PRIAPISM – Types, Causes, Clinical Manifestations, Diagnostic Evaluations, Management and Treatment
Priapism refers to an erection, usually painful, that lasts for more than four hours and is not necessarily the result of sexual arousal. This condition develops when blood in the penis becomes trapped and unable to orgasm. The condition is most common between the ages of 5 to 10 years and 20 to 50 years. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.
TYPES OF PRIAPISM
Priapism is classified into two types – ischemic (no-flow) or non-ischemic (high-flow)
- Ischemic Priapism: This is the most common form of priapism and usually occurs with several hours or days of a painful erection. It is caused by an obstruction in the penis venous drainage, which results in a buildup of poorly oxygenated blood in the corpora cavernosa, the tissue that forms the bulk of the erectile body of the penis. Ischemic priapism is considered a medical emergency and requires immediate treatment. If left untreated, the condition can significantly damage erectile function, by causing extensive scar tissue build-up and impotence
- Non-ischemic Priapism: This type of priapism is not as common or painful. It is usually caused by an injury to the penis or perineum, the area between the scrotum and anus. The injury causes the artery within the erectile body to rupture, and thus pump large amount of blood to the penis continuously
- Stuttering priapism: Another type of ischemic priapism, stuttering or recurring, priapism occurs off and on. A stuttering erection is usually painful and generally lasts several hours.
CAUSES OF PRIAPISM
- Blood diseases, including leukemia and sickle cell anemia.
- Certain medications, including some antidepressants and blood pressure medications
- Spinal cord trauma or conditions
- Trauma to the genital area
- Black widow spider bites
- Carbon monoxide poisoning
- Illicit drug use, such as marijuana and cocaine
- Anesthesia
- Penile injection therapy ( a treatment for erectile dysfunction)
CLINICAL MANIFESTATIONS
Priapism causes abnormally persistent erections. Priapism symptoms vary somewhat depending on the type of priapism.
1. Ischemic Priapism: Ischemic or low-flow, priapism is the result of blood not being able to leave the penis. It is the most common type of priapism. Signs and symptoms include:
- Unwanted erection lasting more than four hours
- Rigid penile shaft, but usually soft tip of penis (glans)
- Erection not related to sexual stimulation or persistent after stimulation
- Usually painful or tender penis
2. Non-ischemic Priapism: Non-ischemic or high-flow, priapism occurs when too much blood flows into the penis. Signs and symptoms include:
- Unwanted erection lasting at least four hours
- Erect but not rigid penile shaft
- Erection not related to sexual stimulation or persistent after stimulation
- Usually painless
DIAGNOSTIC EVALUATIONS
Diagnosis of Ischemic Priapism: Diagnosis involves a medical history and examination to determine any underlying medical causes and the duration of the condition. During the medical examination, doctor will assess the severity of pain, the rigidity of the penis and lack of involvement of certain parts of the penis. This also will include checking the rectum and the abdomen for evidence of unusual growths or abnormalities that may indicate the presence of cancer. In addition, a sample of blood will be analyzed to exclude sickle cell disease, thalasaemia major and leukemia
Diagnosis of Non-ischemic Priapism: Diagnosis of non-ischemic priapism also involves a medical history and examination to determine any underlying medical causes and duration of the condition. In addition, doctor will conduct a Doppler examination, which measures the blood flow of penis. When in doubt, a small needle may be placed in the penis to draw some blood, which is then sent to a lab for analysis. This will help determine which type of priapism the patient is experiencing
MANAGEMENT
Treatment for all forms of priapism aims to eliminate the erection and pain and preserve normal erectile function. Doctors recommend that anyone experiencing an erection lasting four hours should seek medical evaluation and treatment
TREATMENT OF ISCHEMIC PRIAPISM
Ischemic priapism is considered a medical emergency and requires immediate treatment. If left untreated, the condition can significantly damage erectile function
In the early stages of ischemic priapism, a cold shower or ice pack may relieve symptoms. Exercise in the form of climbing stairs also may help. Medications, such as analgesics and opiates to control pain, may be recommended as well.
- Aspiration: After penis is numbed with local anesthetic, excess blood is drained from it, using a small needle and syringe. As part of this procedure, the penile veins may also be flushed with a saline solution.
- Intracavernous Drug Therapy: This treatment is often very effective in treating low-flow priapism. It involves injecting drugs known as alpha-agonists, such as diluted neosynephrine, phenylephrine into the spongy tissue of penis, which causes the veins to open. As a result, the blood circulation to the penis is re-established.
- Shunt Surgery: During this procedure, a surgical shunt is created to restore blood circulation. A surgical shunt creates a new route for the trapped blood to return to the body
TREATMENT OF NON-ISCHEMIC PRIAPISM
This condition does not require urgent treatment and in some cases, the condition may resolve itself spontaneously after days or months, at which point erectile capacity returns to normal. In some instances where treatment is necessary, the following procedures may be recommended:
- Embolization: This technique reduces blood flow in the penis by obstructing the ruptured artery. This may be achieved by having a radiologist insert specially designed coils, glues or spheres into the penis.
- Surgical Ligation: The condition can also treated by tying off the ruptured artery, which helps to restore normal blood flow in the penis.
PREVENTION
Depending on the probable cause of the priapism, steps to prevent priapism may include:
- Treating the disease that may have caused priapism
- Changing medications if a prescription medication was the probable cause
- Avoiding triggers, such as alcohol or illegal drugs
- Self-injection of phenylephrine to stop prolonged erections
- Hormone treatment – only for adult men
- Prescription muscle relaxant, such as baclofen (Lioresal)
PRIAPISM – Types, Causes, Clinical Manifestations, Diagnostic Evaluations, Management and Treatment