const pptxgen = require("pptxgenjs"); const pres = new pptxgen(); pres.layout = "LAYOUT_16x9"; pres.title = "Priapism - A Urological Emergency"; pres.author = "Urology"; // ─── COLOR PALETTE ──────────────────────────────────────────────────────── const DARK_NAVY = "0D1B2A"; // dominant background for title/section slides const MID_BLUE = "1B4F72"; // secondary dark const ACCENT = "2E86C1"; // bright blue accent const LIGHT_BLUE = "AED6F1"; // subtle tint const WHITE = "FFFFFF"; const LIGHT_GRAY = "F2F6FA"; const DARK_TEXT = "1A1A2E"; const RED_ALERT = "C0392B"; // emergency emphasis const GOLD = "F1C40F"; // highlight accent // ─── HELPER: add slide header bar ───────────────────────────────────────── function addHeader(slide, title) { slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.85, fill: { color: DARK_NAVY }, line: { color: DARK_NAVY } }); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0.85, w: 10, h: 0.06, fill: { color: ACCENT }, line: { color: ACCENT } }); slide.addText(title, { x: 0.3, y: 0.05, w: 9.4, h: 0.75, fontSize: 22, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle", margin: 0 }); } // ─── HELPER: add body content slide ─────────────────────────────────────── function addContentSlide(title, bullets) { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, title); slide.addText(bullets, { x: 0.4, y: 1.05, w: 9.2, h: 4.3, fontSize: 16, color: DARK_TEXT, fontFace: "Calibri", valign: "top", margin: 4 }); return slide; } // ─── HELPER: two-column slide ───────────────────────────────────────────── function addTwoColSlide(title, col1Label, col1Bullets, col2Label, col2Bullets, col1Color, col2Color) { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, title); const colY = 1.05, colH = 4.3; // Left column slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.25, y: colY, w: 4.55, h: colH, fill: { color: col1Color || DARK_NAVY }, line: { color: col1Color || DARK_NAVY }, rectRadius: 0.08 }); slide.addText(col1Label, { x: 0.35, y: colY + 0.05, w: 4.35, h: 0.45, fontSize: 14, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0 }); slide.addText(col1Bullets, { x: 0.35, y: colY + 0.55, w: 4.35, h: colH - 0.65, fontSize: 13.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4 }); // Right column slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 5.2, y: colY, w: 4.55, h: colH, fill: { color: col2Color || MID_BLUE }, line: { color: col2Color || MID_BLUE }, rectRadius: 0.08 }); slide.addText(col2Label, { x: 5.3, y: colY + 0.05, w: 4.35, h: 0.45, fontSize: 14, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0 }); slide.addText(col2Bullets, { x: 5.3, y: colY + 0.55, w: 4.35, h: colH - 0.65, fontSize: 13.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4 }); return slide; } // ─── HELPER: section divider ────────────────────────────────────────────── function addSectionSlide(number, text, sub) { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_NAVY }, line: { color: DARK_NAVY } }); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 2.5, w: 0.18, h: 0.8, fill: { color: ACCENT }, line: { color: ACCENT } }); slide.addText(number, { x: 0.5, y: 0.8, w: 9, h: 1, fontSize: 52, bold: true, color: ACCENT, fontFace: "Calibri", align: "left", margin: 0 }); slide.addText(text, { x: 0.5, y: 1.7, w: 9, h: 1.2, fontSize: 28, bold: true, color: WHITE, fontFace: "Calibri", align: "left", margin: 0 }); if (sub) { slide.addText(sub, { x: 0.5, y: 2.85, w: 9, h: 0.6, fontSize: 16, color: LIGHT_BLUE, fontFace: "Calibri", align: "left", margin: 0, italic: true }); } return slide; } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 1 — TITLE // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); // Full dark background slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_NAVY }, line: { color: DARK_NAVY } }); // Accent strip slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 4.1, w: 10, h: 0.08, fill: { color: ACCENT }, line: { color: ACCENT } }); // Decorative left bar slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 0.25, h: 5.625, fill: { color: