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Priapism Following hCG Administration In A Cat

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  • Ministry of Municipality & Environment - Doha - Qatar

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Priapism, defined as a persistent and painful penile erection in the absence of sexual excitation, is an uncommon disorder of cats that usually requires penile amputation and perineal urethrostomy. This report describes a case of priapism in a short-haired Persian male cat aged 3 years. The condition had appeared after attempted mating with a female at the end of oestrus and the time of referral to the authors was 10 days after onset. Previous treatment had consisted of corticosteroids and local lubricants. On physical examination, the cat appeared bright and alert; the penis was erect but the colour was normal; blood analysis excluded viral pathologies. The cat history revealed that he had been treated with 500 IU hCG i.m. because he had to mate with three queens in a short period of time. In consideration of the mild symptoms, conservative treatment was adopted. The condition resolved in about 40 days. This is the first report of priapism following hCG administration in a cat and indicates that the misuse of this gonadotropin might cause potentially harmful side effects.
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Acta Veterinaria-Beograd 2015, 65 (4), 568-571
UDK: 636.8.09:616.69
DOI: 10.1515/acve-2015-0048
Case report
Corresponding author: e-mail: ada.rota@unito.it
PRIAPISM FOLLOWING hCG ADMINISTRATION IN A CAT
QUARANTA Giuseppe1, ROTA Ada1*, DOGLIERO Andrea1, PECCHIA Flaviana2
1Dipartimento di Scienze Veterinarie, Grugliasco, Torino, Italia
2Practitioner, Centro Veterinario Specialistico, Roma, Italia
(Received 14 May; Accepted 8 September 2015)
Priapism, de ned as a persistent and painful penile erection in the absence of sexual
excitation, is an uncommon disorder of cats that usually requires penile amputation
and perineal urethrostomy. This report describes a case of priapism in a short-haired
Persian male cat aged 3 years. The condition had appeared after attempted mating with
a female at the end of oestrus and the time of referral to the authors was 10 days after
onset. Previous treatment had consisted of corticosteroids and local lubricants. On
physical examination, the cat appeared bright and alert; the penis was erect but the
colour was normal; blood analysis excluded viral pathologies. The cat history revealed
that he had been treated with 500 IU hCG i.m. because he had to mate with three
queens in a short period of time. In consideration of the mild symptoms, conservative
treatment was adopted. The condition resolved in about 40 days. This is the rst report
of priapism following hCG administration in a cat and indicates that the misuse of this
gonadotropin might cause potentially harmful side effects.
Key words: cat, priapism, hCG, conservative treatment
INTRODUCTION
Priapism, de ned as a persistent and painful penile erection in the absence of sexual
excitation, is an uncommon disorder in cats [1]. Erectile tissue engorgement can either
be the consequence of an increase in arterial blood ow or of a reduction in venous
drainage: in man, the high- ow (arterial) priapism is almost always the consequence
of trauma to the perineum or penis, while the low- ow (veno-occlusive) priapism
can be idiopathic or secondary to haematologic disorders, prostatic diseases, spinal
cord trauma, pharmacological agents [2]. Low- ow (ischemic) priapism is more
prevalent than high- ow (nonischemic) priapism in man and has a worse prognosis
[3]. Stagnation of blood leads to thrombosis of the cavernous spaces, and corporal
ischemia lasting more than 24 hours leads to necrosis of smooth muscle and nerves
and irreversible penile brosis with permanent erectile dysfunction after 48 hours [3].
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Priapism has so far been reported only in ten cats, some of which neutered: in all
ten cases low- ow priapism was diagnosed and the causes included trauma following
attempted mating, spinal trauma, genitourinary infection or in ammation, vasculitis
following feline infectious peritonitis [1,4-6].
CASE PRESENTATION
A short-haired Persian male cat, aged 3 years, was referred for a condition of persistent
penile erection that had appeared 10 days previously, after attempted mating with a
queen at the end of the oestrus period.
