Priapism: Causes, Types and Treatments

Definition:

Priapism is a painful, persistent, abnormal erection, accompanied by sexual desire or excitement. It is more common in children aged 5 to 10 years and in men between the ages of 20 and 50 years.

Causes

Sickle cell anemia: Scientists believe that about 42% of men with sickle cell disease will get priapism at some point.

Medications: medications that can cause priapism include those formulated for depression, as well as pills or injections to treat erectile dysfunction can also cause priapism.

Other causes:

  • An injury to the spinal cord or the genital area.
  • Black widow spider bites and scorpion stings.
  • Poisoning by carbon monoxide.
  • The use of illegal drugs such as marijuana and cocaine.

It is rare, but priapism can happen due to cancers that affect the penis and prevent blood from flowing out of the area.

Types of priapism

Ischemic priapism

Most cases of priapism involve detumescence and it is due to the lack of venous outflow (ie, low flow), also known as ischemic priapism. The severe pain of ischemia occurs after 4 hours. If prolonged for more than 4 hours, priapism can lead to bodily fibrosis and erectile dysfunction or even to necrosis of the penis and gangrene.

Non-ischemic priapism

Non-ischemic priapism is due to unregulated arterial inflow (ie, high flow), usually as a result of the formation of an arterial fistula after a trauma. Non-ischemic priapism is not painful and does not lead to necrosis.

Priapism requires immediate treatment to avoid chronic complications (erectile dysfunction mainly). The evaluation and treatment must be done simultaneously.

Treatment

The treatment is often difficult and sometimes unsuccessful, even when the etiology is known. Whenever possible, patients should be referred to an emergency department; they must be seen and treated urgently by a urologist.
Ischemic priapism

Treatment should begin immediately, with aspiration of blood from the base of one of the corpora cavernosa using a syringe, often with saline irrigation and intracavernous injection of phenylephrine receptor agonist.

If these measures are unsuccessful or if the priapism has lasted more than 48 hours (and therefore is unlikely to be resolved with these measures), a surgical bypass can be created between the corpus cavernosum and the glans penis or the corpus spongiosum .

Non-ischemic priapism

Conservative therapies (eg, ice packs and analgesics) are usually successful; if not, selective embolization or surgery is indicated.

Refractory Priapism

If other treatments are not effective, a penile prosthesis can be placed.