Diagnostic and therapeutic options for the management of ischemic and nonischemic priapism

University of California at Los Angeles Los Angeles, CA.
Reviews in urology 01/2010; 12(1):56-63.
Source: PubMed


Priapism is defined as persistent penile erection continuing beyond, or unrelated to, sexual stimulation. Proper diagnosis encompasses at least 2 very different pathophysiologic processes. Ischemic priapism ("low flow") is a disorder of venous outflow and/or stasis. Nonischemic priapism ("high flow") is a disorder of arterial flow. We present 2 cases that review each condition. The first case highlights a 32-year-old man with a medical history of sickle cell disease who presented to the emergency department complaining of a persistent, painful erection that had continued for 18 hours. The second case describes a 24-year-old man with no significant medical history who sustained trauma to his pelvis while skateboarding. Although the initial evaluation of both types of priapism is similar, pathophysiology and resulting interventions differ for each, underscoring the importance of proper diagnosis.

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    • "Knowing that priapism is rare, practitioners may be unfamiliar with the standard therapeutic treatment plan for priapism. High-flow versus low-flow states may be established by history and physical exam, cavernosal blood gas or color duplex ultrasonography of the penis.11 High-flow priapism is most commonly caused by penile arterial laceration and resultant excessive inflow of arterial blood. "
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    ABSTRACT: Priapism is rarely related to use of non-erectile related medications. The objective was to educate about the multiple possible causes of priapism and to provide treatment recommendations for the different types of priapism. We present the case of a 43-year-old African American male with a history of schizoaffective disorder who presented to our emergency department multiple times over a three year period with priapism, each episode related to the ingestion of quetiapine. Following penile aspiration and intercavernosal injection of phenylephrine, this patient had resolution of his priapism. This case demonstrates an unusual case of recurrent priapism.
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