinephrine", options: {} },
{ text: "α+β agonist", options: {} },
{ text: "100-200 µg IC diluted", options: {} },
{ text: "Avoid in cardiac disease; β effects may cause arrhythmia", options: { color: "C0392B" } }
],
[
{ text: "Norepinephrine", options: {} },
{ text: "α+β agonist", options: {} },
{ text: "100 µg IC diluted", options: {} },
{ text: "Alternative if phenylephrine unavailable", options: {} }
],
[
{ text: "Terbutaline (oral)", options: {} },
{ text: "β₂-agonist", options: {} },
{ text: "5 mg PO, repeat q15min", options: {} },
{ text: "Less effective than IC phenylephrine; stuttering priapism", options: {} }
],
[
{ text: "Sildenafil (oral)", options: {} },
{ text: "PDE5 inhibitor", options: {} },
{ text: "Low-dose, long-term", options: {} },
{ text: "Paradoxical: prevents recurrence in stuttering priapism", options: {} }
],
[
{ text: "Methylene Blue", options: {} },
{ text: "Guanylate cyclase inhibitor", options: {} },
{ text: "50 mg IC", options: {} },
{ text: "Experimental; inhibits NO-cGMP pathway", options: {} }
]
];
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fontSize: 12.5,
rowH: 0.55,
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}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 14 — COMPLICATIONS & PROGNOSIS
// ══════════════════════════════════════════════════════════════════════════
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slide.addText("Complications", {
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fontSize: 14, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0
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slide.addText([
{ text: "Erectile Dysfunction (most feared):\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Incidence: 35-90% after ischemic priapism\n• Higher risk with prolonged duration (>24h)\n• Early treatment (<4-6h) offers best preservation\n\n", options: { breakLine: true } },
{ text: "Penile Fibrosis:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Smooth muscle necrosis → fibrosis → Peyronie's-like changes\n• Occurs with prolonged ischemia\n\n", options: { breakLine: true } },
{ text: "Penile Necrosis:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Rare; with very prolonged untreated cases\n\n", options: { breakLine: true } },
{ text: "Procedural Complications:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Shunt failure (premature clot closure)\n• Infection\n• Urethral fistula (rare)\n• Priapism recurrence post-shunt", options: {} }
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fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4
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// Right column
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fill: { color: "145A32" }, line: { color: "145A32" }, rectRadius: 0.1
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slide.addText("Prognosis & Time Correlation", {
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fontSize: 14, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0
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slide.addText([
{ text: "Duration vs. Outcome:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• <4-6 hours: Excellent recovery likely\n• 12-24 hours: Moderate risk of ED (~35%)\n• 24-48 hours: High risk of ED (~50-60%)\n• >48 hours: Very high ED risk (>80%)\n• >72 hours: Near-certain ED; early prosthesis advised\n\n", options: { breakLine: true } },
{ text: "Non-Ischemic Prognosis:\n", options: { bold: true, color: LIGHT_BLUE, breakLine: true } },
{ text: "• Generally good; embolization preserves erectile function in >80%\n• No time pressure vs. ischemic type\n\n", options: { breakLine: true } },
{ text: "Key Message:\n", options: { bold: true, color: GOLD, breakLine: true } },
{ text: "\"Early recognition and prompt treatment of priapism offer the best opportunity to avoid permanent erectile dysfunction\"", options: { italic: true, color: GOLD } }
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fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4
});
}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 15 — PEDIATRIC PRIAPISM
// ══════════════════════════════════════════════════════════════════════════
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addHeader(slide, "Priapism in Pediatric Population");
