Priapism

Priapism is a medical condition characterized by a persistent, often painful erection of the penis that lasts for more than four hours and occurs without sexual arousal. This condition necessitates immediate medical attention to prevent potential complications, including erectile dysfunction. Priapism can be classified into two main types, each with distinct causes and treatments: ischemic (low-flow) and non-ischemic (high-flow) priapism.

Ischemic Priapism

Ischemic priapism, the more common type, occurs when blood is not able to leave the penis. This form of priapism is usually painful and is considered a medical emergency due to the risk of tissue damage and other complications.

Non-Ischemic Priapism

Non-ischemic priapism, also known as high-flow priapism, is rarer and less painful. It is often the result of trauma to the genitals or perineum causing an abnormal connection between an artery and the corpora cavernosa, leading to increased blood flow to the penis.

Causes and Risk Factors

Various conditions and substances can contribute to the onset of priapism. These include hematological disorders like sickle cell anemia, leukemia, and thalassemia, certain medications (such as those for erectile dysfunction or depression), and illicit substances like cocaine and cannabis.

Symptoms

The primary symptom of priapism is a prolonged erection that persists for more than four hours and occurs without sexual stimulation. In ischemic priapism, the erection is usually painful, whereas in non-ischemic priapism, it is often not.

Diagnosis

The diagnosis of priapism typically involves a thorough medical history, physical examination, and possibly blood gas measurement and color Doppler ultrasound to differentiate between ischemic and non-ischemic priapism.

Treatment

Treatment strategies for priapism aim to relieve the persistent erection and prevent future episodes. For ischemic priapism, initial treatment often involves aspiration of blood from the penis or injection of a sympathomimetic drug. Surgery may be required if these measures are not successful. Non-ischemic priapism may resolve spontaneously or require selective arterial embolization or surgery.

Complications

If left untreated, priapism can lead to fibrosis of the penile tissue and permanent erectile dysfunction. Therefore, it is critical to seek immediate medical attention.

See Also

• Erectile Dysfunction
• Sickle Cell Disease

References

• [1] Montague DK, Jarow J, Broderick GA, et al. (2003). American Urological Association guideline on the management of priapism. Journal of Urology, 170(4 Pt 1), 1318–24.
• [2] Salonia A, Eardley I, Giuliano F, et al. (2014). European Association of Urology guidelines on priapism. European Urology, 65(2), 480-9.

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