Priapism is an unwanted and prolonged erection of the penis, which can cause irreversible damage.
The diagnosis of priapism itself is quite evident: the penis appears erect, very rigid in the case of ischemic priapism, and does not relax despite the absence of sexual activity. The man with priapism can be very restless about the pain. The difference with a normal erection is that in priapism the glans and the spongy body can remain flaccid.
It is very important to determine whether priapism is ischemic or non-ischemic. If there are doubts about whether it is one type or another, a blood gas analysis of the cavernous blood can be performed. If the erection has lasted more than four hours, blood is drawn from one of the cavernous bodies with a very fine needle to minimize trauma. It is enough with 3-5 ml of blood, which will then be analyzed in a gasometer.
A blood test can also be performed. In hematological diseases such as sickle cell disease, thalassemia, or leukemia, there are usually alterations in the counting of blood cell numbers, or alterations in the shape of red blood cells. It would also be important to perform coagulation tests. Doppler ultrasound may be used instead of blood analysis of the cavernous bodies.
It is considered that ischemic priapism is a medical emergency, and requires rapid and early treatment by a specialist in urology to solve the problem quickly and avoid long-term sequelae in the form of erectile dysfunction. In addition to the specific treatment, analgesics, including opioids, should be given if the pain is very intense.
It can be expected at most until 3-4 hours of evolution to see if the priapism goes away on its own, but no more because of the risk of sequelae. The treatment of priapism that has an evolution of fewer than 4-6 hours can be done with the decompression of the cavernous bodies by aspiration (with or without irrigation with serum) of 5 ml of blood, and then administer an intracavernous injection of a sympathomimetic drug as phenylephrine. The injection of the drug is done every 3-5 minutes until resolution, or for one hour.
What Is The Surgery For Priapism?
If the treatment with aspiration and injection of sympathomimetics is not effective, the next step would be surgical treatment, creating a fistula (abnormal connection or channel between organs, vessels or tubes) between the cavernous bodies and the spongy, the glans, or one of the veins of the penis. In patients who have a long-term priapism (more than 48-72 hours), surgery can be performed and in the same act place a penile prosthesis, because it is assumed that patients will not recover erectile function.
In addition to the treatment of priapism itself, the disease that caused it must be treated. Specifically in the case of recurrent priapism is important to avoid repeated episodes to be increasingly intense. It is important to diagnose the cause in order to treat it properly, not only the priapism itself, which does not stop being a symptom of very serious illnesses.
On the other hand, non-ischemic priapism is not an emergency situation. It can resolve spontaneously in a few hours or a few days. If after a while it is not finished solving, arteriography and embolization of the fistula that produces the clinical presentation can be performed. Other times surgery may be necessary. In these cases, the aspiration and the sympathomimetic drugs injected are not useful.
Prevention of Priapism
There are many forms of priapism that cannot be avoided while in others cases are convenient not to consume drugs or inject substances without medical indication in the penis. Avoiding the consequences of priapism is the most important once it is presented. Therefore, if the penis has a painful, unwanted erection, and it does not resolve itself, it should be consulted in the emergency room without delay.
Conclusion
The majority of patients respond to the treatment offered by urologists, but in the aforementioned cases it is necessary to perform shunt surgeries or arterial embolization of the fistula to achieve detumescence, which is the physiological process of recoil of blood congestion. It can be the emptying of the cavernous bodies of the penis, with the consequent loss of erection.
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