slide.addText([
{ text: "• Most pediatric priapism is LOW-FLOW (ischemic) due to ", options: { breakLine: false } },
{ text: "sickle cell disease (homozygous HbSS)\n", options: { bold: true, color: RED_ALERT, breakLine: true } },
{ text: "• Sickle cell priapism affects 2-29% of males with the disease\n", options: { breakLine: true } },
{ text: "• Priapism typically occurs during sleep (hypoventilatory acidosis ↓ pO₂ → potentiates sickling)\n", options: { breakLine: true } },
{ text: "• Stuttering (transient episodes <2h) more common than fulminant priapism in children\n\n", options: { breakLine: true } },
{ text: "Other pediatric causes: ", options: { bold: true } },
{ text: "Leukemia, other hemoglobinopathies, local malignancy, idiopathic\n\n", options: { breakLine: true } },
{ text: "Management follows adult AUA/EAU guidelines with pediatric adjustments:\n", options: { bold: true, breakLine: true } },
{ text: "• Hydration + O₂ + alkalinization + analgesia first\n", options: { breakLine: true } },
{ text: "• Exchange transfusion to reduce HbS < 30-50%\n", options: { breakLine: true } },
{ text: "• Pseudoephedrine at bedtime for prevention of stuttering episodes\n", options: { breakLine: true } },
{ text: "• Intracavernous phenylephrine + aspiration if conservative fails\n", options: { breakLine: true } },
{ text: "• Surgical shunting (distal first) if all else fails\n", options: { breakLine: true } },
{ text: "• Hydroxyurea may reduce sickle cell crises (and stuttering priapism episodes) long-term", options: {} }
], {
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fontSize: 14.5, color: DARK_TEXT, fontFace: "Calibri", valign: "top", margin: 4
});
}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 16 — DIFFERENTIAL DIAGNOSIS
// ══════════════════════════════════════════════════════════════════════════
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addHeader(slide, "Differential Diagnosis");
const diffs = [
{ title: "Penile Fracture", color: "7B241C",
body: "Trauma during erection; audible snap; acute detumescence; penile deviation. No prolonged erection. Requires surgical exploration." },
{ title: "Peyronie's Disease", color: DARK_NAVY,
body: "Painful erections with curvature; fibrous plaque formation; usually no prolonged erection. Chronic condition, not emergency." },
{ title: "Psychogenic Erection", color: MID_BLUE,
body: "Normal erection related to sexual stimulation; resolves spontaneously. Duration <30 minutes, no pain, no tenderness." },
{ title: "Penile Tumour / Metastasis", color: "145A32",
body: "Penile induration/mass; may cause venous engorgement. Painless or minimally painful. Check PSA, imaging. Often secondary to prostate/bladder Ca." },
{ title: "Penile Infection / Fournier's", color: "4A235A",
body: "Scrotal/perineal involvement; fever; crepitus; systemic sepsis. Aggressive surgical debridement required. No prolonged erection typically." },
{ title: "Normal Nocturnal Penile Tumescence", color: "6E2C00",
body: "Physiological; occurs during REM sleep; not sustained on waking; no pain. Duration <30 min. No treatment required." }
];
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 17 — PENILE PROSTHESIS IN PRIAPISM
// ══════════════════════════════════════════════════════════════════════════
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addContentSlide("Penile Prosthesis Implantation in Refractory Priapism", [
{ text: "INDICATIONS:\n", options: { bold: true, color: ACCENT, breakLine: true } },
{ text: "• Ischemic priapism > 48–72 hours unresponsive to all conservative and shunting measures\n", options: { breakLine: true } },
{ text: "• Corporal fibrosis established on MRI / clinical assessment\n", options: { breakLine: true } },
{ text: "• Patient counselled about expected erectile dysfunction\n\n", options: { breakLine: true } },
{ text: "TIMING:\n", options: { bold: true, color: ACCENT, breakLine: true } },
{ text: "• Early (within 2–4 weeks of acute episode): preferred — easier insertion, less fibrosis, fewer complications\n", options: { breakLine: true } },
{ text: "• Delayed (>3 months): more difficult due to dense fibrosis; higher erosion/infection risk; may require penile reconstruction\n\n", options: { breakLine: true } },
