RENAL AND GENITOURINARYEMERGENCIESPriapism is defined as persistent painful erection unrelated to stimulation or
desire. Priapism is divided into two types: Low-flow (ischemic) priapism
(most common) and high-flow (nonischemic) priapism.
Low-Flow (Ischemic) Priapism
Low-flow (ischemic) priapism occurs secondary to venous stasis and blood
pooling in the corpora cavernosa with resulting ischemia. This type is most
commonand is a true emergency.
Predisposing Factors for Low-flow Priapism:
■ Sickle cell disease
■ Malaria
■ Cancer
■ Leukemia, multiple myeloma
■ Illicit drug use
■ Cocaine, ecstasy, marijuana
■ Medications
■ Antihypertensives, anticoagulants, psychiatric medications
■ Penile injection for erectile dysfunction
■ Phentolamine, prostaglandin
SYMPTOMS/EXAM
■ The corpora cavernosa are rigid and tenderwith palpation.
DIAGNOSIS
■ Primarily based on presence of predisposing factor and clinical exam
■ CBC may be used to screen for hematologic malignancy.
■ Tests that may confirm diagnosis, if in question:
■ Corpus cavernosum blood gas showing hypercarbia, hypoxia, and acidosis
■ Ultrasound showing diminished cavernous blood flow
TREATMENT
■ Emergent urology consult
■ Supportive care with analgesia and ice packs to perineum; IV hydration
■ Aspiration of the corpus cavernosum
■ Injection of 1 mL of diluted phenylephrine (100–500 μg/mL) into the cor-
pus cavernosum with repeated attempts q 3–5 minutes
■ Terbutaline (SQ or PO) and pseudoephedrine (PO) have been used
with some success and may be tried while preparing for aspiration/
injection.
■ Systemic treatment of underlying disorders
COMPLICATIONS
■ Permanent erectile dysfunction
High-Flow (Nonischemic) Priapism
High-flow (nonischemic) priapism occurs secondary to unregulated corpora
cavernosum arterial inflow.