Priapism (quick review)

31 Jul

Definition

 –Prolonged and persistent penile erection unassociated with sexual interest or stimulation.

-Persists > 4 hours, although there is really a spectrum of time less than this up to months

 -priapism of the clitoris also reported

 -corpora cavernosa typically engorged, although spongiosum also observed

 -pain not required

 

Complications of priapism if left untreated are penile fibrosis, urinary retention, impotence

 

Conditions associated with priapism

Ischemic (“low-flow”, more common, 2/2 decreased venous outflow, +pain)

  • sickle cell disease,
  • vasoactive drugs,
  • ED drugs,
  • antihypertensives (hydralazine, prazosin),
  • antiphsychotics,
  • antidepressants (trazodone),
  • ETOH,
  • cocaine,
  • neoplastic disease,
  • spinal cord injury

 

Nonischemic (high-flow, e.g. laceration of penile artery w/ excessive inflow of arterial blood, typically painless)

  • trauma,
  • straddle injury,
  • vasoactive drugs,
  • neurologic conditions

 

Laboratory testing

-CBC to eval for infections/hematologic abnormalities

-reticulocyte count to eval for sickle cell disease

 

Diagnosis

aspirated blood from corpus cavernosum

-> dark = ischemic (officially test with ABG, PO2 <30mmHg, PCO2 >60mmhg, Ph <7.25)

 -> bright red = non-ischemic (Po2>90mmhg, PCO2 <40mmhg, Ph 7.4)

 

Treatment

ischemic priapism = true emergency, requires evacuation of blood and irrigation of the corpora cavernosa.

Followed by IV injection of an alpha-adrenergic sympathomimetic agent (phenylephrine 100-200 microgm every 5-10 min until detumescence).  40-80% resolution rate,

if refractory then surgical shunting

*parenteral vasodilators (terbutaline) have been used with varying success

 

non-ischemic => observation, 62% have spontaneous resolution

 

Submitted by K. Estes.

 

References: 1. Priapism: Current Principles and Practice. Urologic clinics of North America. Vol 34, Issue 4. November 2007.; 2. Rosen’s Emergency Medicine. 7th Edition

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