Priapism

Question 1

What is priapism?

Answer 1

Persistent penile erection, typically defined as lasting longer than 4 hours, and is not associated with sexual stimulation.

Question 2

What are the types of priapism?

Answer 2

Ischaemic

Non-ischaemic

Question 3

What are the causes of ischaemic priapism?

Answer 3

Typically due to impaired vasorelaxation resulting in trapping of de-oxygenated blood with the corpus cavernosa.

Question 4

What are the causes of non-ischaemic priapism?

Answer 4

Typically due to high arterial inflow, typically due to fistula formation often either as the result of congenital or traumatic mechanisms.

Question 5

What is the epidemiology of priapism?

Answer 5

Bimodal peaks

Between 5-10 years and 20-50 years

Question 6

What are the causes of priapism?

Answer 6

Idiopathic
Sickle cell disease or haemoglobinopathies
Erectile dysfunction medications
Other drugs (anti-hypertensive, anticoagulants, antidepressant, cocaine, cannabis, ecstasy)
Trauma

Question 7

What is the presentation of priapism?

Answer 7

A persistent erection lasting over 4 hours
Pain localised to the penis
Relevant history

Question 8

What features of the history are more suggestive of non-ischaemic priapism?

Answer 8

Non-painful
Not fully rigid
History of trauma

Question 9

What are the investigations of priapism?

Answer 9

Cavernosal blood gas analysis (ischaemia or non-ischaemic)
Doppler or duplex ultrasonography
FBC and toxicology screen

Question 10

What is the management of priapism?

Answer 10

Ischaemic priapism - medical emergency
> 4hr aspiration of blood and saline flush
If fails - injection of vasoconstrictive agent such as phenylephrine
Surgery

Non-ischaemic - observation