Introduction to Priapism
Priapism is a persistent penile erection that continues beyond, or is not related to sexual stimulation.
Predisposing factors:
- Thromboembolic disorders e.g. sickle cell disease, leukaemia.
- Spinal injuries
- Perineal and genital trauma
- Drugs e.g. chlorpromazine, prazosin and prostaglandins
Clinical features of Priapism
- Persistent painful erection lasting several hours
- Penis is rigid and tender but the glans penis and corpus spongiosum are soft
Complication of Priapism
- Erectile dysfunction
Investigations
- Full Blood Count
- Haemoglobin electrophoresis.
- Colour Doppler/duplex ultrasound
Treatment for Priapism
Treatment objectives
- To increase venous drainage from the corpora cavernosa
- Decrease arterial inflow in high flow priapism
- Treat the primary cause(s)
Non-drug treatment
Shunting procedures
- Caverno-glandular shunt
- Caverno-spongiosum shunt intensity
- Caverno-saphenous shunt
Spinal or epidural anaesthesia
Drug treatment
A. Specialist management
Intracavernosal injection of alpha adrenergic agonist:
- Phenylephrine 250-500 microgram
Or:
- Ephedrine 50-100 mg
B. Conservative management
Evidence Rating: [C]
Sodium Chloride 0.9%, IV,
Adults: 1 L 6 hourly and liberal oral fluids
Children: 500 ml 6 hourly and liberal oral fluids
And
Pethidine, IM,
Adults: 100 mg 8 hourly if required
Children: 1 mg/kg (max. 50 mg) 8 hourly if required
And
Diazepam, IV,
Adult: 10 mg stat. (given slowly over 2-3 minutes, approximately 2.5 mg
every 30 seconds) then refer
Children: 0.3 mg/kg stat. (given slowly over 2-3 minutes) then refer
Prevention
- Avoid causative drugs
Referral Criteria
Patients not responding to conservative management should be promptly referred to a urologist or surgical specialist