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Priapism – prolonged and painful erection

Priapism is characterized by a painful and prolonged erection that is the result of blood circulation disorders limited to corpus cavernosum (two columns of erectile tissue of the penis).

Priapism may also be defined as a maximum blood filling of corpus cavernosum which takes over two hours in the absence of sexual stimulation.

Causes

Etiology of priapism is vast. Priapism may occur after ingestion of drugs or may be found in various diseases as clinical sign.

Priapism may occur after administration of the following drugs: chlorpromazine, guanethidine, reserpine, hydralazine, phenothiazines, heparin.

Also a drug priapism can occur after intracavernous injections, particularly papaverine.

Priapism may be a clinical sign of the following conditions:

– Blood disorders – sickle-cell anemia, leukemia, thalassemia;

– Inflammatory diseases – typhoid, malaria, pneumonia, acute articular rheumatism;

– Metabolic diseases – diabetes, gout;

– Thrombosis of penis and small pelvis;

– Tumor of the genital area which may affect the normal blood drainage;

– Spinal or genital region trauma.

Priapism may be the result of alcohol intoxication, drugs (marijuana, cocaine) or carbon monoxide intoxication.

Symptoms

From clinical point of view, priapism is characterized by a progressive and painful erection. At palpation, corpus cavernosum have increased consistency (due to massive blood filling), spongy body (the penis erectile organ, odd and median, is crossed by the urethra) is soft, the glans (the free and rounded part) is soft.

Physiological micturition (the act of urine) is preserved.

Priapism can lead to severe complications such as erectile dysfunction or impotence.

Priapism is a medical-surgery emergency.

Treatment

Treatment options are multiple and must be applied within 4-5 hours to prevent irreversible changes. Therapeutic methods:

– Taking pain killers to combat the pain;

– Injecting in corpus cavernosum drugs like alpha-adrenergic agonists (produce vasoconstriction and thereby reduce the amount of blood to the penis);

– Puncture and aspiration of thrombotic material, then washing with saline solution;

– Creation of a glando-cavernous shunt;

– Creation of a safeno-cavernous shunt.

Prognosis depends on the precocity of diagnosis and promptitude of treatment application. If treatment is delayed there may occur a number of complications as erectile dysfunction or impotence.




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