Priapism

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
may lead to permanent erectile dysfunction and penile necrosis if untreated
2 types:
arterial high flow: usually due to rupture of cavernous artery (rare, not usually painful) from trauma or blunt injury
low flow: due to veno-occlusion causing pooling of deoxygenated blood in the cavernous tissue
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

==Work-Up==

cbc (in sickle cell patients and to look for leukemia if pt is without other predisposing factors)
coags
platelet count
UA
Doppler to differentiate between high-flow and low-flow priapism

==DDx==

==Treatment==

aspiration/injection of corpus cavernosum
penile nerve block
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

==Disposition==

admit if refractory to treatment
may dispo home if treatment is successful with:
close follow up by urology
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

Adapted from Donaldson