Priapism

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Priapism

  1. 1. GU Emergencies Priapism July 2004
  2. 2. Priapism <ul><li>Anatomy </li></ul><ul><li>Pathophysiology </li></ul><ul><li>Treatment </li></ul><ul><li>AUA guidelines </li></ul>
  3. 3. Anatomy
  4. 4. Anatomy
  5. 5. Anatomy
  6. 6. Pathophysiology <ul><li>High Flow Priapism </li></ul><ul><ul><li>Results from traumatic injuries to the cavernous arterial system </li></ul></ul><ul><ul><li>Development of arterial-sinusoidal fistula </li></ul></ul><ul><ul><li>May take several days to develop </li></ul></ul><ul><ul><li>Not ischemic </li></ul></ul><ul><ul><li>Treatment observation followed by embolization </li></ul></ul><ul><ul><ul><li>Non permanent materials preferred (clot, gels) </li></ul></ul></ul>
  7. 7. Pathophysiology <ul><li>Low Flow Priapism </li></ul><ul><ul><li>Decreased venous outflow </li></ul></ul><ul><ul><li>Etiologies </li></ul></ul><ul><ul><ul><li>Idiopathic-30-50% of cases </li></ul></ul></ul><ul><ul><ul><li>Sickle cell disease </li></ul></ul></ul><ul><ul><ul><ul><li>Sickling of blood cells and sludging of blood within the corporal sinusoids </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Sludging leads to hypoxia, acidosis, impaired smooth muscle function </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tarry et al (1987)-10% of sickle cell patients develop priapism </li></ul></ul></ul></ul>
  8. 8. Pathophysiology <ul><li>Other Etiologies </li></ul><ul><ul><li>Leukemia-sludging of WBC’s in corpora </li></ul></ul><ul><ul><li>Heparin-abnormal platelet aggregation </li></ul></ul><ul><ul><li>TPN-related to lipid infusion with increased coagulability, distorted erythrocytes, increased RBC aggregation </li></ul></ul><ul><ul><li>Intracavernosal Therapy-most common cause in many ER’s, 1% incidence with alprostadil </li></ul></ul>
  9. 9. Pathophysiology <ul><li>Other Etiologies </li></ul><ul><ul><li>Prescription Drugs </li></ul></ul><ul><ul><ul><li>Trazadone, SSRI’s, hydralazine, guanethidine, alpha blockers, testosterone, sildenafil, FK506 </li></ul></ul></ul><ul><ul><li>Illegal Drugs </li></ul></ul><ul><ul><ul><li>Cocaine, marijauna </li></ul></ul></ul><ul><ul><li>Malignancy </li></ul></ul><ul><ul><ul><li>Bladder, prostate, renal, rectal, penile cancers </li></ul></ul></ul>
  10. 10. Diagnosis <ul><li>CBC </li></ul><ul><li>Reticulocyte count </li></ul><ul><li>Hemoglobin electropheresis </li></ul><ul><li>Psychoactive med screening </li></ul><ul><li>Urine drug screen </li></ul><ul><li>Blood gas </li></ul><ul><li>Duplex ultrasound </li></ul><ul><li>Arteriography </li></ul>
  11. 11. Treatment
  12. 12. Corporal Irrigation <ul><li>“ Grocery List” </li></ul><ul><ul><li>ED suture kit </li></ul></ul><ul><ul><li>Sterile basin </li></ul></ul><ul><ul><li>1% lidocaine </li></ul></ul><ul><ul><li>2 large butterfly needles </li></ul></ul><ul><ul><li>2 60 cc luer lock syringes </li></ul></ul><ul><ul><li>Sterile gloves </li></ul></ul><ul><ul><li>Betadine </li></ul></ul><ul><ul><li>Injectable saline </li></ul></ul><ul><ul><li>1 vial phenylephrine </li></ul></ul><ul><ul><li>TB syringe </li></ul></ul>
  13. 13. Corporal Irrigation <ul><li>Get informed consent </li></ul><ul><li>Monitored bed </li></ul><ul><li>Ancef </li></ul>

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