ACCENT }, line: { color: ACCENT } }); // EMERGENCY badge slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.6, y: 0.35, w: 2.5, h: 0.45, fill: { color: RED_ALERT }, line: { color: RED_ALERT }, rectRadius: 0.08 }); slide.addText("UROLOGICAL EMERGENCY", { x: 0.6, y: 0.35, w: 2.5, h: 0.45, fontSize: 10, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 }); slide.addText("PRIAPISM", { x: 0.5, y: 0.9, w: 9, h: 1.6, fontSize: 64, bold: true, color: WHITE, fontFace: "Calibri", align: "left", margin: 0, charSpacing: 8 }); slide.addText("Pathophysiology • Classification • Diagnosis • Management", { x: 0.5, y: 2.55, w: 9, h: 0.6, fontSize: 17, color: LIGHT_BLUE, fontFace: "Calibri", align: "left", margin: 0 }); slide.addShape(pres.shapes.RECTANGLE, { x: 0.5, y: 3.25, w: 3, h: 0.04, fill: { color: ACCENT }, line: { color: ACCENT } }); slide.addText("A Comprehensive Urology Review", { x: 0.5, y: 3.4, w: 9, h: 0.5, fontSize: 14, color: LIGHT_BLUE, fontFace: "Calibri", align: "left", italic: true, margin: 0 }); slide.addText("Source: Smith & Tanagho's General Urology • Campbell-Walsh-Wein Urology", { x: 0.5, y: 4.25, w: 9, h: 0.4, fontSize: 11, color: LIGHT_BLUE, fontFace: "Calibri", align: "left", margin: 0, italic: true }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 2 — DEFINITION & OVERVIEW // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Definition & Overview"); // Definition box slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 1.0, w: 9.4, h: 1.1, fill: { color: ACCENT }, line: { color: ACCENT }, rectRadius: 0.1 }); slide.addText([ { text: "Definition: ", options: { bold: true, color: WHITE } }, { text: "A prolonged, persistent penile erection unrelated to sexual interest or stimulation lasting ", options: { color: WHITE } }, { text: ">4 hours", options: { bold: true, color: GOLD } }, { text: " — constituting a urological emergency", options: { color: WHITE } } ], { x: 0.5, y: 1.05, w: 9, h: 1.0, fontSize: 15.5, fontFace: "Calibri", valign: "middle", margin: 4 }); slide.addText([ { text: "Key characteristics:\n", options: { bold: true, breakLine: true } }, { 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: {} } ], { x: 0.4, y: 2.25, w: 9.2, h: 3.1, fontSize: 15, color: DARK_TEXT, fontFace: "Calibri", valign: "top", margin: 4 }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 3 — CLASSIFICATION (3 types) // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Classification of Priapism"); const cards = [ { 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"] } ]; cards.forEach(c => { slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: c.x, y: 1.0, w: 3.15, h: 4.35, fill: { color: c.color }, line: { color: c.color }, rectRadius: 0.1 }); slide.addText(c.label, { x: c.x + 0.1, y: 1.05, w: 2.95, h: 0.4, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0 }); slide.addText(c.sub, { x: c.x + 0.1, y: 1.42, w: 2.95, h: 0.3, fontSize: 10.5, color: LIGHT_BLUE, fontFace: "Calibri", align: "center", italic: true, margin: 0 }); slide.addShape(pres.shapes.RECTANGLE, { x: c.x + 0.2, y: 1.74, w: 2.75, h: 0.03, fill: { color: GOLD }, line: { color: GOLD } }); const bulletText = c.pts.map((p, i) => ({ text: "• " + p, options: { breakLine: i < c.pts.length - 1, color: WHITE } })); slide.addText(bulletText, { x: c.x + 0.12, y: 1.82, w: 2.91, h: 3.4, fontSize: 12, fontFace: "Calibri", valign: "top", margin: 3 }); }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 4 — ETIOLOGY / CAUSES // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Etiology & Predisposing Factors"); const cats = [ { 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)"] } ]; cats.forEach((c, i) => { const col = i % 2; const row = Math.floor(i / 2); const x = col === 0 ? 0.2 : 5.1; const y = row === 0 ? 