{ text: "TYPES:\n", options: { bold: true, color: ACCENT, breakLine: true } },
{ text: "• Malleable (semi-rigid) prosthesis — simpler, preferred in acute setting\n", options: { breakLine: true } },
{ text: "• Inflatable (3-piece) prosthesis — better cosmesis; for elective setting post-fibrosis\n\n", options: { breakLine: true } },
{ text: "OUTCOMES:\n", options: { bold: true, color: ACCENT, breakLine: true } },
{ text: "• Patient satisfaction high when appropriately counselled\n", options: { breakLine: true } },
{ text: "• Best outcomes when implanted early in the post-priapism period\n", options: { breakLine: true } },
{ text: "• Source: Campbell-Walsh-Wein Urology; Smith & Tanagho's General Urology", options: { italic: true, color: ACCENT } }
]);
}
// ══════════════════════════════════════════════════════════════════════════
// SLIDE 18 — AUA GUIDELINES SUMMARY
// ══════════════════════════════════════════════════════════════════════════
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const guidelines = [
{ num: "1", text: "History + physical exam → determine ischemic vs non-ischemic type FIRST", tag: "Diagnosis" },
{ num: "2", text: "Corporal blood gas aspiration is the diagnostic gold standard (+ color Doppler USS)", tag: "Diagnosis" },
{ num: "3", text: "Ischemic priapism: corporal aspiration ± irrigation as first intervention (Grade A)", tag: "Treatment" },
{ num: "4", text: "Phenylephrine is the preferred intracavernous sympathomimetic (safest cardiac profile)", tag: "Treatment" },
{ num: "5", text: "Distal shunts (T-shunt with tunneling preferred) for failed pharmacotherapy", tag: "Surgery" },
{ num: "6", text: "Perioperative anticoagulation mandatory to prevent shunt thrombosis", tag: "Surgery" },
{ num: "7", text: "Non-ischemic: observation acceptable; selective arterial embolization is definitive", tag: "Non-ischemic" },
{ num: "8", text: "Early penile prosthesis (within 2-4 weeks) for prolonged ischemic cases to prevent fibrosis complications", tag: "Prosthesis" }
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 19 — QUICK REFERENCE / EXAM TABLE
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{ text: "Idiopathic, sickle cell, meds", options: {} },
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{ text: "No — usually painless", options: { color: "1A7A40" } }
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{ text: "Partial tumescence, not fully rigid", options: {} }
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[
{ text: "Emergency?", options: { bold: true } },
{ text: "YES — urological emergency", options: { color: "C0392B", bold: true } },
{ text: "No — can observe", options: { color: "1A7A40" } }
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[
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{ text: "Aspiration → phenylephrine → shunt → prosthesis", options: {} },
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{ text: "High (duration-dependent)", options: { color: "C0392B" } },
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// ══════════════════════════════════════════════════════════════════════════
// SLIDE 20 — KEY TAKEAWAYS / CONCLUSION
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"Priapism = erection >4 hours unrelated to sexual stimulation — ischemic type is a UROLOGICAL EMERGENCY",
"Always classify FIRST: ischemic vs non-ischemic vs stuttering — management differs completely",
"Corporal blood gas is the gold standard (pO₂ <30 + pCO₂ >60 + pH <7.25 = ischemic)",
"Ischemic treatment: aspiration → phenylephrine → distal shunts → tunneling → early prosthesis",
"Non-ischemic: NOT an emergency — selective pudendal artery embolization is definitive (>80% preserve erections)",
"Sickle cell: hydration + O₂ + alkalinization + exchange transfusion FIRST before invasive procedures",
"Stuttering priapism: paradoxical long-term PDE5 inhibitors prevent recurrence",
"TIME IS PENILE FUNCTION — erectile dysfunction risk rises sharply beyond 24–48 hours of ischemia"
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// ─── WRITE FILE ──────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/priapism-ppt/Priapism_Urology.pptx" })
.then(() => console.log("SUCCESS: Priapism_Urology.pptx created"))
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