Priapism Flashcards
1
Q
What is priapism?
A
Prolonged unwanted erection (> 4 hours), often painful and not associated with sexual arousal
2
Q
What are some causes of priapism?
A
- Intracorporeal injection for ED e.g. papavarine
- Trauma (penile/perineal)
- Haematological dyscrasias e.g. sickle cell
- Neurological conditions
- Idiopathic
3
Q
What are the 2 pathophysiological mechanisms of priapism?
A
Ischaemic (Veno-oclusive or low-flow)
Non-ischaemic - Less urgent
4
Q
Describe the pathophysiology of ischaemic priapism
A
- Vascular stasis in penis and decreased venous outlfow - a true compartment syndrome
- Corposa cavernosa are rigit and tender, penis often painful
5
Q
Describe the pathophysiology of non-ischaemic priapism?
A
- Traumatic distuption of penile vasculature results in unregulated blood entry and filling of corpora
- Fistula formation betweenc cavernous artrery and lacinar spaces allows blood to bypass the normal helicine arteriolar bed
6
Q
What investigations are required in priapism?
A
Aspirate blood from corpus cavernosum
Colour duplex USS
7
Q
What will be seen on blood aspiration from the corpus cavernosum in priapism?
A
- Dark blood, low O2 and high CO2 in low-flow
- Normal arterial blood in high-flow
8
Q
What will be seen on colour duplex USS in priapism?
A
- Minimal or absent flow in cavernosal arteries in low-flow
- Normal to high flow in non-ischaemic priapism
9
Q
How is ischaemic priapism managed?
A
- Aspiration +/- irrigation with saline
- If fails to resolve - injection of ⍺-agonist e.g. phenylephrine
- If fails to resolve - surgical shunt
10
Q
How is delayed presentation of priapism managed?
A
- Ischaemic priapism > 48-72 hours unlikely to respond to intracavernosal treatment
- For very delayed presentation, may even consider immediate placement of a penile prosthesis
11
Q
How is non-ischaemic priapism managed?
A
- Observe, may resolve spontaneously
- Selective arterial embolization with non-permanent materials
12
Q
A
