Priapism
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Priapism is a persistent erection not caused by sexual stimulation that lasts over 6 hours. It is classified as low-flow or high-flow. Low-flow priapism is more common and painful due to tissue ischemia. Causes include medications, sickle cell disease, and trauma. Treatment involves aspiration of blood from the corpora followed by injection of medications to restore blood flow. If unsuccessful, surgical shunting procedures may be required to prevent erectile dysfunction. High-flow priapism is less common and usually painless due to direct arterial inflow. Treatment involves embolization of arteries to resolve the erection. Untreated low-flow priapism can lead to permanent erectile dysfunction.
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Priapism
Priapism is a prolonged, often painful erection unrelated to sexual stimulation. The document defines and discusses the types, causes, pathophysiology, epidemiology, and treatment challenges of priapism. Specifically, it distinguishes between ischemic (low-flow) priapism caused by failure of venous outflow, and nonischemic (high-flow) priapism caused by unregulated arterial inflow. Sickle cell disease and medications are common causes and prolonged ischemia can lead to erectile dysfunction due to corporal fibrosis.
Priapism.pptx
1. Priapism is classified as ischemic or non-ischemic based on blood flow and oxygen levels in the corpora cavernosa. Ischemic priapism requires emergency treatment due to hypoxic conditions while non-ischemic can often be managed conservatively.
2. Treatment for ischemic priapism involves aspiration of blood from the corpora cavernosa followed by injection of vasoconstrictors if needed. If unsuccessful, surgical shunting procedures are used to drain blood and reestablish outflow.
3. Non-ischemic priapism does not require emergency intervention as it is caused by arterial inflow without venous leakage. Conservative management is attempted initially using ice or observation
Priaprism
This document discusses Priapism, which is a prolonged and sometimes painful erection that lasts over 4 hours and is unrelated to sexual stimulation. It defines two types, ischemic (low blood flow) and non-ischemic (high blood flow). The case presented is of a 64-year old man who developed an erection after injecting his penis with medications for erectile dysfunction. His priapism was determined to be ischemic based on history and blood gas analysis. He underwent drainage of blood from his penis, injection of the drug phenylephrine, and follow up with urology.
Priapism ppt
Priapism is a prolonged, unwanted erection that continues hours beyond sexual stimulation. There are two main types: ischemic (low-flow) priapism which is painful and involves little blood flow out of the penis, and non-ischemic (high-flow) priapism which is painless and involves an abnormal connection allowing high arterial inflow. Ischemic priapism is a medical emergency requiring aspiration of blood from the penis and injection of medications to induce detumescence within 4-6 hours to prevent permanent erectile dysfunction. Treatment options depend on duration and include aspiration, intracavernosal injections of medications, or surgical shunting if conservative measures fail.
urology.Urethral strictures.(dr.ismaeel)
Urethral strictures can be caused by injury or infection leading to scar tissue formation in the urethra. Common causes include trauma, instrumentation, surgery, and STDs. Presentation includes obstructive voiding symptoms. Diagnosis involves history, exam, and imaging tests. Treatment depends on location and severity but may include dilation, incision, stents, reconstruction, or tissue grafts. Complications can include recurrence, infection, and incontinence if not properly managed.
Priapism.ppt sumit
1) Priapism is a prolonged, painful erection that persists without sexual stimulation. It is caused by a failure of the penis to return to its flaccid state after erection and can lead to permanent erectile dysfunction if not properly treated.
2) There are two main types - low-flow (ischemic/veno-occlusive) priapism which is painful due to a lack of blood flow, and high-flow (non-ischemic) priapism which is usually painless. Low-flow priapism is more common and a medical emergency requiring treatment to prevent tissue damage.
3) Treatment depends on the type of priapism and involves initially aspirating blood
Priapism
This document summarizes information about priapism, beginning with epidemiology and classifications. It describes low-flow (ischemic) priapism and high-flow (non-ischemic) priapism, as well as recurrent priapism. Potential causes and pathophysiology are discussed. Evaluation, management, and treatment options are provided for both ischemic and non-ischemic priapism, including aspiration, injection therapy, and various surgical shunt procedures. Complications of prolonged priapism are also noted.
Priapism
The correct answer is e. Hemodialysis is not associated with high-flow priapism. The other answer choices are all known causes or associations of high-flow priapism.
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Priapism
Priapism is a prolonged, often painful erection unrelated to sexual stimulation. The document defines and discusses the types, causes, pathophysiology, epidemiology, and treatment challenges of priapism. Specifically, it distinguishes between ischemic (low-flow) priapism caused by failure of venous outflow, and nonischemic (high-flow) priapism caused by unregulated arterial inflow. Sickle cell disease and medications are common causes and prolonged ischemia can lead to erectile dysfunction due to corporal fibrosis.
Priapism.pptx
1. Priapism is classified as ischemic or non-ischemic based on blood flow and oxygen levels in the corpora cavernosa. Ischemic priapism requires emergency treatment due to hypoxic conditions while non-ischemic can often be managed conservatively.
2. Treatment for ischemic priapism involves aspiration of blood from the corpora cavernosa followed by injection of vasoconstrictors if needed. If unsuccessful, surgical shunting procedures are used to drain blood and reestablish outflow.
