Priapism
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Basics
Description
- Penile erection (engorgement of corpora cavernosa) in the absence of sexual arousal that is prolonged and frequently painful
- Low-flow priapism:
- Most common mechanism
- Poor venous outflow
- Usually painful
- Ischemia and thrombosis from stagnant, hypoxic blood can occur after a few hours
- Fibrosis and erectile dysfunction are late sequelae
- High-flow priapism:
- Rare
- Penile arterial laceration with uncontrolled inflow of arterial blood
- Usually painless
- Presentation may be later than in low-flow priapism
- Ischemia and erectile dysfunction are uncommon
Etiology
- Idiopathic
- Pharmacologic agents:
- Intracavernosal injectables for the treatment of erectile dysfunction:
- Prostaglandin E1
- Papaverine
- Phentolamine
- Psychotropics:
- Phenothiazines
- Butyrophenones
- Trazodone
- Sedative–hypnotics
- Selective serotonin uptake inhibitors
- Antihypertensives:
- Prazosin
- Hydralazine
- Phenoxybenzamine
- Guanethidine
- Rarely implicated agents:
- Phosphodiesterase inhibitors: Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra)
- Anticoagulants
- Cocaine
- Marijuana
- Ethanol
- Androstenedione
- Toxins (Black Widow, scorpion)
- Intracavernosal injectables for the treatment of erectile dysfunction:
- Hematologic disorders predisposing to sludging of blood:
- Sickle cell anemia (most common cause)
- Leukemia
- Multiple myeloma
- Polycythemia
- Penile and perineal trauma (arterial laceration and high-flow priapism)
- Spinal trauma (loss of inhibitory adrenergic tone)
- Rare causes:
- Pelvic neoplasms and infections
- Infiltrative diseases (e.g., amyloidosis)
- Dialysis
- Parenteral nutrition solutions containing a fat emulsion
Pediatric Considerations
Sickle cell anemia is the cause of most priapism in children
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Basics
Description
- Penile erection (engorgement of corpora cavernosa) in the absence of sexual arousal that is prolonged and frequently painful
- Low-flow priapism:
- Most common mechanism
- Poor venous outflow
- Usually painful
- Ischemia and thrombosis from stagnant, hypoxic blood can occur after a few hours
- Fibrosis and erectile dysfunction are late sequelae
- High-flow priapism:
- Rare
- Penile arterial laceration with uncontrolled inflow of arterial blood
- Usually painless
- Presentation may be later than in low-flow priapism
- Ischemia and erectile dysfunction are uncommon
Etiology
- Idiopathic
- Pharmacologic agents:
- Intracavernosal injectables for the treatment of erectile dysfunction:
- Prostaglandin E1
- Papaverine
- Phentolamine
- Psychotropics:
- Phenothiazines
- Butyrophenones
- Trazodone
- Sedative–hypnotics
- Selective serotonin uptake inhibitors
- Antihypertensives:
- Prazosin
- Hydralazine
- Phenoxybenzamine
- Guanethidine
- Rarely implicated agents:
- Phosphodiesterase inhibitors: Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra)
- Anticoagulants
- Cocaine
- Marijuana
- Ethanol
- Androstenedione
- Toxins (Black Widow, scorpion)
- Intracavernosal injectables for the treatment of erectile dysfunction:
- Hematologic disorders predisposing to sludging of blood:
- Sickle cell anemia (most common cause)
- Leukemia
- Multiple myeloma
- Polycythemia
- Penile and perineal trauma (arterial laceration and high-flow priapism)
- Spinal trauma (loss of inhibitory adrenergic tone)
- Rare causes:
- Pelvic neoplasms and infections
- Infiltrative diseases (e.g., amyloidosis)
- Dialysis
- Parenteral nutrition solutions containing a fat emulsion
Pediatric Considerations
Sickle cell anemia is the cause of most priapism in children
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