Penile Complaints



Penile Complaints





PRIAPISM

Priapism is an abnormally prolonged penile erection (>6 hours) that does not result from sexual desire. It generally involves only the corpora cavernosa and not the spongiosum. It is often associated with pain and difficulty urinating. It can occur at any age and may last for several days to several weeks if left untreated.


Etiology

Priapism can be classified into two distinct types: low-flow (ischemic) veno-occlusive and high-flow (nonischemic) arterial priapism. Low-flow ischemic priapism is secondary to failure of the detumescence mechanism and obstruction of the venous drainage of the corpora cavernosa. Ischemic priapism is associated with acidotic cavernosal blood gases. High-flow priapism is generally the result of trauma that causes laceration or rupture of the cavernous artery within the corpora cavernosa.

Many cases are classified as primary or idiopathic because the etiology is unknown. Other major causes of priapism include drug and alcohol abuse, erectile dysfunction drug therapy, sickle cell disease, neoplastic diseases, and trauma. Drugs that affect the neurovascular or central nervous system can potentially cause priapism. These include psychotropics (e.g., chlorpromazine and trazodone), antihypertensives (especially hydralazine, guanethidine, and prazosin), and alcohol. Anticoagulants (e.g., heparin) have also been associated with cases of priapism. Pharmacologic injection therapy to treat erectile dysfunction, such as intracavernous injection of papaverine or prostaglandin E1, has become the most common cause of priapism.

Sickle cell disease and trait are common etiologies in boys and account for about 10% to 20% of cases overall. Attacks often occur during sleep with sludging of red cells in the corpora cavernosa after a normal physiologic nocturnal erection. It is referred to as stuttering priapism because of its intermittent recurrent pattern.


Neoplastic diseases can obstruct corporal outflow. Leukemias are the most common cause of priapism in boys.

Trauma can result in priapism secondary to hematoma formation and compression of venous drainage or injury to the cavernous artery and high-flow priapism.


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Jun 10, 2016 | Posted by in UROLOGY | Comments Off on Penile Complaints

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