Priapism

Source: Wikipedia, the free encyclopedia.
Priapism
blood thinners, cocaine, trauma[3]
TreatmentIschemic: Removal of blood from the corpus cavernosum with a needle[3]
Non-ischemic: Cold packs and compression[3]
Frequency1 in 60,000 males per year[3]

Priapism is a condition in which a

clitoral priapism occurs in women.[4]

blood gas analysis of blood aspirated from the penis or an ultrasound.[3]

Treatment depends on the type.

normal saline or injected with phenylephrine.[3] Nonischemic priapism is often treated with cold packs and compression.[3] Surgery may be done if usual measures are not effective.[3] In ischemic priapism, the risk of permanent scarring of the penis begins to increase after four hours and definitely occurs after 48 hours.[3][6] Priapism occurs in about 1 in 20,000 to 1 in 100,000 males per year.[3]

Classification

Priapism is classified into three groups: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic.[3] The majority of cases (19 out of 20) are ischemic in nature.[3]

Some sources give a duration of four hours as a definition of priapism, but others give six. "The duration of a normal erection before it is classifiable as priapism is still controversial. Ongoing penile erections for more than 6 hours can be classified as priapism."[7]

In women

Priapism in women (continued, painful erection of the clitoris) is significantly rarer than priapism in men and is known as clitoral priapism or clitorism.[4] It is associated with persistent genital arousal disorder (PGAD).[8] Only a few case reports of women experiencing clitoral priapism exist.[4]

Signs and symptoms

Complications

Because ischemic priapism causes the blood to remain in the penis for unusually long periods of time, the blood becomes deprived of oxygen, which can cause damage to the penile tissue. Such damage can result in erectile dysfunction or disfigurement of the penis.[9] In extreme cases, if the penis develops severe vascular disease, the priapism can result in penile gangrene.[10]

Low-flow priapism

Causes of low-flow priapism include

sickle cell anemia (most common in children), leukemia, and other blood dyscrasias such as thalassemia and multiple myeloma, and the use of various drugs, as well as cancers.[11] A genome-wide association study on Brazilian patients with sickle cell disease identified four single nucleotide polymorphisms in LINC02537 and NAALADL2 significantly associated with priapism.[12]

Other conditions such as

Fabry's disease, as well as neurologic disorders such as spinal cord lesions and spinal cord trauma (priapism has been reported in people who have been hanged; see death erection
).

Priapism can also be caused by reactions to

Brazilian wandering spider.[14]

High-flow priapism

Causes of high-flow priapism include:

Diagnosis

The diagnosis is often based on the history of the condition as well as a

physical exam.[3]

Blood gas testing the blood from the cavernosa of the penis can help in the diagnosis.[3] If the low-flow type of priapism is present, the blood typically has a low pH, while if the high-flow type is present, the pH is typically normal.[3] Color Doppler ultrasound may also help differentiate the two.[3] Testing a person to make sure they do not have a hemoglobinopathy may also be reasonable.[3]

Ultrasonography

Color Doppler ultrasound demonstrating a hypoechoic collection that corresponds to hematoma with arteriovenous fistula secondary to traumatic injury of the penis due to impact with bicycle handlebars, resulting in high-flow priapism[11]

Penile ultrasonography with Doppler is the imaging method of choice, because it is noninvasive, widely available, and highly sensitive. By means of this method, it is possible to diagnose priapism and differentiate between its low- and high-flow forms.[11]

In low-flow (ischemic) priapism the flow in the cavernous arteries is reduced or absent. As the condition progresses, there is an increase in echogenicity of the corpora cavernosa, attributed to tissue edema. Eventually, changes in the echotexture of the corpora cavernosa can be observed due to the fibrotic transformation generated by tissue anoxia.[11]

In high-flow priapism normal or increased, turbulent blood flow in the cavernous arteries is seen. The area surrounding the fistula presents a hypoechoic, irregular lesion in the cavernous tissue.[11]

Treatment

Medical evaluation is recommended for erections that last for longer than four hours. Pain can often be reduced with a

ring block.[3] For those with nonischemic priapism, cold packs and pressure to the area may be sufficient.[3]

Pseudoephedrine

Orally administered

alpha-agonist
agent that exerts a constriction effect on smooth muscle of corpora cavernosum, which in turn facilitates venous outflow. Pseudoephedrine is no longer available in some countries.