The cat had immediately been visited in emergency and a diagnosis of priapism
of neurologic/traumatic origin had been formulated. A short-acting corticosteroid
(injectable prednisolone) was administered and prescribed for 5 days (1 mg/kg SID)
followed by a tapering schedule (alternate day administration for 5 times and alternate
day half-dosage administration for 5 times); in addition, local application of lubricants
was prescribed. Subsequent neurologic and orthopedic examinations did not show
any abnormality, so that spinal or pelvis trauma were deleted from the list of possible
causes; also urinary tract pathologies were excluded after urethral catheterisation and
urinalisys.
When was referred to the authors, the cat looked bright, alert and comfortable, was
reported to eat normally and not to show excessive licking of the penis. On clinical
examination, the penis appeared protruding from the prepuce and was erect, although
no signs of in ammation were present and the surface was not dry (Fig. 1); palpation
did not elicit pain; urination was normal.
Figure 1. Partially erect cat penis: mucosa colour appears normal
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Acta Veterinaria-Beograd 2015, 65 (4), 568-571
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A blood sample was collected for complete analysis and serum protein electrophoresis:
the mild alterations found in white blood cell number and hepatic enzymes
concentration could be a consequence of the corticosteroid treatment. FIP was
excluded as a possible causative factor because total serum protein content and protein
electrophoresis were normal.
In consideration of the anomalous benign course of the condition, and of the
exclusion of the known possible causes, the owner was asked again whether anything
had been administered to the cat and this time he remembered having treated him with
hCG (500 UI, i.m. Corulon®), as suggested by a breeder, since the cat was going to
mate with three queens in a short period of time.
The mild symptoms and the detection of the supposed causative agent (hCG)
suggested that the condition could be managed with local medications only. After
about 40 days from the onset, symptoms had progressively disappeared, the penis was
again contained within the prepuce and the cat was again able to mate.
Conservative treatment for priapism in the cat is generally unsuccessful and the
condition is resolved with penile amputation and perineal urethrostomy because of
pain, dif cult urination, mucosal congestion and penis tip necrosis. In a single case
the corpora cavernosa were drained after tunica albuginea incision and irrigated with
heparinized saline, and the penis returned to its normal state; however, since the cat
had been neutered, erectile functionality could not be assessed [4].
Exogenous gonadotropins are usually administered to cats for ovarian-stimulatory
effects in the case of arti cial insemination or in vitro fertilization procedures: the
pharmacokinetics of hCG has been evaluated only in queens, together with the
ovarian-stimulatory effect [7]. After intramuscular administration of 75 IU, hCG was
detectable for at least 96 h and its half-life was 22.9 ± 4.1 h. Estradiol concentration
increased above basal levels 24-72 h after hCG administration, reached peak values by
120-144 h, and then declined to baseline by 168 h [7]. There are no studies on male
cats. In two pony stallions testosterone concentrations were markedly elevated for ve
days after injection of 6,000 IU hCG [8]. The extremely high dosage administered to
the male cat could be the reason for the prolonged yet transitory effect.
Although the temporal association between hCG administration and development of
priapism does not prove the gonadotropin causative role, and the condition had been
previously reported also in neutered cats, the fact that our case is the only one reported
in which the condition resolved increases the likelihood of causality.
This report could in any case be useful to emphasize the necessity of treating the
animals with a correct hCG dosage, if necessary, in order to prevent potentially
harmful side effects.
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REFERENCES
1. Gunn-Moore DA, Brown PJ, Holt PE, Gruffydd-Jones TJ: Priapism in seven cats. J Small
Anim Pract 1995, 36:262-266.
2. Rochat MC: Priapism: a review. Theriogenology 2001, 56:713-722.
3. Bivalacqua TJ, Burnett AL: Priapism: new concepts in the pathophysiology and new
treatment strategies. Curr Urol Rep 2006, 7:497-502.
4. Orima H, Tsutsui T, Waki T, Kawakami E, Ogasa A: Surgical treatment of priapism
observed in a dog and a cat. Jpn J Vet Sci 1989, 51:1227-1229.
