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UROLOGY

PRIAPISM

PromptCauses of Priapism
ResponseDrugs
  • Anticoagulants
  • impotence agents (Sildenafil, papaverine) ilicit drugs,
  • antihypertensives (prazocin, hydralazine)
  • antipsychotics
Haematologic
  • Sickle cell, spherocytosis, thalasaemia
  • Haematologic malignancy - eg. CML
  • Procoagulant states (Eg: Malaria infection)
Neurologic/neurogenic
  • Spinal cord injury
  • MS
  • Redback spider venom
Metabolic - Gout/amyloidosis
High flow - Fistula (Usually not the emergency “Priapism” we all hear about”
Self-rate:
PromptInvestigations in priapism
ResponseCavernosal blood gas - differentiates ischaemic vs non ischaemic causes of priapism.
  • pH <7.25 = ischaemic
FBC/film - haematologic cause
Biochem - seek causes - CKD, gout, diabetes
Malaria thin and thick films, sickle cell screen
Coags/thrombophilia screen ? clotting disorder
Doppler ultrasound - alternate to blood gas ischaemic vs non ischaemic
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PromptEmergency department management of priapism
ResponsePain relief + anxiolysis - IV opioids, sedation, dorsal penile blocke
Systemic vasoconstrictors - pseudoepherdrine 120 mg PO or terbutaline 0.25-0.5mg SC
Urgent urologic consultation
Cavernosal aspiration - 19-21 ga needle aspirate 20-30 mL blood initially - send for VBG. (+/- saline washout)
Cavernosal injection of vasoconstrictor
  • Dilute adrenaline 1-2mL of 1:100,000 Q5 min max 10 mL
O2 + fluids if sickle cell crisis
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PromptComplications of priapism
ResponseIrreversible erectile dysfunction (Due to penile ischaemia)
Disfiguration of the penis
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PromptPrognosis factors
ResponseDuration of erection
  • Risk of impotence starts at 4h, 50% 24h, 100% 72h
Ischaemic vs non ischaemic
Self-rate:
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