๐ท๐๐๐๐๐๐๐ Flashcards
What is priapism?
An involuntary prolonged erection unrelated to sexual stimulation lasting more than 4 hours & unrelieved by ejaculation.
It is considered a urologic emergency
What are the three main types of priapism?
Ischemic (low-flow), Non-ischemic (high-flow), and Stuttering priapism
What is the key pathophysiological difference in non-ischemic priapism?
Persistent erection caused by unregulated arterial inflow into the penis without adequate venous return
What are common medications that can cause priapism?
Sildenafil and antidepressants that block ฮฑ-receptors
What hematologic conditions are associated with priapism?
Sickle cell disease thalassemia and hypercoagulable states
What are the key differences in pain between ischemic and non-ischemic priapism?
Ischemic is usually painful while non-ischemic is typically painless
What initial imaging study is recommended for priapism evaluation?
Duplex doppler ultrasonography
What is the first-line pre-hospital treatment for priapism?
Apply ice pack to the perineum and penis; ask patient to walk upstairs
What is the primary hospital treatment for ischemic priapism?
Intracavernosal phenylephrine (adrenergic agonist) Aspiration if needed
Shunting
How much aspiration volume is recommended during corpus cavernosum drainage?
20-30mls from either 2 oโclock or 10 oโclock while making the shunt
What blood tests should be ordered in priapism evaluation?
Full blood count peripheral blood film penile blood gas and drug screening
What are potential complications of priapism?
Erectile dysfunction and penile gangrene
What is the pathophysiology of ischemic priapism?
Venous congestion with consequent thrombosis and ischemia leading to smooth muscle relaxation
Name three types of surgical shunts used in priapism treatment.
Al-Ghorab shunt Burnett shunt and T-shunt
What is the anatomical basis for distal shunting?
Creates a hole for blood to pass through using Winter or biopsy needle
What history elements are crucial in priapism evaluation?
Duration
Drug history
Association with pain/trauma
Malignancy history
Event surrounding onset
SCD history
โDAMESโ
What physical exam findings should be documented?
Obvious Erection
Penile color, rigidity & Sensation
Penile discharge
Evidence of trauma
Regional lymphadenopathy
Why is time crucial in priapism management?
Itโs a urologic emergency that can lead to permanent tissue damage if not treated promptly
What is stuttering priapism?
A recurrent form of priapism that occurs intermittently
What malignancies are associated with priapism?
Leukemia bladder cancer renal cancer prostate cancer and melanoma
What are the hospital treatments for Non-ischemic priapism?
Observation alone may suffice
Embolization of offending vessel may be done
Surgical ligation of fistula
What type of shunts are used in proximal shunting?
Quackels shunt
Barry shunt
Grayhack shunt
What type of shunts are used in proximal shunting?
Quackels shuntโ- spongiossal
Barry shuntโ- Dorsal
Grayhack shuntโ Saphenous
Remember:
H in grayhack is for h in saphenous
R in Barry is for r in dorsal