5. Rota A, Paltrinieri S, Jussich S, Ubertalli G, Appino S: Priapism in a castrated cat associated
with feline infectious peritonitis. J Feline Med Surg 2008, 10:181-184.
6. Swalec KM, Smeak DD: Priapism after castration in a cat. J Am Vet Med Assoc 1989,
195:963-964.
7. Swanson WF, Wolfe BA, Brown JL, Martin-Jimenez T, Riviere JE, Roth TL, Wildt DE:
Pharmacokinetics and ovarian-stimulatory effects of equine and human Chorionic
Gonadotropins administered singly and in combination in the domestic cat. Biol Reprod
1997, 57:295-302.
8. Cox JE, Redhead PH: Prolonged effect of a single injection of human chorionic
gonadotrophin on plasma testosterone and oestrone sulphate concentrations in mature
stallions. Equine Vet J 1990, 22:36-38.
PRIAPIZAM KOD MAČKA NAKON PRIMENE hCG
QUARANTA Giuseppe, ROTA Ada, DOGLIERO Andrea, PECCHIA Flaviana
Priapizam, de nisan kao perzistentna i bolna erekcija penisa u odsustvu seksualne
ekscitacije, je redak poremećaj kod mačora koji obično zahteva amputaciju penisa ili
perinealnu uretrostomu. Ovaj rad opisuje slučaj priapizma kod kratkodlakog persi-
jskog mačora starosti 3 godine. Navedeno stanje je nastalo nakon pokušaja parenja
sa ženkom pri kraju estrusa. Vlasnici su se obratili za stručnu pomoć 10 dana nakon
nastanka simptoma. Predhodna terapija se sastojala u primeni kortikosteroida i lokalno
lubrikanata. Tokom kliničkog pregleda mačor je bio budan i u svesnom stanju, penis
je bio u erekciji i normalne boje. Analize krvi su isključile postojanje virusne etiologije.
Anamneza je pokazala da je mačor tretiran sa 500 IU hCG i.m., s obzirom na to da
je morao da se pari sa tri ženke tokom kratkog vremenskog perioda. Uzimajući u
obzir blagu simptomatologiju, opredelili smo se za konzervativnu terapiju. Stanje se
popravilo nakon 40 dana. Ovaj rad predstavlja prvi izveštaj priapizma nakon aplikacije
hCG mačoru i ukazuje da zloupotreba ovog gonadotropina može da ima potencijalno
štetne nuspojave.
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... A total of 12 cats have been diagnosed with priapism since 1989; none of these studies reported non-ischemic priapism, and the treatment was mostly related to surgical options such as penile amputation and perineal urethrostomy, due to poor responses to conservative management [12][13][14][15][16][17]. ...
... 2022, 9, x FOR PEER REVIEW 2 of 8 imaging (MRI) and corporal biopsies for the diagnosis of corpus cavernosum smooth muscle necrosis [7]. A total of 12 cats have been diagnosed with priapism since 1989; none of these studies reported non-ischemic priapism, and the treatment was mostly related to surgical options such as penile amputation and perineal urethrostomy, due to poor responses to conservative management [12][13][14][15][16][17]. ...
... A few single reports of non-ischemic priapism have been documented in canine veterinary medicine, but not in feline medicine [8,18]. Priapism is very rare, and a total of 12 cases have been previously described, none of which mentions non-ischemic priapism [12][13][14][15][16][17]. The treatment of priapism was mostly related to surgical options such as penile amputation and perineal urethrostomy, as priapism was not fully resolved by conservative and supportive management [12][13][14][15][16][17]. ...
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A 14-year-old neutered male British shorthair cat presented with a 21-day history of persistent erection and dysuria, along with overgrooming of the perineal region. Mild palpation induced pain and rigid corpora cavernosa with flaccid glans were observed during physical examination. Ultrasonography of the penis did not detect significant blood flow in the penile cavernosal artery. The drawing of aspirate blood from cavernosal bodies for gas analysis was impossible because of the anatomically small penis size of cats. Conservative management, including topical steroid ointment, lidocaine gel, gabapentin, and diazepam, was prescribed for supportive management. The clinical signs resolved, and ultrasonographic examination of the penis revealed no abnormalities. The cat remains clinically well without recurrence during the 6 months after treatment. To our knowledge, this is the first report of non-ischemic priapism in a cat.
