Priapism

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
  1. penile nerve block
  2. puncture corpus cavernosum through the shaft of the penis with a 19 gauge needle attached to a large syringe
  3. 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