Priapism is defined as penile erection disease that is characterized by its prolongation and by the absence of stimulation or sexual excitement. It usually occurs with a lapse of more than 6 hours and typically involves only the cavernous bodies resulting in the dorsal erection of the penis with flaccid gland and ventral penis.
Some researchers have mentioned time as a criterion to identify this disorder, they have defined in a 4-hour interval, based on clinical experience that has shown that a lapse greater to this one associates serious consequences for sexual function.
Classically this disorder has been divided into two types, very different from each other, with different physiopathological mechanisms and different treatments. There are 2 types of priapism: ischemic or veno occlusive and non-ischemic or arterial. The first represents the most common form of presentation and is more severe, while the non-ischemic one does not represent a urological urgency.
What can Cause Priapism?
The causes of priapism can be primary, secondary or idiopathic. Priapism with primary etiology is not accompanied by an organic disorder that is responsible for the prolonged erection, so in this case physical and psychological causes are indicated. The secondary is induced by factors that directly or indirectly affect the penile erection, for example: sickle cell anemia, leukemia, coagulopathies, and thrombosis of cavernous bodies, among others.
On the other hand, low flow priapism is associated with a severe decrease in the venous drainage of the cavernous bodies. It is usually due to a partial or complete obstruction in the drainage that prevents the entry of arterial blood and generates acidosis and ischemia. It is the most common form of presentation and behaves like a compartment syndrome with excessive pressure increase in the cavernous bodies.
In low flow priapism or occlusive vein, the spectrum of symptoms and signs is analogous to any of those who are in a compartment syndrome.
In high-flow priapism, the cavernous bodies are not completely rigid or painful.
Conclusion
Priapism represents a rare disease, with a relatively low incidence for the general population. However, the early recognition of this disease is of great importance, since it has been seen that fatal consequences for the patient’s sexual life increase the longer the clinical presentation and the later the treatment.
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