Priapism: Difference between revisions
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****A/w SCD, meds, trauma, leukemia, infection, spinal cord injury/cauda equin, hypercoag | ****A/w SCD, meds, trauma, leukemia, infection, spinal cord injury/cauda equin, hypercoag | ||
***Painful | ***Painful | ||
***Fibrotic change | ***Fibrotic change leads to impotence | ||
== Clinical Features == | == Clinical Features == | ||
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== Work-Up == | == Work-Up == | ||
#CBC (eval leukemia, sickle cell) | #CBC (eval leukemia, sickle cell) | ||
#type & screen (may need to exchange transfuse) | #type & screen (may need to exchange transfuse) | ||
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== DDx == | == DDx == | ||
#Peyronie's Disease | #Peyronie's Disease | ||
#Urethral foreign body | #Urethral foreign body | ||
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#Aspiration/injection of corpus cavernosum | #Aspiration/injection of corpus cavernosum | ||
##Rarely beneficial after 48hr | ##Rarely beneficial after 48hr | ||
##Penile nerve block (2 | ##Penile nerve block (2 and 10 o'clock)<br> | ||
##Aspirate 5cc of blood from corpus cavernosum (3 or 9 o'clock position of shaft) w/ 19ga needle | ##Aspirate 5cc of blood from corpus cavernosum (3 or 9 o'clock position of shaft) w/ 19ga needle | ||
###Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5min until resolution or one hour (max 1000mcg) | ###Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5min until resolution or one hour (max 1000mcg) | ||
Revision as of 15:42, 10 May 2012
Background
- Prolonged, unwanted erection not a/w sexual stimulation > 4h
- 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)
- Usually not painful
- Ischemia/impotence does not occur
- 2. Low-flow (ischemic)
- Veno-occlusion causing pooling of deoxygenated blood in cavernous tissue
- A/w SCD, meds, trauma, leukemia, infection, spinal cord injury/cauda equin, hypercoag
- Painful
- Fibrotic change leads to impotence
- Veno-occlusion causing pooling of deoxygenated blood in cavernous tissue
- 1. High-flow (nonischemic)
Clinical Features
- Erect corpus cavernosum
- Flacid glans and spongiosum
Work-Up
- CBC (eval leukemia, sickle cell)
- type & screen (may need to exchange transfuse)
- coags
- urinalysis/tox (etoh, marijuana, cocaine can cause priapism)
- abg from cavernosa (if hx unclear) hypoxic, hypercapneic, acidotic --> low flow
- Ultrasound
- Can distinguish between high-flow and low-flow
DDx
- Peyronie's Disease
- Urethral foreign body
- Penile surgical implant
- Erection from sexual arousal
Treatment
- Morphine
- IV hydration (sickle cell)
- O2 (sickle cell)
- Transfusion (sickle cell)
- Urology consult (especially important with traumatic priapism)
- Aspiration/injection of corpus cavernosum
- Rarely beneficial after 48hr
- Penile nerve block (2 and 10 o'clock)
- Aspirate 5cc of blood from corpus cavernosum (3 or 9 o'clock position of shaft) w/ 19ga needle
- Inject 1mL diluted phenylephrine (100-500mcg/mL) q3-5min until resolution or one hour (max 1000mcg)
Disposition
- Admit if refractory to treatment
- May dispo home if treatment is successful with close f/u by urology
Source
- Tintinalli
- UpToDate
- emedicine