Priapism

aka Imagine this – you are Captain at the Helm of an Emergency Departmental ship, critically ill patients floundering all over your very untidy deck, and you have a rudimentary knowledge of most of them. You have sorted out dispositions for most of the very unwell ones, and are awaiting intensive care beds to become available. You think that you have a modest handle on the teetering pathophysiology of those in your resus bay. Just at that moment, a nurse hands you a blood gas on one of your patients. You glance at it, and your heuristic mind starts to spin; you jump up, piece of paper fluttering to the flight deck as you race around, seeking out the obviously near-terminal owner of the blood gas… Here is the gas: Try googling this one. At best, most sites will quote a pH of 6.8. There is no acceptable answer. We probably all have anecdotal stories of apocryphal pHs – the post seizure patient, the ROSC after prolonged cardiac arrest, the toxicological conundrums. However there is no agreed lowest pH that is survivable. Description • Gross acidaemia • Respiratory and metabolic acidosis • Anion gap = 7 – hey, what the…. With a lactic acid of 29!!!! • Delta ratio = -0.71 – but! Difficult to interpret in setting of low-normal anion gap in first place • Gross hyperkalememia, hypocalcemia • Normal creatinine/sodium • But damn! Look at that lactate!! Interpretation • WTF! gas is the clearest way of subdividing priapism into its two main subgroups: • Ischaemic – pH < 7.25, pO2 60mm...

Priapism is a rare condition resulting in an uncontrolled erection lasting for an unusually long time. It can be painful. Sexual stimulation can be involved, but there are often other causes such as medical conditions, medications or recreational drugs. Immediate treatment is important to prevent tissue damage and erectile dysfunction (ED). When an erection lasts for too long, blood becomes trapped in the penis. One function of blood is to carry oxygen to different organs in the body. When the blood is trapped in the penis, the erectile tissues no longer receive the oxygen they need to stay healthy and to function normally. A prolonged lack of oxygenated blood can irreversibly damage or destroy tissue in the penis. This can disfigure the penis. It may also cause problems like erectile dysfunction (when the penis cannot become erect). If you have an erection that lasts for four (4) or more hours, go to the emergency room for treatment. If a long-lasting erection eventually goes away, still make time to see your doctor. Treatment can prevent this from happening again and from causing damage. Types of Priapism Priapism can happen in a wide age range of males. There are two types of priapism: • Acute Ischemic (veno-occlusive, low flow): when blood cannot enter or leave the penis. This erection can last for more than four (4) hours. The penis shaft may be very hard, while the tip is soft. It is known to cause pain and discomfort. This type may stop and start (stuttering priapis...

Back to top About Priapism Priapism is an erection that lasts too long. Priapism can develop without sexual stimulation and doesn’t go away after orgasm. There is a risk of having priapism after penile injection therapy. When you have a full erection, no fresh blood flows into your penis. This means that your penis isn’t getting oxygen, which can damage the tissue and lead to permanent erectile dysfunction (ED). Figure 1. Pseudoephedrine HCl (Sudafed) If you have priapism, taking pseudoephedrine HCl (Sudafed ®) can help. You can buy pseudoephedrine HCl at your local pharmacy without a prescription, but the boxes are kept behind the pharmacy counter. To buy pseudoephedrine HCL, take the pseudoephedrine HCl card that’s hanging on the shelf to the pharmacist (see Figure 1). You will have to show a photo ID before the pharmacist gives you the box to purchase. Do not purchase pseudoephedrine HCL that’s on the shelf. This is phenylephrine and is not the appropriate medication to use for priapism. If you have problems with your heart, talk with your cardiologist about whether it’s safe for you to take pseudoephedrine HCl. If you’re taking penile injections, make sure to have pseudoephredrine HCl with you as long as you’re using the injections. Back to top If You Develop Priapism • If you have an erection at penetration hardness (a 6 or higher on the erection hardness scale) that lasts 2 hours, take 4 (30 mg) tablets of pseudoephedrine HCl (Sudafed). Don’t take extended-release or...

