Priapism

Priapism is characterised by a prolonged, typically painful erection, which lasts > 4 hours in the absence of sexual excitation. This condition is not usually related to sexual desire or stimulation.

This is a a urological emergency as there's a risk of irreversible damage to the penis.

Classification

• Ischaemic (low-flow) priapism - Most common type. It's caused by a lack of venous drainage from the corpora cavernosa. This form of priapism is related to hematologic disorders e.g. sickle cell disease, malignancies, or the use of certain drugs.

• Non-ischaemic (high-flow) priapism - Less common type. It's caused by unregulated arterial inflow, and is often related to trauma.

Management

• 1st line - Aspiration within the corpus cavernosa and irrigation with normal saline

  • If unsuccessful, intra-cavernosal injection of alpha agonists such as Adrenaline or Phenylephrine may be used

  • A surgical shunt may be considered in refractory cases