Priapism Flashcards
What is priapism?
an unwanted painful erection of the penis not associated with sexual desire lasting for more than 4 hours
Is priapism a urological emergency?
yes
What happens to the penis tissue during priapism?
blood stays within the corpus cavernosa but the glans and corpus spongiosum are unaffected
What are the two types of priapism?
Low flow and high flow
What is high flow priapism?
non ischaemic- usually due to unregulated cavernous arterial inflow, enters more quickly than it can be drained, usually due to trauma
What is low flow priapism?
ischaemic priapism- veno-occlusive in nature and caused by blockage to the venous drainage of the corpus cavernous
What can happen in low flow priapism?
failure of detumescence from prolonged venous stasis which results in ischaemia and then fibrous and impotence
What is stuttering Priapism?
repetitive and painful episodes of prolonged erection with intervening periods of detumescence and often self limiting, each episode could become a serious ischaemic episode
What are the causes of priapism?
non-ischaemic- penile trauma or spinal cord injury
Ischaemic- laterogenic e.g. intracavernosal drug therapy, sickles cell disease, leukaemia thalassaemia and pelvic malignancy
What are the clinical features of priapism?
Ongoing and unwanted erection that persists with absence of sexual desires, painful and rigid erection, if non ischaemic would be painless and not fully rigid
What investigations would you do for Priapism?
corporeal blood gas will determine if ischaemic or non-ischaemic, routine bloods and potential spinal injury bu a colour doppler ultrasonography
What is the management for priapism?
Corporeal aspiration wrks in 30% of patients, ice packs,physcial exertion and masturbation may work, intracavernosal injection of sympathomimetic agent, surgical shunt between erect copra cavernosa and either the glans penis, corpus spongiosume or saphenous vein can be attempted
What is the likelihood of having inter coarse again after 24hours of priapism?
90% chance they will not regain ability to have inter-course
