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Penis and scrotum
Priapism
Editors: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 24 May 2010, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Prolongation of penile erection without sexual stimuli for more than 4 hours
Terminology
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● Either low flow / ischemic (disorder of venous outflow or stasis) or high flow / nonischemic (disorder of arterial flow, may be due to anatomic abnormality or perineal trauma with resulting fistula, Can Urol Assoc J 2009;3:60)
Etiology
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● Usually due to vascular diseases (sickle cell disease, leukemia, thalassemia, Fabry’s disease) or neurological disorders (spinal cord lesions/trauma) or medications (treatment for erectile dysfunction, antihypertensives, antipsychotics, antidepressants, blood thinners)
● Metastatic carcinoma to the penis may present with “malignant” priapism in up to 40% of cases
Clinical features
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● Frequently associated with pain
● May have fever and difficulty voiding
● Associated with erectile dysfunction in 17% to 50%
● Potential complications include ischemia, thrombosis and permanent impaired erectile dysfunction
Treatment
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● Low flow / ischemic priapism: prompt intervention is required; corpora cavernosal aspiration/irrigation with concomitant usage of a sympathomimetic agent; may also need systemic therapy if an underlying systemic disorder; surgical intervention may be necessary if medication fails (Rev Urol 2010;12:56)
● High flow / nonischemic priapism: not a surgical emergency; resolves spontaneously in 60%, particularly if no underlying anatomic abnormality; selective arterial embolization if it persists
Additional references
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End of Penis and scrotum > Priapism
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