Aspiration

For those with ischemic priapism, the initial treatment is typically

normal saline may be injected and removed.[3]

Medications

If aspiration is not sufficient, a small dose of

arrhythmia.[3] If this medication is used, it is recommended that people be monitored for at least an hour after.[3] For those with recurrent ischemic priapism, diethylstilbestrol (DES) or terbutaline may be tried.[3]

Surgery

Distal shunts, such as the Winter's,[clarification needed] involve puncturing the glans (the distal part of the penis) into one of the cavernosa, where the old, stagnant blood is held. This causes the blood to leave the penis and return to the circulation. This procedure can be performed by a urologist at the bedside. Winter's shunts are often the first invasive technique used, especially in hematologically induced priapism, as it is relatively simple and repeatable.[16]

Proximal shunts, such as the Quackel's,[clarification needed] are more involved and entail operative dissection in the perineum where the corpora meet the spongiosum while making an incision in both and suturing both openings together.[17] Shunts created between the corpora cavernosa and great saphenous vein called a Grayhack shunt can be done though this technique is rarely used.[18]

As the complication rates with prolonged priapism are high, early penile prosthesis implantation may be considered.[3] As well as allowing early resumption of sexual activity, early implantation can avoid the formation of dense fibrosis and, hence, a shortened penis.

Sickle cell anemia

In sickle cell anemia, treatment is initially with

Blood transfusions are not usually recommended as part of the initial treatment, but if other treatments are not effective, exchange transfusion may be done.[19][3]

History

Persistent semi-erections and intermittent states of prolonged erections have historically been sometimes called semi-priapism.[20]

Terminology

The name comes from the Greek god

Ancient Greek: Πρίαπος), a fertility god, often represented with a disproportionately large phallus.[21][22]

References

  1. ^ "priapism". Oxford English Dictionary (2nd ed.). Oxford University Press. 1989. (as /ˈpraɪəpɪz(ə)m/)
  2. ^ "priapism". Merriam-Webster.com Dictionary. Retrieved 2017-03-07. "Definition of PRIAPISM". Archived from the original on 2017-06-06. Retrieved 2017-09-10.{{cite web}}: CS1 maint: bot: original URL status unknown (link).
  3. ^
    PMID 28027457
    .
  4. ^
    ISBN 978-1-119-16470-8
    . Retrieved February 8, 2018.
  5. ^ "Alprostadil". The American Society of Health-System Pharmacists. Archived from the original on 16 January 2017. Retrieved 8 January 2017.
  6. ISBN 978-1-58112-411-8. Archived
    from the original on 2017-04-27.
  7. ^ C. VAN DER HORST, HENRIK STUEBINGER, CHRISTOPH SEIF, DIETHILD MELCHIOR, F.J. MARTÍNEZ-PORTILLO, K.P. JUENEMANN; "Priapism: Etiology, Pathophysiology and Management" (PDF). Archived (PDF) from the original on 2013-04-29. Retrieved 2011-12-07.
  8. ISBN 978-0-8261-2309-1
    . Retrieved February 8, 2018.
  9. ^ "Priapism - Symptoms and Causes". Mayo Clinic. Archived from the original on 2014-08-06. Retrieved 2014-08-30.
  10. PMID 22022653
    .
  11. ^
    PMID 30202130.
    CC-BY
    license
  12. PMID 31668730
    .
  13. PMID 24347777
    .
  14. ^ "Spider Venom for Erectile Dysfunction?". webmd.com. Archived from the original on 11 February 2015. Retrieved 11 February 2015.
  15. ^ "Priapism (An Erection that Lasts Too Long)". mskcc.org. Retrieved 22 July 2021.
  16. PMID 4035837
    .
  17. PMID 14501756
    .
  18. PMID 20428295
    .
  19. ^ a b Evidence Based Management of Sickle Cell Disease (PDF). NHLBI. 2014. pp. 39–40. Archived from the original (PDF) on 2017-01-25. Retrieved 2017-03-07.
  20. PMID 7015666
    .
  21. PMID 16447594
  22. PMID 3051631
    .

External links
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