Priapism Disease

DESCRIPTION

Painful and/or abnormally prolonged penile erection

System(s) affected: Reproductive
Genetics: N/A
Incidence/Prevalence in USA: Unknown
Predominant age: Young adult
Predominant sex: Male only

SIGNS AND SYMPTOMS

Penile erection that is persistent, prolonged, painful, and tender
Urination difficult during erection
Loss of sexual function if treatment is not prompt and effective
Low flow or ischemic priapism - glans penis flaccid
High flow or arterial priapism - glans penis rigid

CAUSES

Intracavernosal injections of vasoactive drugs for erectile dysfunction; most common cause
Pelvic vascular thrombosis
Prolonged sexual activity
Sickle cell anemia
Leukemia
Other blood dyscrasias
Pelvic hematoma or neoplasia
Cerebrospinal tumors
Tertiary syphilis
Bladder calculus
Injury to penis
Urinary tract infections, especially prostatitis, urethritis, cystitis
Several drugs suspected as causing priapism, such as chlorpromazine, prazosin, trazodone, and certain corticosteroids, anticoagulants, antihypertensives
Intracavernous fat emulsion

RISK FACTORS

Dehydration

LABORATORY

CBC
Sickle prep and hgb electrophoresis
Coagulation profile
Platelet count
Urinalysis

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Pelvic vascular thrombosis
Partial thrombosis of corpora cavernosa
Corpus spongiosum, glans penis: No involvement
Arterial priapism will show arteriocavernous fistula

SPECIAL TESTS

N/A

IMAGING

Penile doppler testing may be necessary to differentiate high-flow from low-flow priapism

DIAGNOSTIC PROCEDURES

Physical examination

APPROPRIATE HEALTH CARE

Inpatient

GENERAL MEASURES

Reassurance about outcome if warranted
Continuous caudal or spinal anesthesia if etiology is neurogenic
Treat any underlying cause
In sickle cell anemia: Intravenous hydration; partial exchange or repeated transfusions to reduce percent of sickle cells below 50%
Pain relief

SURGICAL MEASURES

Introduction of 12 or 16 gauge needles into corpora cavernosa (best done by urologist if available)
- First: aspiration of 20-30 cc of blood from corpora cavernosum with 12-16 gauge needle
- Then: if caused by injected vasodilator, use intracavernous injection of 10-25 mg ephedrine sulfate or 5-10 µg epinephrine or 125-250 µg phenylephrine
- May repeat one time in 20-30 minutes if no response
Create fistula between glans and corpus cavernosum (with biopsy needle by urologist)
Semipermanent diversion by saphenous shunt from one or both corpora
Cavernosa-spongiosum shunt to permit reestablishment of pelvic circulation

ACTIVITY

Bedrest until relieved

DIET

N/A

PATIENT EDUCATION

Information about long-term outlook, referral for counseling
Reduction of vasoactive drug therapy, if responsible for priapism and elimination of offending drugs if causal

PREVENTION/AVOIDANCE

Avoid dehydration
Avoid excessive sexual stimulation
Avoid causative drugs (see Causes) when possible

POSSIBLE COMPLICATIONS

Erectile dysfunction (impotence)

EXPECTED COURSE AND PROGNOSIS

Even with excellent treatment, detumescence may require several weeks
Impotence is likely

ASSOCIATED CONDITIONS

Sickle cell anemia

AGE-RELATED FACTORS

Pediatric: > 85% likelihood of sickle cell in African American children
Geriatric: Treatment more difficult and less likely successful
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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