Priapism: Difference between revisions
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==Background== | ==Background== | ||
* priapism = presence of a persistent, usually painful, erection of penis unrelated to sexual stimulation or desire as a result of persistent engorgment of the corpora cavernosa | |||
* may lead to permanent erectile dysfunction and penile necrosis if untreated | |||
* 2 types: | |||
** arterial high flow: usually due to rupture of cavernous artery (rare, not usually painful) from trauma or blunt injury | |||
** low flow: due to veno-occlusion causing pooling of deoxygenated blood in the cavernous tissue | |||
* associated with sickle cell disease, trauma, neoplasm, infection, fabry disease, spinal cord injury/cauda equina, and certain medications (phenothiazines,sed-hypnotics,SSRIs,BP meds (guanethidine), Phentolamine | |||
==Work-Up== | |||
<font size="100%"> </font> | |||
* cbc (in sickle cell patients and to look for leukemia if pt is without other predisposing factors) | * cbc (in sickle cell patients and to look for leukemia if pt is without other predisposing factors) | ||
| Line 19: | Line 18: | ||
* platelet count | * platelet count | ||
* UA | * UA | ||
* Doppler to differentiate between high-flow and low-flow priapism | * Doppler to differentiate between high-flow and low-flow priapism | ||
==DDx== | |||
* Peyroine disease | * Peyroine disease | ||
* urethral foreing body | * urethral foreing body | ||
* penile surgical implant | * penile surgical implant | ||
* erection from sexual arousal | * erection from sexual arousal | ||
==Treatment== | |||
* saline hydration | * saline hydration | ||
* morphine | * morphine | ||
* oxygen (if secondary to sickle cell) | * oxygen (if secondary to sickle cell) | ||
* transfusion (if secondary to sickle cell, goal Hg of >10) | * transfusion (if secondary to sickle cell, goal Hg of >10) | ||
* pseudoephedrine 60-120mg orally | * pseudoephedrine 60-120mg orally | ||
* terbutaline 0.5 mg sq | * terbutaline 0.5 mg sq | ||
* aspiration/injection of corpus cavernosum | * aspiration/injection of corpus cavernosum | ||
* penile nerve block | *# penile nerve block | ||
* puncture corpus cavernosum through the shaft of the penis with a 19 gauge needle attached to a large syringe | *# puncture corpus cavernosum through the shaft of the penis with a 19 gauge needle attached to a large syringe | ||
* aspirate blood from either 2 or 10 o'clock position while milking the shaft or inject phenylephrine, epinephrine, or methylene blue | *# aspirate blood from either 2 or 10 o'clock position while milking the shaft or inject phenylephrine, epinephrine, or methylene blue | ||
==Disposition== | |||
* admit if refractory to treatment | * admit if refractory to treatment | ||
* may dispo home if treatment is successful with: | * may dispo home if treatment is successful with: | ||
* close follow up by urology | ** close follow up by urology | ||
* PO alpha-adrednergic agonist for 3-5 days to prevent recurrence | ** PO alpha-adrednergic agonist for 3-5 days to prevent recurrence | ||
* consider giving terbutaline (PO or SubQ) to patient for self administration at home in those who have recurrent episodes | ** consider giving terbutaline (PO or SubQ) to patient for self administration at home in those who have recurrent episodes | ||
==Source== | ==Source== | ||
Adapted from Donaldson | Adapted from Donaldson | ||
Revision as of 19:46, 11 March 2011
Background
- priapism = presence of a persistent, usually painful, erection of penis unrelated to sexual stimulation or desire as a result of persistent engorgment of the corpora cavernosa
- may lead to permanent erectile dysfunction and penile necrosis if untreated
- 2 types:
- arterial high flow: usually due to rupture of cavernous artery (rare, not usually painful) from trauma or blunt injury
- low flow: due to veno-occlusion causing pooling of deoxygenated blood in the cavernous tissue
- associated with sickle cell disease, trauma, neoplasm, infection, fabry disease, spinal cord injury/cauda equina, and certain medications (phenothiazines,sed-hypnotics,SSRIs,BP meds (guanethidine), Phentolamine
Work-Up
- cbc (in sickle cell patients and to look for leukemia if pt is without other predisposing factors)
- coags
- platelet count
- UA
- Doppler to differentiate between high-flow and low-flow priapism
DDx
- Peyroine disease
- urethral foreing body
- penile surgical implant
- erection from sexual arousal
Treatment
- saline hydration
- morphine
- oxygen (if secondary to sickle cell)
- transfusion (if secondary to sickle cell, goal Hg of >10)
- pseudoephedrine 60-120mg orally
- terbutaline 0.5 mg sq
- aspiration/injection of corpus cavernosum
- penile nerve block
- puncture corpus cavernosum through the shaft of the penis with a 19 gauge needle attached to a large syringe
- aspirate blood from either 2 or 10 o'clock position while milking the shaft or inject phenylephrine, epinephrine, or methylene blue
Disposition
- admit if refractory to treatment
- may dispo home if treatment is successful with:
- close follow up by urology
- PO alpha-adrednergic agonist for 3-5 days to prevent recurrence
- consider giving terbutaline (PO or SubQ) to patient for self administration at home in those who have recurrent episodes
Source
Adapted from Donaldson