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What is Priapism? |
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Most
erection due to sexual stimulation never approach four to
six hours. Priapism is not associated with sexual
excitement, at least not initially, and the erection does
not subside after ejaculation. Priapism can occur in all age
groups, including newborns. Most cases of priapism are
clustered between two age groups: between the ages of five
to ten and twenty to fifty years. Priapism constitutes a
true urologic emergency. Men often joke that they wish they
could have a permanent erection, but in reality, men are
extremely miserable when this actually happens.
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| How
is Priapism caused? |
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Children
with priapism are typically those who have leukemia.
In this situation, the white blood cells occlude, or
block the outflow of blood from the penis causing
priapism.
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Children
with sickle-cell disease can be afflicted with
priapism. In this situation, the penis receives low
oxygen, and therefore, the blood sickles and
prevents outflow because of sludging.
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Other
rare causes of priapism in childhood include trauma,
wither to the penis or to the area underneath the
penis known as the perineum. Additionally, spinal
cord injuries can cause priapism. Extremely rare
causes of priapism include drug side effects, but
typically these drugs are not used in children.
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In
adults, priapism either has a known cause or an
unknown cause, in which case it is idiopathic, or
has no identifiable cause.
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Typical
causes in adults include sickle-cell disease, which
accounts for almost a third of all cases. It is
reported that 42 percent of all sickle-cell adults
and 64 percent of all sickle-cell children will
eventually develop priapism.
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The
most common cause of priapism is pharmacological
injection therapy, which far out shadows all
currently known causes.
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Drug-related
priapism includes those drug used to treat psychotic
type illness, including Thorazine and
chlorpromazine. Other more uncommon drugs include
those used to treat high-blood pressure such as
prazosin.
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Rare
causes may also be related to cancers that can
infiltrate the penis and prevent the outflow of
blood.
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| How is it diagnosed? |
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Once
a diagnosis is made, it is extremely important to get prompt
treatment. The diagnosis is not difficult. It is a painful
erection unrelated to sexual stimulation. One of the key
factors in the examination is that the glans is not
tumescent, or swollen.
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| What
are the types of Priapism? |
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Once
priapism and its source have been identified, it is
categorized into two major types:
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Low-flow
priapism or ischemic, which means that little or no
blood flow is getting to the penis and this lack can
cause damage
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High-flow
priapism, which is the result of trauma to the
penis. In this case, there is actually a large
amount of blood flow to the penis.
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The
first step after the careful history and physical
examination is to obtain a blood-gas measurement of
the blood from the penis.
This provides a clue as to
how long the condition has been present and how much
damage has occurred. A small needle is placed in the
penis; some of the blood is aspirated and then sent
to a lab for determination. This will also help
categorize whether the cause of the priapism is low
flow or high flow.
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| How
is Priapism treated? |
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The
goal of all treatment modalities is to make the
erection go away and preserve future erectile
functioning. The faster the erection subsides the
better the outcome.
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The
length of time the erection has been present should
be carefully documented. It is also important to
note what medications the patient has been taking,
including any use of illicit drugs such as
marijuana, which has also been linked to priapism
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It
is also important to get an idea of how long the
erections normally last and if there has been
associated trauma. Following a medical history, a
careful physical examination should reveal a hard
penis with a soft glans.
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It
is also important to check the rectum and the
abdomen for evidence of unusual cancers and the
other causes of priapism.
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If
a patient gets treatment within four to six hours,
the erection can almost always be reduced with
medication. The first step for the patient with
priapism of less than four hours duration is the use
of decongestant medication. These medications
include drugs such as pseudoephedrine and
terbutaline, which may act to decrease blood flow to
the penis and is very successful in early cases.
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If
the erection does not respond, then aspiration is
done. The longer the condition goes without
treatment, the worse the prognosis.
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Once
the blood-gas measurement has been performed and
priapism is determined to be ischemic, or that in
fact the penis has very poor blood flow, then the
old blood is evaluated by aspirating through a small
needle placed directly in a corporal body. This is
done by first cleansing the area, then infiltrating
the local anesthetic over the skin of the penis and
placing the needle. 50-to 150cc of old blood is
withdrawn. This allows the engorged penis to become
flaccid.
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| What
are the complications of priapism? |
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Complications
can occur after treatment of priapism. They are :
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Recurrence
of priapism.
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Impotency
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Bleeding
from the holes placed in penis as part of the
shunting procedure.
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Infections
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Skin
necrosis
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Infection
of the corporal body
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Infection
of skin around the penis
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Damage
and strictures to urethra
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Loss
of penis.
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Pulmonary
embolism - in rare cases.
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| How
is priapism avoided? |
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Best
way to avoid priapism is to be alert. If erections following
penile injections last more than two or three hours, an over
the counter decongestant can be used successfully in many
cases. Most non-urologists have little experience in
treating priapism. Careful history, good examination and a
specialized treatment plan are essential in the successful
management of priapism.
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