0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57
Priapism 1207■Oncologic lesions
➣Compression or obstruction of venous drainage of the penis
■Neurologic disease
➣Spinal trauma and stenosis
➣General anesthesia
■Trauma
management
Classification:
■Non-ischemic (arterial or high-flow) priapism
➣Rare
➣Associated with injury to a branch of the cavernosal artery
➣Usually after perineal or direct penile trauma
➣Results in uncontrolled high arterial inflow within the corpora
cavernosa
➣Painless
➣Not emergent – may be followed for many months safely
➣May require eventual angiographic embolization of rupture cav-
ernosal artery
➣Assess function of contralateral artery prior to embolization of
ruptured vessel.
■Ischemic priapism
➣More common
➣Inadequate venous outflow creates an acidotic and hypoxic envi-
ronment.
➣Painful prolonged erection
➣Most common identified causes: intracavernous agents for erec-
tions or sickle cell disease
➣Emergency
➣Goal of therapy to evacuate the old blood and re-establish circu-
lation
■Untreated penile ischemia leads to edema, endothelial, nerve termi-
nal and smooth muscle destruction and necrosis.
■If untreated within 24 hours, penile fibrosis and erectile dysfunction
can occur.
■Initial therapy consists of corporeal aspiration of blood and intracav-
ernous therapy with sympathomimetic drugs (phenylephrine, drug
of choice).
specific therapy
■Sickle cell disease
➣Treated with intracavernosal sympathomimetic drug as soon as
possible