- penis maintains a prolonged erection (>4 hours) in the absence of appropriate stimulation.
- is compartment syndrome of the penis.
- Ischemia and infarction can occur with prolonged priapism and rapid treatment and detumescence is critical
- Do not delay aspiration and irrigation if more conservative measures fail as complications (fibrosis, impotence) can occur
- The commonest causes of priapism in children are sickle cell disease (65%), leukaemia (10%) and trauma (10%)
- types:
- Ischemic – low flow
- Decreased venous outflow results in increased cavernosal pressure
- When cavernosal pressure exceeds arterial pressure, ischemia develops
- More common than high-flow version
- Typically accompanied by significant pain due to ischemia (can be considered to be compartment syndrome of the penis)
- Nonischemic – high flow
- Excess arterial inflow resulting in priapism
- Often painless
- Common causes – Arterial laceration, Spinal trauma
- ischemic causes of priapism are a true emergency and require prompt intervention to prevent damage to the penis, which can progress to erectile dysfunction and permanent impotence.
- Risks
- Vasoactive medications – erectile dysfunction medications -PDE5 inhibitors
- Antipsychotics and trazodone
- intracaveronal theapy
- Pediatric: Sickle cell disease, leukemia
- coccaine
- gout
- spinal shock
- Treatment
- Cold shower
- Oral pseudoephedrine 120mg stat
- Walking/ gentle jog
- Cold pack – perineum
- Urgent urology input
- Corporal aspiration under Penile local anaesthetic block
- Intracavernosus injection of phenylphrine
- Complications
- Penile fibrosis
- Urinary retention
- Incontinence
- Thrombosis + Ischemia (resulting from blood stagnation)
- Permanent damage erectile tissue – erectile dysfunction and disfigurement
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