Priapism: Difference between revisions
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==Work-Up== | ==Work-Up== | ||
#CBC | #CBC | ||
## | ##Rule-out SCD, leukemia | ||
#Ultrasound | #Ultrasound | ||
##Can distinguish between high-flow and low-flow | ##Can distinguish between high-flow and low-flow | ||
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###Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5m until resolution or one hour | ###Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5m until resolution or one hour | ||
#Urology consult | #Urology consult | ||
==Disposition== | ==Disposition== | ||
#Admit if refractory to treatment | #Admit if refractory to treatment | ||
Revision as of 20:05, 17 August 2011
Background
- Prolonged, unwanted erection not a/w sexual stimulation
- May lead to erectile dysfunction and penile necrosis if untreated
- 2 types:
- 1. High-flow (nonischemic)
- AV fistula from trauma (lacerated cavernous artery shunts blood into cavernous bodies)
- Not painful
- Ischemia/impotence does not occur
- 2. Low-flow (ischemic)
- Veno-occlusion causing pooling of deoxygenated blood in cavernous tissue
- A/w SCD, trauma, leukemia, infection, spinal cord injury/cauda equina, meds
- Painful
- Veno-occlusion causing pooling of deoxygenated blood in cavernous tissue
- 1. High-flow (nonischemic)
Work-Up
- CBC
- Rule-out SCD, leukemia
- Ultrasound
- Can distinguish between high-flow and low-flow
DDx
- Peyronie's Disease
- Urethral foreign body
- Penile surgical implant
- Erection from sexual arousal
Treatment
- IV hydration (sickle cell)
- Morphine
- O2 (sickle cell)
- Transfusion (sickle cell)
- Aspiration/injection of corpus cavernosum
- Penile nerve block
- Aspirate 5cc of blood from corpus cavernosum (2 or 10 o'clock position of shaft) w/ 19ga needle
- Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5m until resolution or one hour
- Urology consult
Disposition
- Admit if refractory to treatment
- May dispo home if treatment is successful with close f/u by urology
Source
Tintinalli, UpToDate