1.0 : 3.2; slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w: 4.65, h: 2.0, fill: { color: c.color }, line: { color: c.color }, rectRadius: 0.08 }); slide.addText(c.label, { x: x + 0.1, y: y + 0.07, w: 4.45, h: 0.35, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", align: "left", margin: 0 }); const bulletText = c.items.map((item, idx) => ({ text: "• " + item, options: { breakLine: idx < c.items.length - 1, color: WHITE } })); slide.addText(bulletText, { x: x + 0.1, y: y + 0.45, w: 4.45, h: 1.45, fontSize: 12, fontFace: "Calibri", valign: "top", margin: 2 }); }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 5 — PATHOPHYSIOLOGY // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Pathophysiology"); // Ischemic pathway (left) slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 1.0, w: 4.6, h: 4.35, fill: { color: DARK_NAVY }, line: { color: DARK_NAVY }, rectRadius: 0.1 }); slide.addText("ISCHEMIC (Low-Flow)", { x: 0.3, y: 1.05, w: 4.4, h: 0.38, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0 }); slide.addText([ { text: "Venous outflow obstruction\n", options: { breakLine: true } }, { text: "↓\n", options: { breakLine: true, color: ACCENT, bold: true } }, { text: "Impaired arterial inflow\n", options: { breakLine: true } }, { text: "↓\n", options: { breakLine: true, color: ACCENT, bold: true } }, { text: "Stagnant blood in corpora cavernosa\n", options: { breakLine: true } }, { text: "↓\n", options: { breakLine: true, color: ACCENT, bold: true } }, { text: "Tissue hypoxia + acidosis + hypercapnia\n", options: { breakLine: true } }, { text: "↓\n", options: { breakLine: true, color: ACCENT, bold: true } }, { text: "Endothelial & smooth muscle damage\n", options: { breakLine: true } }, { text: "↓\n", options: { breakLine: true, color: ACCENT, bold: true } }, { text: "Interstitial edema → Fibrosis → ED", options: { bold: true, color: GOLD } } ], { x: 0.3, y: 1.5, w: 4.4, h: 3.7, fontSize: 13.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4 }); // High-flow / Stuttering (right) slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 5.2, y: 1.0, w: 4.6, h: 2.0, fill: { color: MID_BLUE }, line: { color: MID_BLUE }, rectRadius: 0.1 }); slide.addText("NON-ISCHEMIC (High-Flow)", { x: 5.3, y: 1.05, w: 4.4, h: 0.38, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0 }); slide.addText([ { 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 } }, { text: "↓\n", options: { breakLine: true, color: GOLD, bold: true } }, { text: "Venous drainage INTACT → no ischemia", options: {} } ], { x: 5.3, y: 1.48, w: 4.4, h: 1.42, fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 3 }); slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 5.2, y: 3.15, w: 4.6, h: 2.2, fill: { color: "4A235A" }, line: { color: "4A235A" }, rectRadius: 0.1 }); slide.addText("STUTTERING Pathophysiology", { x: 5.3, y: 3.2, w: 4.4, h: 0.38, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0 }); slide.addText([ { 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: {} } ], { x: 5.3, y: 3.63, w: 4.4, h: 1.62, fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 3 }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 6 — CLINICAL FEATURES // ══════════════════════════════════════════════════════════════════════════ { addTwoColSlide( "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: {} } ], "NON-ISCHEMIC (High-Flow)", [ { text: "• Partially rigid, often PAINLESS erection\n", options: { breakLine: true } }, { text: "• History of perineal/penile trauma\n", options: { breakLine: true } }, { 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 } }, { text: "• Cavernosal artery aneurysm possible\n", options: { breakLine: true } }, { text: "• Erectile function usually preserved", options: {} } ], "8B0000", MID_BLUE ); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 7 — DIAGNOSTIC EVALUATION // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Diagnostic Evaluation"); const steps = [ { 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" } ]; steps.forEach((s, i) => { const col = i % 2; const row = Math.floor(i / 2); const x = col === 0 ? 