- Priapism is persistent erection of the penis
- It is uncommon but early diagnosis and treatment is essential
- Delayed presentation or treatment results in corporal anoxia and loss or erectile function
Pathophysiology
- Two types of priapism exist
- Low-flow priapism is more common
- Due to venous stasis and ischaemia
- Aetiological factors include
- Intracavernosal injection
- Pelvic malignancy
- Blood disorders - sickle-cell disease, leukaemia
- Trauma - spinal cord injury
- Prolonged sexual activity
- Urogenital tract inflammation
- Drugs
- High-flow priapism is uncommon
- Due to the development of an arteriocavernosal fistula
- Can follow blunt or penetrating penile or perineal trauma
Clinical features
- History and clinical features will allow differentiation of low-flow and high-flow priapism
- Low-flow priapism presents with painful persistent erection
- Penile shaft is firm and glans penis is usually soft
- High-flow priapism is often painless
- There is invariably a clear history of trauma
Management
- Aspiration of the corpora will distinguish the two types
- In high-flow priapism the blood is arterial
- In low-flow priapism the blood is dark and viscous and is similar to venous
- Early treatment is essential, preferably within 12 hours of onset
- Low-flow priapism requires urgent aspiration and instillation of a vasoconstrictor
- This should be followed by a drainage procedure into
- The glans penis (Modified Winter / Ebbehoj shunt)
- The corpora spongiosum (Quackel's procedure)
- The long saphenous vein (Grayhack procedure)
- Detumescence can be achieved in 50-70% of patients
- Maintenance of erectile function is present in about 40%
- High-flow priapism requires closure of the arteriocavernosal fistula
- Can often be performed by an interventional radiologist
Bibliography
Kalsi J S, Arya M, Minhas S, Ralph D J. Priapism: a medical emergency. Hosp
Med 2002; 63: 224-225.
Keoghane S R, Sullivan M E, Miller M A. The aetiology, pathogenesis and management of
priapism. BJU Int 2002; 90: 149-154.
Gorich J, Ermis C, Kramer S C et al. Interventional treatment of traumatic
priapism. J Endovasc Ther 2002; 9: 614-617. |