Priapism

Question 1

histology changes priapism

Answer 1

Progressive hypoxia, hypercapnia and acidosis
At 4 hours – deterioration of cavernous smooth muscle contractile responses

Biopsy corporal smooth muscle at 12 hours
Interstitial oedema
Destruction of sinusoidal endothelium
Exposure of basement membrane
Thrombocyte adherence by 24 hours

At 48 hours, thrombi in sinusoidal spaces and smooth muscle necrosis with fibroblast like cell transformation
So 48 hours there is smooth muscle necrosis and irreversible ischaemia changes

Question 2

trucut biopsy

Answer 2

winter technique

do 3 each side in glans to get histology

Question 3

t shunt adjunct with dilator

Answer 3

The T-shunt can be followed by a tunnelling procedure using a size 8/10 Hegar dilator (make sure bend inserted away from urethra) inserted through the glans and into the corpus cavernosum, which can also be performed using US guidance, mainly to avoid urethral injury.
The entry sites in the glans are sutured following detumescence. Tunnelling with a 7 mm metal sound or 7/8 Hegar dilator is necessary in
patients with priapism duration > 48 hours.
Tunnelling is a potentially attractive procedure as it combines the
features of distal and proximal shunts with proximal drainage of the corpus cavernosum and may ameliorate the profibrotic effect of sludged blood retained in the corpus cavernosum

Question 4

HISOTRY POINTS - 8

Answer 4

DURATION OF ERECTION
SEVERITY OF PAIN IF PRESENT
PREVIOUS EPISODES AND METHODS OF TREATMENT
CURRENT ERECTILE FUNCTION, ANY THERAPIES
MEDICATIONS AND RECREATIONAL DRUG USE
SICKLE CELL DISEASE, BLOOD DISORDERS, HYPERCOAGUABLE STATES
TRAUMA TO PELVIS PERINEUM OR PENIS

Question 5

blood gas analysis

Answer 5

ischaemic first aspirate
PO2 <30 (>90-arterial normal)
pCO2 > 60 (<40 -normal arterial) mmHg
PH <7.25 (7.4 - normal arterial)

Question 6

normal mixed venous blood gas values

Answer 6

PO2 =40
PCO2= 50
PH 7.35

Question 7

causes low flow priapism - 6

Answer 7

drugs -anti psychotics, PDE5i, cocaine

neurological - SCI, cauda equina

idiopathic
haematological - SCD, leukaemia, lymphoma

iatrogenic

infections - rabies, malaria, scorpian bite

Question 8

management SCD

problem with exchange transfusion -3

Answer 8

venous hydration
oxygen
alkalinisation
analgesia, sedation

transfusion no evidence
risk of infection, immunologic and aspen -stroke induced in SCD with priapism having exchange transfusion

Question 9

success rate of distal shunt

risk ED

Answer 9

100-70%

around 50%

Question 10

distal shunt

Answer 10

winter - trucut needle
ebbehoj - scalpel
T shunt +snake manouvre

Question 11

distal shunt

Answer 11

winter - trucut needle
ebbehoj - scalpel
T shunt +snake manouvre

Question 12

risk of PPI after distal shunt

how long to wait

Answer 12

risk of skin breakthrough as distal shunts connects CC to skin
wait one month before PPI