Priapism

General Illness Information

Common Name: Priapism

Medical Term: Priapism

Description: Priapism is a pathological erection that lasts more than 4 hours and is not associated with sexual arousal. In this case, the erection does not disappear even after sexual intercourse. In addition, priapism can be accompanied by pain in the penis. An important difference of pathological erection from the natural (associated with sexual arousal) is the absence of blood filling of the glans penis.

Causes:

  • Diseases of the nervous system;
  • Poisoning;
  • Drug addiction;
  • Taking drugs that affect the nervous system; drugs that affect blood coagulability; hormonal preparations; drugs that reduce blood pressure;
  • Diseases of the blood (most often sickle cell anemia – a disease in which red blood cells (erythrocytes) change shape);
  • Taking drugs for the treatment of impotence (a condition in which a man can not perform sexual intercourse);
  • Injuries of the penis;
  • Infectious diseases (tularemia (high fever, weakness, enlargement of the lymph nodes), typhus (high fever, rash on the body, bowel damage), rabies (damage to the nervous system), spotted fever of the Rockies (a disease typical of America, manifested by high body temperature, rash on the body, vascular lesions, delirium).
  • Inflammation of the urethra and prostate;
  • Thrombophlebitis of the veins of the penis (inflammation of the vein wall and occlusion of the lumen by the impression of blood);
  • Chronic renal failure (the kidneys can not cope with the removal of toxins, which leads to their accumulation in the blood);
  • Systemic diseases. Most often Fabry’s disease – many benign formations on the skin.

Signs & Symptoms:

  • an erection lasts more than 4 hours;
  • there is no sexual arousal;
  • an erection does not disappear after sexual intercourse;
  • pain;
  • there is no increase in the glans penis, as with a natural erection.

Classification:

  • Ischemic priapism is the most common form (95%), which develops as a result of a violation of the outflow of blood from the penis. Ischemic form requires urgent medical measures, as it threatens with the development of fibrosis of cavernous bodies and subsequent erectile dysfunction. The reasons for the development of this form include blood diseases: erythrocytosis, sickle-cell anemia, leukemia); defeat of the central nervous system; intoxication of the body (alcoholic, narcotic); oncological diseases (prostate cancer, kidney cancer); the use of certain drugs (androgens, a-adrenoblockers, anticoagulants, psychotropic drugs, antihypertensive drugs); intracavernous administration of preparations based on alprostadil (prostaglandin E-1);
  • Non-ischemic priapism – develops as a result of damage to the cavernous bodies in case of trauma to the penis or perineum. A distinctive feature of this form is the absence of phenomena of ischemia (lack of oxygen) in cavernous bodies. Thus, non-ischemic form does not threaten the development of fibrosis of cavernous bodies. Pain, as a rule, is absent, or is associated with an injury. In some cases, the problem disappears a few days after the injury;
  • Recurrent priapism (synonyms: nocturnal, recurrent, intermittent) is a type of ischemic form. The pathological erection tends to spontaneously disappear and reappear at regular intervals, usually at night. The causes are the same as for ischemic ulcers;
  • Idiopathic form – the cause can not be established.

Diagnosis:

The diagnosis is not difficult and is based on patient survey data and examination. Laboratory and instrumental methods are used to determine the form and cause of priapism:

  • general blood analysis;
  • a study of the gas composition of blood in cavernous bodies;
  • dopplerography of the penis;
  • in some cases it is necessary to exclude lesions of the peripheral and central nervous system.

Treatment:

The tactics of treatment, in many respects, is determined by the duration of the attack and the form of the disease:

Ischemic priapism requires urgent, often surgical interventions.

At the initial stage, the treatment of ischemic priapism may be conservative:

  • anticoagulants;
  • antidepressants;
  • aspiration of blood from cavernous bodies.

In the absence of effect, surgical treatment is performed.

After performing surgical treatment, anti-inflammatory and anticoagulation therapy are prescribed.

The treatment of intermittent priapism is difficult, since this form has not been sufficiently studied. Usually, complex conservative therapy is conducted: psychotherapy, physiotherapy, the use of antidepressants, digoxin, gonadotropic hormones.

Possible Complications:

If the man delays a visit to the doctor or attempts to solve the problem on his own, serious complications can arise: impotence, fibrosis, cavities of cavernous bodies, as well as life-threatening necrosis and gangrene of the penis. In these cases, the body will need to be removed.

Other:

Not specified.

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