Priapism
Rosalind Oakes
7TH May 2015
 Son of Zeus and Aphrodite
 Cursed by Hera (Zeus’ wife) whilst Aphrodite was
pregnant to have oversized genitalia
 Reje...
 Persistent erection (>4hrs duration) not associated with
sexual desire
 Relatively rare: 0.73 per 100,000 men per year
...
 ‘Compartment syndrome of the penis’
 characterized by little or no cavernous blood flow
 Relaxation of the smooth musc...
 Unknown
 Intra corporeal injections in patients undergoing
treatment for erectile dysfunction (25%)
 Drugs: heparin, c...
 Unregulated cavernous arterial inflow
 Due to trauma to the perineum or penis e.g. rupture
the cavernous artery or a br...
 1345 on a Thursday
 Cat 2
 64 year old man with erection since since 2200 last
night.
Case
 Duration of erection
 Prior episodes
 Medications
 Use of recreational drugs
 History of haematological disease, esp...
 64 year old presenting at 1345
 At 2200 injected penis with a combination of
phentolamine (non selective alpha antagoni...
 History
 ISCHAEMIC
 typically presents with a painful and rigid erection
 Cavernosal blood gas analysis : hypoxemia, ...
Management
PO Analgesia + Dorsal nerve
block
Aspirate +/- irrigate
Phenylephrine up to 1mg
Surgical shunt
Aspiration / injection sites
Aspiration
Insert 19 G butterfly needle at 3
or 9 o’clock position proximally.
Direct needle toward centre.
You may need t...
Irrigation + Aspiration
Haematoma can form within the
cavernosa especially in prolonged
cases. Inject normal saline proxim...
 Sympathomimetics induce contraction of the
cavernous smooth muscle permitting venous outflow.
 Inject 1-2 mL of the 100...
 Dorsal penile block
 30 – 40mls of blood drained
 300mcg phenylephrine injected
 Gas pH 7.140, pCO2 73.1, P02 25.7, L...
 http://www.scancrit.com/2014/04/28/seriously-
let%C2%B4s-talk-erections/
 https://www.auanet.org/education/guidelines/p...
Priaprism
Priaprism
of 19

Priaprism

Priaprism
Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Priaprism

  • 1. Priapism Rosalind Oakes 7TH May 2015
  • 2.  Son of Zeus and Aphrodite  Cursed by Hera (Zeus’ wife) whilst Aphrodite was pregnant to have oversized genitalia  Rejected by Aphrodite and cast down to earth and raised amongst shepherds who noticed that flowers would bloom in his presence  God of fertility and horticulture Priapus
  • 3.  Persistent erection (>4hrs duration) not associated with sexual desire  Relatively rare: 0.73 per 100,000 men per year  Classified into ischaemic (low flow) and non ischaemic (high flow)  Ischaemic is more common and is a urological emergency as causes progressive fibrosis of the cavernosal tissues and erectile dysfunction  Any age but bimodal between 5 and 10 years in children and 20 to 50 years in adults Definition & Incidence
  • 4.  ‘Compartment syndrome of the penis’  characterized by little or no cavernous blood flow  Relaxation of the smooth muscle of cavernosal tissue leads to increased inflow and decreased venous outflow  Intracorporal pressure rises to mean arterial pressure, the inflow of blood ceases. Ischaemic type: Pathophysiology
  • 5.  Unknown  Intra corporeal injections in patients undergoing treatment for erectile dysfunction (25%)  Drugs: heparin, cocaine, phenothiazines  Sickle cell disease (most common cause in children) Aetiology: Ischaemic type
  • 6.  Unregulated cavernous arterial inflow  Due to trauma to the perineum or penis e.g. rupture the cavernous artery or a branch causing uncontrolled arterial flow  Or due to spinal injury. In SCI there is loss of sympathetic input to the pelvic vasculature.. causing increased parasympathetic input and uncontrolled arterial inflow. Lesion can be anywhere in the cord. Aetiology: Non-ischaemic or high flow type
  • 7.  1345 on a Thursday  Cat 2  64 year old man with erection since since 2200 last night. Case
  • 8.  Duration of erection  Prior episodes  Medications  Use of recreational drugs  History of haematological disease, especially sickle cell anaemia  Penile or perineal trauma  Presence and severity of pain History
  • 9.  64 year old presenting at 1345  At 2200 injected penis with a combination of phentolamine (non selective alpha antagonist) and papaverine  Erection since 2200 and painful since morning  PMH  TURP with resultant erectile dysfunction  One previous episode of priapism which had resolved with analgesia Case
  • 10.  History  ISCHAEMIC  typically presents with a painful and rigid erection  Cavernosal blood gas analysis : hypoxemia, hypercarbia, and acidemia  NON ISCHAEMIC  erection that is less painful and usually less than fully rigid  Blood gases: arterial – mixed venous  Doppler ultrasonography Ischaemic or Non Ischaemic?
  • 11. Management PO Analgesia + Dorsal nerve block Aspirate +/- irrigate Phenylephrine up to 1mg Surgical shunt
  • 12. Aspiration / injection sites
  • 13. Aspiration Insert 19 G butterfly needle at 3 or 9 o’clock position proximally. Direct needle toward centre. You may need to actively aspirate using a syringe and straight needle.
  • 14. Irrigation + Aspiration Haematoma can form within the cavernosa especially in prolonged cases. Inject normal saline proximally and aspirate distally.
  • 15.  Sympathomimetics induce contraction of the cavernous smooth muscle permitting venous outflow.  Inject 1-2 mL of the 100 μg/mL phenylephrine solution into each corpora using the same needle as for blood aspiration. Max dose is 1000μg (1mg)  Beware possible sympathomimetic side effects : acute hypertension, headache, reflex bradycardia, tachycardia, palpitations, and cardiac arrhythmia. Phenylephrine 1%
  • 16.  Dorsal penile block  30 – 40mls of blood drained  300mcg phenylephrine injected  Gas pH 7.140, pCO2 73.1, P02 25.7, Lac 9.1  Follow up within 24 hours with urology Case
  • 17.  http://www.scancrit.com/2014/04/28/seriously- let%C2%B4s-talk-erections/  https://www.auanet.org/education/guidelines/priapis m.cfm  http://emedicine.medscape.com/article/115710- overview#a15  Uptodate References

Related Documents