Priapism: Difference between revisions
(→Source) |
No edit summary |
||
| Line 11: | Line 11: | ||
****A/w SCD, trauma, leukemia, infection, spinal cord injury/cauda equina, meds | ****A/w SCD, trauma, leukemia, infection, spinal cord injury/cauda equina, meds | ||
***Painful | ***Painful | ||
==Clinical Features== | |||
*Erect corpus cavernosum, but flacid glans and spongiosum | |||
==Work-Up== | ==Work-Up== | ||
| Line 17: | Line 20: | ||
#Ultrasound | #Ultrasound | ||
##Can distinguish between high-flow and low-flow | ##Can distinguish between high-flow and low-flow | ||
==DDx== | ==DDx== | ||
| Line 31: | Line 32: | ||
#O2 (sickle cell) | #O2 (sickle cell) | ||
#Transfusion (sickle cell) | #Transfusion (sickle cell) | ||
#Urology consult (especially important with traumatic priapism) | |||
#Aspiration/injection of corpus cavernosum | #Aspiration/injection of corpus cavernosum | ||
##Penile nerve block | ##Penile nerve block | ||
##Aspirate 5cc of blood from corpus cavernosum (2 or 10 o'clock position of shaft) w/ 19ga needle | ##Aspirate 5cc of blood from corpus cavernosum (2 or 10 o'clock position of shaft) w/ 19ga needle | ||
###Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5m until resolution or one hour | ###Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5m until resolution or one hour | ||
==Disposition== | ==Disposition== | ||
| Line 44: | Line 43: | ||
==Source== | ==Source== | ||
Tintinalli | *Tintinalli | ||
*UpToDate | |||
[[Category:GU]] | [[Category:GU]] | ||
[[Category:Procedures]] | [[Category:Procedures]] | ||
Revision as of 15:18, 24 March 2012
Background
- Prolonged, unwanted erection not a/w sexual stimulation
- May lead to erectile dysfunction and penile necrosis if untreated
- 2 types:
- 1. High-flow (nonischemic)
- AV fistula from trauma (lacerated cavernous artery shunts blood into cavernous bodies)
- Not painful
- Ischemia/impotence does not occur
- 2. Low-flow (ischemic)
- Veno-occlusion causing pooling of deoxygenated blood in cavernous tissue
- A/w SCD, trauma, leukemia, infection, spinal cord injury/cauda equina, meds
- Painful
- Veno-occlusion causing pooling of deoxygenated blood in cavernous tissue
- 1. High-flow (nonischemic)
Clinical Features
- Erect corpus cavernosum, but flacid glans and spongiosum
Work-Up
- CBC
- Rule-out SCD, leukemia
- Ultrasound
- Can distinguish between high-flow and low-flow
DDx
- Peyronie's Disease
- Urethral foreign body
- Penile surgical implant
- Erection from sexual arousal
Treatment
- IV hydration (sickle cell)
- Morphine
- O2 (sickle cell)
- Transfusion (sickle cell)
- Urology consult (especially important with traumatic priapism)
- Aspiration/injection of corpus cavernosum
- Penile nerve block
- Aspirate 5cc of blood from corpus cavernosum (2 or 10 o'clock position of shaft) w/ 19ga needle
- Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5m until resolution or one hour
Disposition
- Admit if refractory to treatment
- May dispo home if treatment is successful with close f/u by urology
Source
- Tintinalli
- UpToDate