Priapism is defined as partial or full erection of the penis, which lasts for more than 4 hours, which is erect in the absence of sexual stimulation or lasts well beyond sexual stimulation and orgasm.
Is Priapism Dangerous?
Priapism is a dangerous condition as it can cause erectile dysfunction and amputation of the penis. Erectile function after priapism depends on the duration of the priapism. If the priapism is treated with 6 hours, erectile function can be preserved without any problem most of the time. Patients, who present within 24 hours with proper medical or surgical treatment, usually achieve a good erectile function (92%). Penile fibrosis usually occurs 48 hours after priapism. When presented after 36 hours, usually doctors recommend going for a penile prosthesis to preserve function as other medical or surgical methods have less results. There have been only few cases where patients had to undergo penile amputation because of a gangrene penis following priapism. Possible cause for this might be infection and unrecognized arterial insufficiency with other risk factors.
Priapism can be quite dangerous for some males. There are few complications associated with priapism. The common and dangerous complication is erectile dysfunction. Early diagnosis and treatment will prevent the complications associated with priapism.
Complications of Priapism
- Erectile dysfunction/impotence.
- Amputation of the penis.
This is the common and one of the serious complications that can affect the quality of life. Since many men presenting with priapism are young males who are in the reproductive age, erectile dysfunction can be a devastating situation for them. Some men are newly wedded and some does not have children. Considering such a situation erectile dysfunction associated with priapism can be a depressing state.
There are two types of priapism the ischemic (low flow) and non-ischemic (high flow) type; 95% of the cases reported are ischemic type hence its more common than the non-ischemic type. Erectile dysfunction is seen more in patients with ischemic priapism. If we look at the pathophysiology of the ischemic priapism briefly, there is an abnormality in the veno-occlusive (venous blood flow) mechanisms, this result in accumulation of deoxygenated blood within the cavernous tissue. This blocks the oxygenation of the healthy erectile tissue as the arterial blood cannot reach the penis. If not treated expeditiously this will cause death of penile cells and scar formation. This will cause erectile dysfunction/impotence.
Duration of Priapism
- This is the single most important factor which the erectile function depends.
- If you are late to present to the hospital after priapism occurs, especially if it is more than 4 to 6 hours. The risk of getting erectile dysfunction increase.
- Most men are reluctant to come to the hospital due to shame and ignorance.
- Even the treatment methods will not be successful if you are late to present to the hospital because by that time the penile tissues are damaged beyond repair, therefore, the medical or surgical treatment methods will not preserve erectile function if the tissue damage is irreversible.
- Patients who present within 24 hours usually have a good erectile function (92%). Penile fibrosis usually occurs 48 hours after priapism.
- If you are very late to present (>36 hours) the doctors usually recommend to have a penile prosthesis as you will have very poor erectile function.
If you get priapism, you should immediately go to the hospital and seek medical advice as this will drastically reduce the risk of getting erectile dysfunction. Time plays an important role in the preservation of erectile function.
Amputation of The Penis
There have been very few cases reported where patients had to undergo penile amputation because of a gangrene penis (dead penis) following surgery for priapism. The cause of the penile gangrene might have been a local infection, unrecognized long term arterial insufficiency which increases the requirement of oxygen and nutrients. This would result in further damage on the already impaired penile blood supply and result in penile ischemia.
Renal insufficiency, diabetes mellitus, coagulopathy, peripheral vascular coagulopathy and surgery are identified as risk factors for penile gangrene.