0.2 : 5.1; const y = 1.02 + row * 1.48; slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w: 4.65, h: 1.35, fill: { color: DARK_NAVY }, line: { color: DARK_NAVY }, rectRadius: 0.08 }); // Number badge slide.addShape(pres.shapes.RECTANGLE, { x, y, w: 0.48, h: 1.35, fill: { color: ACCENT }, line: { color: ACCENT } }); slide.addText(s.n, { x, y, w: 0.48, h: 1.35, fontSize: 16, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 }); slide.addText(s.t, { x: x + 0.55, y: y + 0.08, w: 3.95, h: 0.32, fontSize: 12.5, bold: true, color: GOLD, fontFace: "Calibri", margin: 0 }); slide.addText(s.d, { x: x + 0.55, y: y + 0.42, w: 3.95, h: 0.85, fontSize: 11, color: WHITE, fontFace: "Calibri", valign: "top", margin: 2 }); }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 8 — CAVERNOUS BLOOD GAS TABLE // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Cavernous Blood Gas Analysis — Diagnostic Criteria"); const tableData = [ [ { 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, { x: 0.3, y: 1.05, w: 9.4, h: 4.25, 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) // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Management: Ischemic Priapism — Step-by-Step"); // Emergency banner slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 0.92, w: 9.4, h: 0.38, fill: { color: RED_ALERT }, line: { color: RED_ALERT }, rectRadius: 0.06 }); 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) => { const x = i % 2 === 0 ? 0.2 : 5.1; const y = 1.42 + Math.floor(i / 2) * 2.05; slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w: 4.65, h: 1.9, fill: { color: s.color }, line: { color: s.color }, rectRadius: 0.08 }); slide.addText(s.num, { x: x + 0.12, y: y + 0.1, w: 1.2, h: 0.3, fontSize: 10, bold: true, color: GOLD, fontFace: "Calibri", margin: 0 }); slide.addText(s.label, { x: x + 0.12, y: y + 0.38, w: 4.35, h: 0.38, fontSize: 14, bold: true, color: WHITE, fontFace: "Calibri", margin: 0 }); slide.addText(s.desc, { x: x + 0.12, y: y + 0.8, w: 4.41, h: 1.0, fontSize: 12, color: LIGHT_BLUE, fontFace: "Calibri", valign: "top", margin: 2 }); }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 10 — SURGICAL SHUNTS // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Surgical Shunt Procedures"); // Distal shunts slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 1.0, w: 4.6, h: 4.35, fill: { color: DARK_NAVY }, line: { color: DARK_NAVY }, rectRadius: 0.1 }); slide.addText("DISTAL SHUNTS (1st choice)", { x: 0.3, 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: "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 }); 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 // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Management: Non-Ischemic (High-Flow) Priapism"); slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.3, y: 0.92, w: 9.4, h: 0.38, fill: { color: MID_BLUE }, line: { color: MID_BLUE }, rectRadius: 0.06 }); 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", align: "center", valign: "middle", margin: 0 }); 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" } ]; mgmt.forEach((m, i) => { const x = i % 2 === 0 ? 0.2 : 5.1; const y = 1.42 + Math.floor(i / 2) * 2.05; slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w: 4.65, h: 1.9, fill: { color: m.color }, line: { color: m.color }, rectRadius: 0.08 }); slide.addText(m.step, { x: x + 0.12, y: y + 0.08, w: 4.41, h: 0.38, fontSize: 13, bold: true, color: GOLD, fontFace: "Calibri", margin: 0 }); slide.addText(m.body, { x: x + 0.12, y: y + 0.5, w: 4.41, h: 1.3, fontSize: 12, color: WHITE, fontFace: "Calibri", valign: "top", margin: 2 }); }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 12 — SICKLE CELL & STUTTERING MANAGEMENT // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Sickle Cell Disease & Stuttering Priapism — Special Management"); slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 1.0, w: 4.6, h: 4.35, fill: { color: DARK_NAVY }, line: { color: DARK_NAVY }, rectRadius: 0.1 }); 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 }); 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 } } ], { x: 0.3, y: 1.48, w: 4.4, h: 3.78, fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4 }); 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 }); 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 } } ], { x: 5.3, y: 1.48, w: 4.4, h: 3.78, fontSize: 12, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4 }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 13 — DRUG TABLE (Intracavernous agents) // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); 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: {} } ] ]; slide.addTable(tableData, { x: 0.2, y: 1.0, w: 9.6, h: 4.35, border: { type: "solid", color: "BBBBBB", pt: 0.5 }, colW: [2.0, 1.8, 2.1, 3.7], fill: { color: WHITE }, fontFace: "Calibri", fontSize: 12.5, rowH: 0.55, firstRowFill: { color: DARK_NAVY } }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 14 — COMPLICATIONS & PROGNOSIS // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Complications & Prognosis"); // Left column slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.2, y: 1.0, w: 4.6, h: 4.35, fill: { color: DARK_NAVY }, line: { color: DARK_NAVY }, rectRadius: 0.1 }); slide.addText("Complications", { x: 0.3, y: 1.05, w: 4.4, h: 0.38, fontSize: 14, bold: true, color: GOLD, fontFace: "Calibri", align: "center", margin: 0 }); slide.addText([ { text: "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: {} } ], { x: 0.3, y: 1.5, w: 4.4, h: 3.7, fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4 }); // Right column slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 5.2, y: 1.0, w: 4.6, h: 4.35, fill: { color: "145A32" }, line: { color: "145A32" }, rectRadius: 0.1 }); slide.addText("Prognosis & Time Correlation", { 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: "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 } } ], { x: 5.3, y: 1.5, w: 4.4, h: 3.7, fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 4 }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 15 — PEDIATRIC PRIAPISM // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); 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: {} } ], { x: 0.4, y: 1.05, w: 9.2, h: 4.3, fontSize: 14.5, color: DARK_TEXT, fontFace: "Calibri", valign: "top", margin: 4 }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 16 — DIFFERENTIAL DIAGNOSIS // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); 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." } ]; diffs.forEach((d, i) => { const col = i % 2; const row = Math.floor(i / 3) * 3 + (i % 3); const x = col === 0 ? 0.2 : 5.1; const baseY = 1.0; const r = Math.floor(i / 2); const y = baseY + r * 1.55; slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x, y, w: 4.65, h: 1.4, fill: { color: d.color }, line: { color: d.color }, rectRadius: 0.08 }); slide.addText(d.title, { x: x + 0.12, y: y + 0.06, w: 4.41, h: 0.33, fontSize: 12.5, bold: true, color: GOLD, fontFace: "Calibri", margin: 0 }); slide.addText(d.body, { x: x + 0.12, y: y + 0.42, w: 4.41, h: 0.88, fontSize: 11.5, color: WHITE, fontFace: "Calibri", valign: "top", margin: 2 }); }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 17 — PENILE PROSTHESIS IN PRIAPISM // ══════════════════════════════════════════════════════════════════════════ { 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 // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "AUA / EAU Guidelines Summary"); 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" } ]; const tagColors = { "Diagnosis": ACCENT, "Treatment": "145A32", "Surgery": "7B241C", "Non-ischemic": MID_BLUE, "Prosthesis": "4A235A" }; guidelines.forEach((g, i) => { const y = 1.05 + i * 0.55; slide.addShape(pres.shapes.RECTANGLE, { x: 0.2, y, w: 0.42, h: 0.45, fill: { color: ACCENT }, line: { color: ACCENT } }); slide.addText(g.num, { x: 0.2, y, w: 0.42, h: 0.45, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 }); const tColor = tagColors[g.tag] || ACCENT; slide.addShape(pres.shapes.ROUNDED_RECTANGLE, { x: 0.7, y: y + 0.06, w: 1.2, h: 0.32, fill: { color: tColor }, line: { color: tColor }, rectRadius: 0.05 }); slide.addText(g.tag, { x: 0.7, y: y + 0.06, w: 1.2, h: 0.32, fontSize: 9.5, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 }); slide.addText(g.text, { x: 2.05, y, w: 7.7, h: 0.45, fontSize: 