Causative and risk factors
Whenever a man is aroused, the blood vessels of the penis relax and expand leading to an increased blood flow to spongy tissues in the penis, which causes the penis to become erect. After the stimulation ends, the blood flows out, and the penis loses its erection and returns to its flaccid state.
Priapism occurs as a result of disturbance to the blood flow caused due to hematological disorder especially sickle cell anemia, leukemia, thalassemia and G6PD deficiency.
Medicines like sildenafil, tadalafil, vardenafil, anti depressant, blood thinners and misuse of alcohol or illegal drugs can also lead to priapism. Injury to spinal cord or genitalia can cause priapism.
Clinical presentation
Priapism can be ischemic (low flow) or non-ischemic (high flow). Ischemic priapism is characterized by a lack of outflow of blood from the penis. In ischemic priapism, the patient experiences an unwanted erection that lasts more than four hours. Sometimes the patient may have an on and off unwanted erection for several hours. The shaft of penis is rigid however tip of penis is soft. Pain and tenderness can be present in the penis. Non-ischemic priapism is characterized by too much blood flow to the penis. In non-ischemic priapism, the penis is erect but not rigid.
Investigations
Priapism can be diagnosed on the basis of the patient history and a physical examination. Certain tests may be advised to detect the cause of priapism. A complete blood count is done and arterial blood gases are measured. Blood and urine tests are performed to detect levels of alcohol or illegal drugs in the system. Color doppler ultrasonography can be done to measure the blood flow within the penis.
Treatment
The intention of the treatment is to stop the erection at the moment and preservation of erectile function in future. Ice and pressure are applied on the perineum in non-ischemic priapism.
Aspiration of blood from the penis is done after numbing the penis with a local anesthetic. Locally injectable medicine is given to constrict blood vessels which supply the penis.
Surgery- A shunt is implanted in the penis in order to normalize the blood flow; surgical ligation is done to tie off the damaged artery. Surgical embolisation is done by inserting a small device to block damaged artery.
Prompt treatment is associated with a good outlook. The longer the treatment is delayed, worse is the prognosis. Complications like erectile dysfunction or disfigurement of the penis may occur.
