priapism

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Priapism

 

Definition

Priapism is a rare condition that causes a persistent, and often painful, penile erection.

Description

Priapism is drug induced, injury related, or caused by disease, not sexual desire. As in a normal erection, the penis fills with blood and becomes erect. However, unlike a normal erection that dissipates after sexual activity ends, the persistent erection caused by priapism is maintained because the blood in the penile shaft does not drain. The shaft remains hard, while the tip of the penis is soft. If it is not relieved promptly, priapism can lead to permanent scarring of the penis and inability to have a normal erection.

Causes and symptoms

Priapism is caused by leukemia, sickle cell disease, or spinal cord injury. It has also been associated as a rare side effect to trazodone (Desyrel), a drug prescribed to treat depression. An overdose of self-injected chemicals to counteract impotence has also been responsible for priapism. The chemicals are directly injected into the penis, and at least a quarter of all men who have used this method of treatment for over three months develop priapism.

Diagnosis

A physical examination is needed to diagnose priapism. Further testing, including nuclear scanning or Doppler ultrasound, will diagnose the underlying cause of the condition.

Treatment

There are three methods of treatment. The most effective is the injection of medicines into the penis that allow the blood to escape. Cold packs may also be applied to alleviate the condition, but this method becomes ineffective after about eight hours. For the most serious cases and those that do not respond to the first two treatments, a needle can be used to remove the blood. The tissues may need to be flushed with saline or diluted medications by the same needle method. That failing, there are more extensive surgical procedures available. One of them shuts off much of the blood supply to the penis so that it can relax. If the problem is due to a sickle cell crisis, treatment of the crisis with oxygen or transfusion may suffice.

Prognosis

If priapism is relieved within the first 12-24 hours, there is usually no residual damage. After that, permanent impotence may result, since the high pressure in the penis compromises blood flow and leads to tissue death (infarction).

Prevention

An antineoplastic drug (hydroxyurea) may prevent future episodes of priapism for patients with sickle cell disease.

Resources

Books

Wertheimer, Neil. Total Health for Men. Emmaus, PA: Rodale Press, 1995.

Periodicals

Werthman, P., and J. Rajfer. "MUSE Therapy: Preliminary Clinical Observations." Urology 50 (November 1997): 809-811.

Key terms

Antineoplastic — A drug used to inhibit the growth and spread of cancerous cells.
Doppler ultrasound — An imaging technique using ultrasound that can detect moving liquids.
Infarction — Death of tissue due to inadequate blood supply.
Nuclear scanning — Use of injected radioactive elements to analyze blood flow.
Sickle cell anemia — A hereditary abnormality of blood cells in which some are deformed and may plug up small blood vessels.

priapism

 [pri´ah-pizm]
persistent abnormal erection of the penis, accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis.

pri·a·pism

(prī'ă-pizm),
Persistent erection of the penis, accompanied by pain and tenderness, resulting from a pathologic condition rather than sexual desire; a term loosely used as a synonym for satyriasis.
[see priapus]

priapism

/pri·a·pism/ (pri´ah-pizm) persistent abnormal erection of penis, accompanied by pain and tenderness.

priapism

(prī′ə-pĭz′əm)
n.
Persistent, usually painful erection of the penis, especially as a consequence of disease and not related to sexual arousal.

priapism

[prī′əpiz′əm]
Etymology: Gk, priapos, phallus
an abnormal condition of prolonged or constant penile erection, often painful and seldom associated with sexual arousal. It may result from localized infection, a lesion in the penis or the central nervous system, or the use of medications or recreational drugs such as cocaine. It sometimes occurs in men who have acute leukemia or sickle cell anemia.
enlarge picture
Priapism

priapism

A rare urologic emergency characterised by painful erection without sexual excitement or desire, in which the penis does not return to its flaccid state—despite the absence of both physical and psychological stimulation—within four hours; 60% are idiopathic, the rest are due to various disorders, such as leukaemia, pelvic infection, pelvic cancer, sickle cell anaemia, abuse substances (alcohol, cocaine, marijuana, methaqualone), drugs (anticoagulants, antihypertensives, corticosteroids, neuroleptics, tolbutamide, papaverine), scorpion bites and penile or spinal cord trauma.

Clinical findings
Painful, prolonged erection with a tense, congested corpora cavernosa.
 
Mechanism
Accumulation of high-viscosity hypoxic blood in corpora cavernosa secondary to obstruction of venous blood.
 
Prognosis
Without decompression, interstitial oedema and fibrosis of the spongiosa of the penile shaft ensue, causing permanent impotence.

priapism

Urology A urologic emergency characterized by painful erection without sexual excitement or desire; 60% are idiopathic, the rest are due to various disorders–eg, leukemia, pelvic infection, pelvic CA, sickle cell anemia, abuse substances–alcohol, cocaine, marijuana, methaqualone, drugs–anticoagulants, antihypertensives, corticosteroids, neuroleptics, tolbutamide, papaverine, scorpion bites, penile or spinal cord trauma Clinical Painful, prolonged erection with a tense, congested corpora cavernosa Prognosis Without decompression, interstitial edema and fibrosis of penile shaft ensue, causing impotence. See Bobbittize, Penile prosthesis, Peyronie's disease.

pri·a·pism

(prī'ă-pizm)
Persistent erection of the penis, accompanied by pain and tenderness, resulting from a pathologic condition rather than sexual desire.

priapism

Persistent, usually painful erection of the corpora cavernosa of the penis without sexual interest. Priapism results from the failure of blood to drain from the penis and may lead to permanent damage from blood clotting. Urgent treatment is needed to withdraw the blood through a wide-bore needle or to obtain detumescence by other means. From the Greek Priapos , the god of procreation.

priapism

persistent abnormal erection of the penis, accompanied by pain and tenderness. It is seen in diseases and injuries of the spinal cord, and may be caused by vesical calculus and certain injuries to the penis.