Priapism
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Priapism (Greek πριαπισμός, erection) is a painful and potentially harmful medical condition in which the erect penis does not return to its flaccid state (despite the absence of both physical and psychological stimulation) within four hours.
Priapism is a medical emergency and needs proper treatment by a qualified medical practitioner.
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[edit] Causes
The causative mechanisms are poorly understood but involve complex neurological and vascular factors. Priapism may be associated with haematological disorders, especially sickle-cell disease, and other conditions such as leukaemia, thalassemia, and Fabry's disease, and neurologic disorders such as spinal cord lesions and spinal cord trauma (priapism has been reported in hanging victims).
Priapism can be caused by medications. Most common medications to cause priapism are intracavernous injections for treatment of erectile dysfunction (papaverine, alprostadil). Other groups reported are antihypertensives, antipsychotics (e.g chlorpromazine, clozapine), antidepressants (most notably trazodone), anticoagulants, and recreational drugs (alcohol and cocaine). Phosphodiesterase type-5 (PDE5) inhibitors such as sildenafil (popularly Viagra), tadalafil and vardenafil have very rarely been implicated, and probably do not cause priapism.
[edit] Complications
Potential complications include ischaemia, clotting of the blood retained in the penis (thrombosis), and damage to the blood vessels of the penis which may result in an impaired erectile function or impotence. In serious cases the condition may result in gangrene, which may necessitate penis removal.
[edit] Treatment
Medical advice should be sought immediately for cases of erection beyond four hours. Generally, this is done at an emergency department. The therapy at this stage is to aspirate blood from the corpus cavernosum under local anaesthetic. If this is still insufficient, then intra-cavernosal injections of phenylephrine are administered. This should only be performed by a trained urologist, with the patient under constant hemodynamic monitoring, as phenylephrine can cause severe hypertension, bradycardia, tachycardia, and arrythmia. If aspiration fails and tumescence re-occurs, surgical shunts are next attempted. These attempt to reverse the priapic state by shunting blood from the rigid corpora cavernosa into the corpus spongiosum (which contains the glans and the urethra). Distal shunts are the first step, followed by more proximal shunts.
Distal shunts, such as the Winter's, involves puncturing the glans (the distal part of the penis) into one of the cavernosa, where the old, stagnant blood is held. This causes the blood to leave the penis and return to the circulation. This procedure can be performed by a urologist at the bedside.
Proximal shunts, such as the Quackel's, are more involved and entail operative dissection in the perineum to where the corpora meet the spongiosum, making an incision in both, and suturing both openings together.
[edit] Miscellaneous
The name comes from the god Priapus, referring to that god's most notable attribute: ironically and pertinently one version of the Priapus myth has Priapus punished by the gods for attempting to rape a goddess by being given a huge but useless set of wooden genitals. The female counterpart of this condition is known as clitorism.[citation needed]
[edit] References
- Beers MH, Berkow R (Eds.) (1999). The Merck Manual of Diagnosis and Therapy (17 ed.). Whitehouse Station: Merck Research Laboratories. ISBN 0-911910-10-7
- Therapeutic Guidelines Limited (2001). Therapeutic Guidelines: Endocrinology (2 ed.). North Melbourne: Therapeutic Guidelines Limited. ISSN 1327-9505
- Montague DK, Jarow J, Broderick GA et al: American Urological Association guideline on the management of priapism. Journal of Urology 2003 Oct;170(4 Pt 1):1318-24. PMID 14501756
- Guidelines on managmenet of priapism - American Urological Association website
- Priapism Primer: Priapism
