Name
PRIAPISM
DESCRIPTION
DETAIL
CAUSES : β’ Intracavernosal injections of vasoactive drugs for erectile dysfunction; most common cause - MAY BE ASSOCIATED WITH SICKLE CELL ANEMIA , HYPERCOAGULABLE STATES , SPINAL CORD INJURY OR INJECTION OF VASODILATOR AGENTS INTO THE PENIS. - PEYRONIE DISEASE - FRACTURED PENIS - UNILATERAL THROMBOSIS OF CORPORA - LEUKEMIA - TRAUMA WITH HAEMATOMA FORMATION - NEW GROWTHS OF THE URETHRA, EITHER PRIMARY OR SECONDARY - Urinary tract infections, especially prostatitis, urethritis, cystitis β’ Several drugs suspected as causing priapism, such as chlorpromazine, prazosin, trazodone, and certain corticosteroids, anticoagulants, antihypertensives β’ Intracavernous fat emulsion β’ Prolonged sexual activity β’ Pelvic hematoma or neoplasia β’ Cerebrospinal tumors β’ Tertiary syphilis β’ Bladder calculusLABORATORY β’ CBC β’ Sickle prep and hgb electrophoresis β’ Coagulation profile β’ Platelet count β’ Urinalysis OTHER TESTS : * COLOR DOPPLER TEST: Penile doppler testing may be necessary to differentiate high-flow from low-flow priapism
TYPENOTES
RISK FACTORS: DehydrationGENERAL 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 MCG epinephrine or 125-250 MCG phenylephrine . May repeat one time in 20-30 minutes if no response . Create fi stula 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 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 DRUG(S) OF CHOICE β’ Narcotics for pain if needed β’ Vasoconstrictors may be injected after dilution, e.g., metaraminol 1 mg into the penis PATIENT MONITORING Close followup after surgery PREVENTION/AVOIDANCE β’ Avoid dehydration β’ Avoid excessive sexual stimulation β’ Avoid causative drugs (see Causes) when possible POSSIBLE COMPLICATIONS β’ Erectile dysfunction (impotence) EXPECTED COURSE/PROGNOSIS β’ Even with excellent treatment, detumescence may require several weeks β’ Impotence is likely
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
PENILE DOPPLER, COMPLETE BLOOD COUNT, ULTRA SOUND EXAM