Priapism

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Priapism

  1. 1. MAHAR NAVEED SARWAR RESIDENT UROLOGIST WARD # 19, JPMC
  2. 2.  25 years old male no known comorbids, presented to us in emergency with c/o  Painful sustained erection for 2 days Erection was spontaneous and severely painful. it did not relieved with analgesics There was no history of trauma to genitelia No significant drug history No significant addiction history There was past history of splenomegaly
  3. 3.  Young male of average height and built, well oriented to time person and placeVitals:•Pulse = 97/min•B.P = 120/90mmhg•R/R = 18/min•Temp = 98.6⁰F Sub-vitals: Anemia = absent Jaundice = absent Cyanosis = absent Clubbing = absent Dehyd: = absent L/Nodes = N/P Edema = absent
  4. 4.  Abdominal examination: ◦ Spleen was palpable 3 finger breadth below the level of umbilicus ◦ Rest of the examination was unremarkable Local examination: ◦ Fully erect, congested and mildly tender penis ◦ No sign of trauma
  5. 5.  Hb = 12.4 gm% PLT = 449000 TLC = 161000 Myelocytes = 07% Promyelocytes = 14% Na+ = 135 K+ = 4.2 U = 35 Cr = 0.9
  6. 6.  Under G.A clotted dark blood aspirated from cavernosa distal shunts created between corpora cavernosa and corpus spongiosum Phenylephrine injected into the corpora until penis became flaccid Next morning pt shifted to Oncology for the management of leukemia.
  7. 7.  DEFINATION: ◦ Priapism is a full or partial erection that continues more than 4 hours beyond sexual stimulation and orgasm or is unrelated to sexual stimulation TYPES: ◦ LOW FLOW(ISCHEMIC): ◦ HIGH FLOW(NONISCHEMIC)
  8. 8.  Common than non-ischemic Results from veno-occlusion Its rigid and very painful Blood flow will be decreased Blood in cavernosa will show hypoxia,hypercarbia and acidosis
  9. 9.  Its post traumatic Unregulated arterial blood flow Semi-rigid and painless erection Cavernosal blood shows arterial values
  10. 10.  Itracorporal injection therapy ◦ PGE ◦ Papavarin Thromboembolism ◦ Sickle cell disease ◦ Leukemia ◦ Fat emboli Drugs TPN Alcohol intoxication Recreational therapy e.g.: cocaine Malignant infiltration of cavernosa Infection ◦ Malaria, rabies, scorpion sting Neurogenic causes ◦ Spinal Cord lesions ◦ Autonomic neuropathy ◦ Anesthesia
  11. 11.  Detailed history (specially past medical history) Examination Investigation ◦ Full blood count and peripheral blood films ◦ ABGs of aspirated cavernous blood  Ischemic priapism  hypoxia,hypercarbia and acidosis  Non ischemic priapism  normal arterial or mixed arterial- venous picture ◦ Duplex Doppler ultrasound of penis  Ischemic priapism  Decreased flow  Non ischemic priapism  Increased flow ◦ Urine and serum toxicology
  12. 12.  Decompression by aspiration followed by injection of sympathomimetics into corpora cavernosa Phenylephrine is the drug of choice ◦ Highly α1 selective without β-mediated ionotropic and chronotropic effects ◦ Diluting it in N/S at concentration of 100 to 500 Ug/ml and giving 1ml every 5 minutes ◦ maximum 1mg of Phenylephrine can be injected ◦ Serial monitoring of B.P and Pulse
  13. 13.  Percutanous distal shunts: ◦ Ebbehoj ◦ Winter ◦ T-shunt (Brant) Open distal shunt ◦ Al-Ghorab ◦ Corporal Snake (Burnett) Open proximal shunt ◦ Quackles Saphenous vein ◦ Grayhack ◦ Deep dorsal vein shunt
  14. 14.  Its not an emergency Start expectant management with cool bathing and ice packing  vasospasm and thrombosis Arteriography and selective embolisation of the internal pudendal artery or its branches Ligation of the site of fistulae

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