Priapism

Priapism
Fresco in Pompeii depicting Priapus
Pronunciation
SpecialtyUrology, emergency medicine
SymptomsPenis remains erect for hours[3]
ComplicationsPermanent scarring of the penis[3]
TypesIschemic (low-flow), nonischemic (high-flow), recurrent ischemic (intermittent)[3]
CausesSickle cell disease, antipsychotics, SSRIs, blood thinners, cocaine, trauma[3]
TreatmentIschemic: Removal of blood from the corpus cavernosum with a needle[3]
Non-ischemic: Cold packs and compression[3]
Frequency1 in 60,000 males per year[3]

Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended.[3] There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent).[3] Most cases are ischemic.[3] Ischemic priapism is generally painful while nonischemic priapism is not.[3] In ischemic priapism, most of the penis is hard; however, the glans penis is not.[3] In nonischemic priapism, the entire penis is only somewhat hard.[3] Very rarely, clitoral priapism occurs in women.[4]

Sickle cell disease is the most common cause of ischemic priapism.[3] Other causes include medications such as antipsychotics, SSRIs, blood thinners and prostaglandin E1, as well as drugs such as cocaine.[3][5] Ischemic priapism occurs when blood does not adequately drain from the penis.[3] Nonischemic priapism is typically due to a connection forming between an artery and the corpus cavernosum or disruption of the parasympathetic nervous system resulting in increased arterial flow.[3] Nonischemic priapism may occur following trauma to the penis or a spinal cord injury.[3] Diagnosis may be supported by blood gas analysis of blood aspirated from the penis or an ultrasound.[3]

Treatment depends on the type.[3] Ischemic priapism is typically treated with a nerve block of the penis followed by aspiration of blood from the corpora cavernosa.[3] If this is not sufficient, the corpus cavernosum may be irrigated with cold, normal saline or injected with phenylephrine.[3] Nonischemic priapism is often treated with cold packs and compression.[3] Surgery may be done if usual measures are not effective.[3] In ischemic priapism, the risk of permanent scarring of the penis begins to increase after four hours and definitely occurs after 48 hours.[3][6] Priapism occurs in about 1 in 20,000 to 1 in 100,000 males per year.[3]

  1. ^ "priapism". Oxford English Dictionary (2nd ed.). Oxford University Press. 1989. (as /ˈpraɪəpɪz(ə)m/)
  2. ^ "priapism". Merriam-Webster.com Dictionary. Retrieved 2017-03-07. "Definition of PRIAPISM". Archived from the original on 2017-06-06. Retrieved 2017-09-10.{{cite web}}: CS1 maint: bot: original URL status unknown (link).
  3. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z Podolej, GS; Babcock, C (January 2017). "Emergency Department Management Of Priapism". Emergency Medicine Practice. 19 (1): 1–16. PMID 28027457.
  4. ^ Lehmiller, Justin J. (2014). The Psychology of Human Sexuality. John Wiley & Sons. p. 545. ISBN 978-1-119-16470-8. Retrieved February 8, 2018.
  5. ^ "Alprostadil". The American Society of Health-System Pharmacists. Archived from the original on 16 January 2017. Retrieved 8 January 2017.
  6. ^ Salam, Muhammad A. (2003). Principles & Practice of Urology: A Comprehensive Text. Universal-Publishers. p. 342. ISBN 978-1-58112-411-8. Archived from the original on 2017-04-27.

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