... Although it can be observed at any age, priapism has usually been reported in animals older than one year (1,5,6,8). While most of the priapism cases in cats have been observed in Siamese cats (1) priapism has also been observed in crossbreeds (1,5,6,8). ...
... Although it can be observed at any age, priapism has usually been reported in animals older than one year (1,5,6,8). While most of the priapism cases in cats have been observed in Siamese cats (1) priapism has also been observed in crossbreeds (1,5,6,8). The three-year-old crossbreed cat described in this case is in line with the data found in the literature. ...
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Pregnancy success and embryo survival are low with the use of assisted reproduction in felids treated with exogenous gonadotropins. In this study, the pharmacokinetics and ovarian-stimulatory effects of eCG and hCG were evaluated in the domestic cat. Catheterized anestrual queens (n = 4 per treatment [Trt] group) were given 100 IU eCG i.v. (Trt 1), 100 IU eCG i.m. (Trt 2), 75 IU hCG i.v. (Trt 3), 75 IU hCG i.m. (Trt 4), or 100 IU eCG i.m. followed 80 h later by 75 IU hCG i.m. (Trt 5). Blood samples were collected at 0, 5, 30, and 60 min and 4, 8, 12, 24, 36, 48, 72, 96, 120, 144, and 168 h postinjection, and serum samples were analyzed for estradiol-17beta, progesterone, eCG, and hCG. Pharmacokinetic traits (volume of distribution, Vd; elimination half-life, t1/2beta; clearance rate, Clr) were calculated for eCG and hCG. When i.v. and i.m. administration were compared, no differences (p > 0.05) were observed in follicle or corpus luteum (CL) number or hormone concentrations for queens receiving eCG or hCG alone. Number of mature ovarian follicles (> or = 2 mm diameter) observed at 168 h postinjection did not differ (p > 0.05) for eCG (mean +/- SEM, 10.5 +/- 2.0) vs. hCG (11.1 +/- 3.0), indicating that these were equally effective in inducing follicular growth. In most queens (> 90%) given single gonadotropins (i.m. or i.v.), eCG and hCG persisted in circulation for at least 120 h and 96 h after injection, respectively, reflecting similar (p > 0.05) pharmacokinetic (i.v.) values for Vd (eCG, 91.4 +/- 24.8 ml/kg; hCG, 59.1 +/- 7.9 ml/kg), t1/2beta (eCG, 23.0 +/- 2.4 h; hCG, 22.9 +/- 4.1 h), and Clr (eCG, 2.7 +/- 0.5 ml/h per kg; hCG, 1.8 +/- 0.1 ml/h per kg). Sequential treatment with eCG+hCG did not affect (p > 0.05) the t1/2beta of individual gonadotropins. In summary, eCG and hCG have comparable pharmacokinetics and ovarian-stimulatory activity when administered alone to the domestic cat. These findings suggest that hCG promotes the ancillary follicle formation that is frequently observed after ovulation in cats treated with eCG+hCG regimens, possibly disrupting the maternal environment and decreasing fecundity following assisted reproductive procedures.
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Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process, and we have little information on the etiology and pathophysiology of this erectile disorder. Two main types of priapism exist: low-flow (ischemic) and high-flow (nonischemic) priapism. When the physician first diagnoses which type of priapism exists, distinguishing the type of priapic event is paramount in order to choose the correct treatment options. Until recently, we had not sufficiently understood the pathogenesis of this erectile disorder and therefore, could not effectively manage its pathologic consequences of erectile tissue damage and erectile dysfunction. In this review, the proposed pathogenesis of ischemic priapism is reviewed, and a survey regarding novel treatment modalities is given.
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