Enter search terms to find related medical topics, multimedia and more. Advanced Search: • Use “ “ for phrases o [ “pediatric abdominal pain” ] • Use – to remove results with certain terms o [ “abdominal pain” –pediatric ] • Use OR to account for alternate terms o [teenager OR adolescent ] Search A-Z Most cases of priapism involve failure of detumescence and are most commonly due to failure of venous outflow (ie, low flow), also known as ischemic priapism. Severe pain from ischemia occurs after 4 hours. If prolonged > 4 hours, priapism can lead to corporeal fibrosis and subsequent Erectile Dysfunction Erectile dysfunction is the inability to attain or sustain an erection satisfactory for sexual intercourse. Most erectile dysfunction is related to vascular, neurologic, psychologic, and hormonal... read more or even penile necrosis and gangrene. Hematologic disorders (eg, Sickle Cell Disease Sickle cell disease (a hemoglobinopathy) causes a chronic hemolytic anemia occurring almost exclusively in people with African ancestry. It is caused by homozygous inheritance of genes for hemoglobin... read more , less commonly Overview of Leukemia Leukemia is a malignant condition involving the excess production of immature or abnormal leukocytes, which eventually suppresses the production of normal blood cells and results in symptoms... read more ) Priapism requires urgent treatment to prevent chronic complications (primarily Erectile Dysfunction Erectile dysfunction is the inability ...

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Share on Pinterest 10’000 Hours/Getty Images Priapism can be caused by certain medications and health conditions. It is uncommon, but when it occurs, it typically affects males in their 30s. There are • Low flow priapism: Also known as ischemic priapism, this occurs when blood becomes stuck in the erection chamber. • High flow priapism: This type is caused by a broken artery that prevents proper blood circulation in the penis, causing high flow or nonischemic priapism. This could be due to an injury. An erection that lasts longer than The symptoms of this condition vary depending on whether you experience low flow or high flow priapism. Ischemic priapism If you have low flow or ischemic priapism, you • erections lasting for more than • rigid penile shaft with a soft tip • penis pain Low flow or ischemic priapism can become a recurrent condition and may start and stop, which is known as stuttering priapism. When symptoms begin, involuntary erections may only last for a few minutes or a short length of time. As time moves on, these erections occur more frequently and last longer. Nonischemic priapism If you have high-flow priapism, you’ll have some of the same symptoms as low-flow priapism, including: • erections lasting for more than • rigid penile shaft and tip The main difference between low-flow and high-flow priapism is that pain doesn’t occur with high-flow priapism. A healthy penile erection With priapism, Blood disorders Different conditions affect how blood flows in...

Priapism is a prolonged and often painful erection of the penis. It causes blood in the penis to become trapped and unable to drain through the penile arteries. It is often unrelated to or continues long beyond sexual activity. It can be a serious condition due to the risk of permanent tissue damage. Here we explore the treatment options for priapism, as well as some of the more common causes. The symptoms and types of priapism will also be covered. Share on Pinterest Priapism may occur in men of any age. There are several different types of priapism: • Ischemic: Also known as low-flow priapism, it occurs when blood is not able to leave the penis after an erection. Most cases of priapism are ischemic. • Recurrent: This is a type of ischemic priapism also called recurrent or stuttering priapism. It is uncommon and usually seen in men with sickle cell • Non-ischemic: Also known as high-flow priapism, this type is caused by poorly regulated blood flow in the penis. The primary symptom of priapism is a prolonged erection. Other symptoms depend on the type of priapism that is occurring. Symptoms of ischemic priapism include: • penile pain that gets worse with time • an erection where the tip of the penis remains soft Non-ischemic priapism is usually painless and causes an erection that is not fully rigid. Share on Pinterest Use of some recreational drugs may cause priapism. There are several different causes of priapism. They include: • Medications: Some medications can affect ...

Once you've decided which second-line treatment option is best (direct injection or aspiration and irrigation) and you've gathered your tools, you're ready to begin. First, we'll review the steps for performing the direct injection technique, and then we'll cover how to perform the aspiration and irrigation technique. Your first line of treatment should involve the direct injection of phenylephrine: • Pick a side of the penis that is most convenient for you and clean the lateral aspect with alcohol. • Draw 0.5 mg of phenylephrine into a 27 gauge (G) syringe. • Place the needle into the corpus cavernosum on the selected side, close to the base of the penis at the two or ten o’clock position. • Aspirate a little to confirm that you are in the corpus, and then inject the phenylephrine. • Remove the needle and wait to see if the priapism resolves in the next 10 minutes. Figure 1. Procedure for direct phenylephrine injection for treating priapism. 1) Clean the lateral aspect of the penis with alcohol. 2) Draw 0.5 mg of phenylephrine. 3) At the base of the penis place the needle in the corpus cavernosum at the ten or two o’clock positions. 4) Aspirate to confirm you are in the corpus then inject the phenylephrine. 5) Remove the needle and wait to see if the priapism resolves within 10 minutes. If the erection does not resolve, and the urologist is not available, it’s time to perform the more invasive aspiration and irrigation procedure: • Clean the penis with a sterilizing solut...