13, color: DARK_TEXT, fontFace: "Calibri", valign: "middle", margin: 2 }); }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 19 — QUICK REFERENCE / EXAM TABLE // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LIGHT_GRAY }, line: { color: LIGHT_GRAY } }); addHeader(slide, "Quick Reference — Ischemic vs Non-Ischemic Comparison"); const tableData = [ [ { text: "Feature", options: { bold: true, color: WHITE, align: "center" } }, { text: "ISCHEMIC (Low-Flow)", options: { bold: true, color: GOLD, align: "center" } }, { text: "NON-ISCHEMIC (High-Flow)", options: { bold: true, color: LIGHT_BLUE, align: "center" } } ], [ { text: "Common cause", options: { bold: true } }, { text: "Idiopathic, sickle cell, meds", options: {} }, { text: "Perineal/penile trauma", options: {} } ], [ { text: "Pain", options: { bold: true } }, { text: "Yes — progressively worsening", options: { color: "C0392B", bold: true } }, { text: "No — usually painless", options: { color: "1A7A40" } } ], [ { text: "Penile rigidity", options: { bold: true } }, { text: "Fully rigid, tense corpora", options: {} }, { text: "Partial tumescence, not fully rigid", options: {} } ], [ { text: "Blood gas pO₂", options: { bold: true } }, { text: "<30 mmHg (hypoxic)", options: { color: "C0392B", bold: true } }, { text: ">90 mmHg (normal)", options: { color: "1A7A40" } } ], [ { text: "Doppler USS", options: { bold: true } }, { text: "Absent / minimal flow", options: { color: "C0392B" } }, { text: "High-velocity turbulent flow", options: { color: "1A7A40" } } ], [ { text: "Emergency?", options: { bold: true } }, { text: "YES — urological emergency", options: { color: "C0392B", bold: true } }, { text: "No — can observe", options: { color: "1A7A40" } } ], [ { text: "Treatment", options: { bold: true } }, { text: "Aspiration → phenylephrine → shunt → prosthesis", options: {} }, { text: "Observation / selective embolization", options: {} } ], [ { text: "ED risk", options: { bold: true } }, { text: "High (duration-dependent)", options: { color: "C0392B" } }, { text: "Low (>80% preserve function post-embolization)", options: { color: "1A7A40" } } ] ]; slide.addTable(tableData, { x: 0.2, y: 1.0, w: 9.6, h: 4.35, border: { type: "solid", color: "BBBBBB", pt: 0.5 }, colW: [2.4, 3.6, 3.6], fill: { color: WHITE }, fontFace: "Calibri", fontSize: 12.5, rowH: 0.43, firstRowFill: { color: DARK_NAVY } }); } // ══════════════════════════════════════════════════════════════════════════ // SLIDE 20 — KEY TAKEAWAYS / CONCLUSION // ══════════════════════════════════════════════════════════════════════════ { const slide = pres.addSlide(); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_NAVY }, line: { color: DARK_NAVY } }); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.06, fill: { color: ACCENT }, line: { color: ACCENT } }); slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.56, w: 10, h: 0.065, fill: { color: ACCENT }, line: { color: ACCENT } }); slide.addText("Key Takeaways", { x: 0.5, y: 0.15, w: 9, h: 0.7, fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", align: "left", margin: 0 }); slide.addShape(pres.shapes.RECTANGLE, { x: 0.5, y: 0.85, w: 2.5, h: 0.05, fill: { color: ACCENT }, line: { color: ACCENT } }); const points = [ "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" ]; points.forEach((p, i) => { slide.addShape(pres.shapes.RECTANGLE, { x: 0.5, y: 0.98 + i * 0.57, w: 0.3, h: 0.38, fill: { color: ACCENT }, line: { color: ACCENT } }); slide.addText((i + 1).toString(), { x: 0.5, y: 0.98 + i * 0.57, w: 0.3, h: 0.38, fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 }); slide.addText(p, { x: 0.9, y: 0.98 + i * 0.57, w: 8.8, h: 0.38, fontSize: 13, color: i === 7 ? GOLD : WHITE, fontFace: "Calibri", bold: i === 7, valign: "middle", margin: 2 }); }); } // ─── WRITE FILE ────────────────────────────────────────────────────────── pres.writeFile({ fileName: "/home/daytona/priapism-ppt/Priapism_Urology.pptx" }) .then(() => console.log("SUCCESS: Priapism_Urology.pptx created")) .catch(err => console.error("ERROR:", err));