Priapism

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