GU EmergenciesGU Emergencies

PriapismPriapism

July 2004July 2004

PriapismPriapism

AnatomyAnatomy PathophysiologyPathophysiology TreatmentTreatment AUA guidelinesAUA guidelines

AnatomyAnatomy

AnatomyAnatomy

AnatomyAnatomy

PathophysiologyPathophysiology

High Flow PriapismHigh Flow Priapism Results from traumatic injuries to the cavernous Results from traumatic injuries to the cavernous

arterial systemarterial system Development of arterial-sinusoidal fistulaDevelopment of arterial-sinusoidal fistula May take several days to developMay take several days to develop Not ischemicNot ischemic Treatment observation followed by embolizationTreatment observation followed by embolization

Non permanent materials preferred (clot, gels)Non permanent materials preferred (clot, gels)

PathophysiologyPathophysiology

Low Flow PriapismLow Flow Priapism Decreased venous outflowDecreased venous outflow EtiologiesEtiologies

Idiopathic-30-50% of casesIdiopathic-30-50% of cases Sickle cell diseaseSickle cell disease

Sickling of blood cells and sludging of blood within the corporal Sickling of blood cells and sludging of blood within the corporal sinusoidssinusoids

Sludging leads to hypoxia, acidosis, impaired smooth muscle Sludging leads to hypoxia, acidosis, impaired smooth muscle functionfunction

Tarry et al (1987)-10% of sickle cell patients develop priapismTarry et al (1987)-10% of sickle cell patients develop priapism

PathophysiologyPathophysiology

Other EtiologiesOther Etiologies Leukemia-sludging of WBC’s in corporaLeukemia-sludging of WBC’s in corpora Heparin-abnormal platelet aggregationHeparin-abnormal platelet aggregation TPN-related to lipid infusion with increased TPN-related to lipid infusion with increased

coagulability, distorted erythrocytes, increased RBC coagulability, distorted erythrocytes, increased RBC aggregationaggregation

Intracavernosal Therapy-most common cause in Intracavernosal Therapy-most common cause in many ER’s, 1% incidence with alprostadilmany ER’s, 1% incidence with alprostadil

PathophysiologyPathophysiology

Other EtiologiesOther Etiologies Prescription DrugsPrescription Drugs

Trazadone, SSRI’s, hydralazine, guanethidine, alpha Trazadone, SSRI’s, hydralazine, guanethidine, alpha blockers, testosterone, sildenafil, FK506blockers, testosterone, sildenafil, FK506

Illegal DrugsIllegal Drugs Cocaine, marijaunaCocaine, marijauna

MalignancyMalignancy Bladder, prostate, renal, rectal, penile cancersBladder, prostate, renal, rectal, penile cancers

DiagnosisDiagnosis

CBCCBC Reticulocyte countReticulocyte count Hemoglobin electropheresisHemoglobin electropheresis Psychoactive med screeningPsychoactive med screening Urine drug screenUrine drug screen Blood gasBlood gas Duplex ultrasoundDuplex ultrasound ArteriographyArteriography

TreatmentTreatment

Corporal IrrigationCorporal Irrigation

““Grocery List”Grocery List” ED suture kitED suture kit Sterile basinSterile basin 1% lidocaine1% lidocaine 2 large butterfly needles2 large butterfly needles 2 60 cc luer lock syringes2 60 cc luer lock syringes Sterile glovesSterile gloves BetadineBetadine Injectable salineInjectable saline 1 vial phenylephrine1 vial phenylephrine TB syringeTB syringe

Corporal IrrigationCorporal Irrigation

Get informed consentGet informed consent Monitored bedMonitored bed AncefAncef