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Priapism

Topic updated on 09/26/16 3:23pm

Snapshot
  • A 32-year-old male with history of sickle cell disease Treatment of priapismpresents to the emergency department complaining of penile discomfort.  He reports that he has had a persistent, painful erection for the last 5 hours.
Introduction
  • Priapism is a prolonged penile erection lasting greater than 4-6 hours in the absence of sexual stimulation
  • Urologic emergency
  • Often associated with drug use (oral phosphodiesterase-5 inhibitors, trazadone), sickle cell disease, or leukemia
  • Two types:
    • low flow priapism
      • ischemic, caused by decreased venous flow
    • high flow priapism
      • nonischemic, caused by fistula between cavernosal artery and corporal tissue.
      • associated with trauma to perineum
Presentation
  • Symptoms
    • persistent erection
    • painful or uncomfortable
  • Physical exam
    • painful penile shaft
    • low flow priapism
      • thick, dark aspirates from corpus cavernosum
    • high flow priapism
      • bright, red aspirates from corpus cavernosum
Evaluation
  • Generally a clinical diagnosis
  • Corpora cavernosa blood analysis
    • low glucose concentration in low flow priapism
    • normal glucose concentration in high flow priapism
  • penile Doppler ultrasonography
    • indicates high arterial flow in high flow priapism
Treatment
  • Ischemic priapism
    • immediate detumescence with aspiration and irrigation
    • intracavernosal injections of sympathomimetics (i.e. phenylephrine)
    • shunt surgery
  • Nonischemic priapism can be initially observed


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