Priapism: Difference between revisions

Revision as of 02:20, 25 June 2011

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

Work-Up

CBC
1. R/o SCD, leukemia
Ultrasound
1. 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)
Pseudoephedrine 60-120mg orally
Terbutaline 0.5 mg sq
Aspiration/injection of corpus cavernosum
1. Penile nerve block
2. Puncture corpus cavernosum through the shaft of the penis with a 19 gauge needle attached to a large syringe
3. Aspirate blood from either 2 or 10 o'clock position while milking the shaft or inject phenylephrine, epinephrine, or methylene blue

Disposition

Admit if refractory to treatment
May dispo home if treatment is successful with:
1. close follow up by urology
2. PO alpha-adrednergic agonist for 3-5 days to prevent recurrence
3. Consider giving terbutaline (PO or SubQ) to patient for self administration at home in those who have recurrent episodes

Source

Tintinalli

@@ Line 1: / Line 1: @@
 ==Background==
-# priapism = presence of a persistent, usually painful, erection of penis unrelated to sexual stimulation or desire as a result of persistent engorgment of the corpora cavernosa
+*Prolonged, unwanted erection not a/w sexual stimulation
-# may lead to permanent erectile dysfunction and penile necrosis if untreated
+*May lead to erectile dysfunction and penile necrosis if untreated
-# 2 types:
+*2 types:
-## arterial high flow: usually due to rupture of cavernous artery (rare, not usually painful) from trauma or blunt injury
+**1. High-flow (nonischemic)
-## low flow: due to veno-occlusion causing pooling of deoxygenated blood in the cavernous tissue
+***AV fistula from trauma (lacerated cavernous artery shunts blood into cavernous bodies)
-# associated with sickle cell disease, trauma, neoplasm, infection, fabry disease, spinal cord injury/cauda equina, and certain medications (phenothiazines,sed-hypnotics,SSRIs,BP meds (guanethidine), Phentolamine
+***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
 ==Work-Up==
-# cbc (in sickle cell patients and to look for leukemia if pt is without other predisposing factors)
+#CBC
-# coags
+##R/o SCD, leukemia
-# platelet count
+#Ultrasound
-# UA
+##Can distinguish between high-flow and low-flow
-# Doppler to differentiate between high-flow and low-flow priapism
 ==DDx==
-# Peyroine disease
+#Peyronie's Disease
-# urethral foreing body
+#Urethral foreign body
-# penile surgical implant
+#Penile surgical implant
-# erection from sexual arousal
+#Erection from sexual arousal
 ==Treatment==
-# saline hydration
+#IV hydration (sickle cell)
-# morphine
+#Morphine
-# oxygen (if secondary to sickle cell)
+#O2 (sickle cell)
-# transfusion (if secondary to sickle cell, goal Hg of >10)
+#Transfusion (sickle cell)
-# pseudoephedrine 60-120mg orally
+#Pseudoephedrine 60-120mg orally
-# terbutaline 0.5 mg sq
+#Terbutaline 0.5 mg sq
-# aspiration/injection of corpus cavernosum
+#Aspiration/injection of corpus cavernosum
-## penile nerve block
+##Penile nerve block
-## puncture corpus cavernosum through the shaft of the penis with a 19 gauge needle attached to a large syringe
+##Puncture corpus cavernosum through the shaft of the penis with a 19 gauge needle attached to a large syringe
-## aspirate blood from either 2 or 10 o'clock position while milking the shaft or inject phenylephrine, epinephrine, or methylene blue
+##Aspirate blood from either 2 or 10 o'clock position while milking the shaft or inject phenylephrine, epinephrine, or methylene blue
 ==Disposition==
-# admit if refractory to treatment
+#Admit if refractory to treatment
-# may dispo home if treatment is successful with:
+#May dispo home if treatment is successful with:
-## close follow up by urology
+##close follow up by urology
-## PO alpha-adrednergic agonist for 3-5 days to prevent recurrence
+##PO alpha-adrednergic agonist for 3-5 days to prevent recurrence
-## consider giving terbutaline (PO or SubQ) to patient for self administration at home in those who have recurrent episodes
+##Consider giving terbutaline (PO or SubQ) to patient for self administration at home in those who have recurrent episodes
 ==Source==
-Adapted from Donaldson
+Tintinalli
 [[Category:GU]]