Priapism

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

1. CBC
   1. R/o SCD, leukemia
2. Ultrasound
   1. Can distinguish between high-flow and low-flow

DDx

1. Peyronie's Disease
2. Urethral foreign body
3. Penile surgical implant
4. Erection from sexual arousal

Treatment

1. IV hydration (sickle cell)
2. Morphine
3. O2 (sickle cell)
4. Transfusion (sickle cell)
5. Pseudoephedrine 60-120mg orally
6. Terbutaline 0.5 mg sq
7. 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

1. Admit if refractory to treatment
2. 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