Priapism

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

Work-Up

1. CBC
   1. Rule-out SCD, leukemia
2. Ultrasound
   1. Can distinguish between high-flow and low-flow
3. Exam
   1. Pt with erect corpus cavernosum, but flacid glans and spongiosum

DDx

1. Peyronie's Disease
2. Urethral foreign body
3. Penile surgical implant
4. Erection from sexual arousal

Treatment

1. IV hydration (sickle cell)
2. Morphine
3. O2 (sickle cell)
4. Transfusion (sickle cell)
5. Aspiration/injection of corpus cavernosum
   1. Consent prior, thoroughly explain impotence is a possible adverse effect
   2. Penile nerve block
   3. Aspirate 5cc of blood from corpus cavernosum (2 or 10 o'clock position of shaft) w/ 19ga needle
      1. Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5m until resolution or one hour
      2. Use three way valve to perform above
6. Urology consult, especially important with traumatic priapism

Disposition

1. Admit if refractory to treatment
2. May dispo home if treatment is successful with close f/u by urology

Source

Tintinalli, UpToDate