Priapism

Signs and Symptoms

Priapism is an uncommon condition that causes a prolonged and often painful erection, which occurs without sexual stimulation. In one-third of the cases, the cause of the disorder is unknown. The remaining cases are caused by an associated condition, including sickle cell disease, pelvic tumors, pelvic infections, leukemia, genital trauma or spinal cord trauma and medications or recreational drugs. For more information on medications and recreational drugs that may cause Priapism, please see Drugs Reported to Cause Priapism.

Priapism is classified into ischemic (no-flow) or non-ischemic (high-flow) types --

• Ischemic Priapism -- This is the most common form of priapism and usually occurs with several hours or days of a painful erection. It is caused by an obstruction in the penis' venous drainage, which results in a buildup of poorly oxygenated blood in the corpora cavernosa, the tissue that forms the bulk of the erectile body of the penis. Ischemic priapism is considered a medical emergency and requires immediate treatment. If left untreated, the condition can significantly damage erectile function, by causing extensive scar tissue build-up and impotence.

• Non-ischemic Priapism -- This type of priapism is not as common or painful. It is usually caused by an injury to the penis or perineum-the area between the scrotum and anus. The injury causes the artery within the erectile body to rupture and thus pumping large amount of blood to the penis continuously.

Diagnosis

Diagnosis depends on the type of priapism --

• Ischemic Priapism-- Diagnosis involves a medical history and examination, to determine any underlying medical causes and duration of the condition. During the medical examination, your doctor will assess the severity of pain, the rigidity of the penis and lack of involvement of certain parts of the penis. This also will include checking the rectum and the abdomen for evidence of unusual growths or abnormalities that may indicate the presence of cancer. In addition, a sample of your blood will be analyzed to exclude sickle cell disease, thalasaemia major and leukemia.

• Non-ischemic Priapism -- Diagnosis also involves a medical history and examination, to determine any underlying medical causes and duration of the condition. Your doctor will also conduct a Doppler examination, which measures the blood flow of your penis. When in doubt, a small needle may be placed in the penis, some of the blood is drawn and then it is sent to a lab for analysis. This will help determine which type of priapism the patient is experiencing.

Treatment

Treatment for all forms of priapism aims to eliminate the erection, pain and preserve normal erectile function. In addition, doctors recommend that any erection lasting four hours should seek medical evaluation and treatment.

Ischemic Priapism

Ischemic priapism is considered a medical emergency and requires immediate treatment. If left untreated, the condition can significantly damage erectile function. In the early stages of ischemic priapism, a cold shower or ice pack may relieve symptoms. Exercise in the form of climbing stairs also may help. Medications, such as analgesics and opiates to control pain, may be recommended as well. Other treatments for the condition include --

• Intracavernous Drug Therapy -- This treatment is often very effective in treating low-flow priapism. It involves injecting drugs known as alpha-agonists, such as diluted neosynephrine, into the penis, which causes the veins to open. As a result, the blood circulation to the penis is re-established.

• Shunt Surgery -- During this procedure, a surgical shunt created to restore normal blood circulation. A surgical shunt creates a new route for the trapped blood to return to the body.

Non-ischemic Priapism

This condition does not require urgent treatment and in some cases, the condition may resolve itself spontaneously after days or months, at which point erectile capacity returns to normal. In some instances where treatment is necessary, the following procedures may be recommended --

• Embolization-- This technique reduces blood flow in the penis by obstructing the ruptured artery. This may be achieved by inserting specially designed coils, glues or spheres into the penis by a radiologist.

• Surgical Litigation -- The condition can also be treated by tying off the ruptured artery, which helps to restore normal blood flow in the penis.