3. Non-ischemic priapism does not require emergency intervention as it is caused by arterial inflow without venous leakage. Conservative management is attempted initially using ice or observation
Priaprism
This document discusses Priapism, which is a prolonged and sometimes painful erection that lasts over 4 hours and is unrelated to sexual stimulation. It defines two types, ischemic (low blood flow) and non-ischemic (high blood flow). The case presented is of a 64-year old man who developed an erection after injecting his penis with medications for erectile dysfunction. His priapism was determined to be ischemic based on history and blood gas analysis. He underwent drainage of blood from his penis, injection of the drug phenylephrine, and follow up with urology.
Priapism ppt
Priapism is a prolonged, unwanted erection that continues hours beyond sexual stimulation. There are two main types: ischemic (low-flow) priapism which is painful and involves little blood flow out of the penis, and non-ischemic (high-flow) priapism which is painless and involves an abnormal connection allowing high arterial inflow. Ischemic priapism is a medical emergency requiring aspiration of blood from the penis and injection of medications to induce detumescence within 4-6 hours to prevent permanent erectile dysfunction. Treatment options depend on duration and include aspiration, intracavernosal injections of medications, or surgical shunting if conservative measures fail.
urology.Urethral strictures.(dr.ismaeel)
Urethral strictures can be caused by injury or infection leading to scar tissue formation in the urethra. Common causes include trauma, instrumentation, surgery, and STDs. Presentation includes obstructive voiding symptoms. Diagnosis involves history, exam, and imaging tests. Treatment depends on location and severity but may include dilation, incision, stents, reconstruction, or tissue grafts. Complications can include recurrence, infection, and incontinence if not properly managed.
Priapism.ppt sumit
1) Priapism is a prolonged, painful erection that persists without sexual stimulation. It is caused by a failure of the penis to return to its flaccid state after erection and can lead to permanent erectile dysfunction if not properly treated.
2) There are two main types - low-flow (ischemic/veno-occlusive) priapism which is painful due to a lack of blood flow, and high-flow (non-ischemic) priapism which is usually painless. Low-flow priapism is more common and a medical emergency requiring treatment to prevent tissue damage.
3) Treatment depends on the type of priapism and involves initially aspirating blood
Priapism
This document summarizes information about priapism, beginning with epidemiology and classifications. It describes low-flow (ischemic) priapism and high-flow (non-ischemic) priapism, as well as recurrent priapism. Potential causes and pathophysiology are discussed. Evaluation, management, and treatment options are provided for both ischemic and non-ischemic priapism, including aspiration, injection therapy, and various surgical shunt procedures. Complications of prolonged priapism are also noted.
Priapism
The correct answer is e. Hemodialysis is not associated with high-flow priapism. The other answer choices are all known causes or associations of high-flow priapism.
Hypospadias
This document discusses hypospadias, a congenital defect where the urethral opening is on the underside of the penis. It has an incidence of about 1 in 300 male newborns. The document covers the definition, causes, diagnosis, classification, surgical techniques like single-stage and two-stage procedures, timing of surgery, complications and goals of repairing hypospadias. It analyzes the demographics, procedures and complications from cases at the author's medical center, finding the most common were fistulas, meatal stenosis and neourethral strictures, and emphasizes the high technical difficulty and complication rates of hypospadias surgery.
Priapism 2015
1) Priapism is defined as an erection lasting over 4 hours without sexual stimulation and can be caused by various medical conditions and medications.
2) It is classified as either ischemic (low blood flow) or non-ischemic (high blood flow) and ischemic priapism can lead to tissue damage due to acidosis and hypoxia if not properly treated.
3) Treatment depends on whether it is ischemic or non-ischemic, with ischemic priapism requiring drainage of blood from the penis and non-ischemic often resolving with observation or minimally invasive procedures.
Penis priapism
This document provides information about the department of urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, including lists of moderators and professors. It then discusses the history, physiology, definition, subtypes, etiology, examination, investigations, and treatment of priapism. The treatment section focuses on approaches for ischemic vs non-ischemic priapism, including aspiration, drug injection, surgical shunting, and arterial embolization. Outcomes and algorithms for treatment are also presented.
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Priapism
Priapism is an abnormal, persistent erection unrelated to sexual stimulation. There are two types - low-flow (ischemic) and high-flow (non-ischemic). Low-flow priapism is more common and results from failure of venous outflow, trapping blood in the penis. If not treated promptly, it can lead to fibrosis and erectile dysfunction. Causes include sickle cell disease, medications, and trauma. Treatment involves differentiating the type and using medical or surgical methods to resolve the erection like irrigation, drugs, or shunt placement. Prognosis depends on duration, with early intervention providing the best chance of functional recovery.
Management of stricture urethra
This document discusses the management of urethral strictures. It defines urethral strictures and describes their etiology, including congenital causes and acquired causes like infection, inflammation, trauma, and iatrogenic factors. Treatment options for urethral strictures include instrumentation methods like dilation and internal urethrotomy as well as open reconstruction techniques like excision and anastomosis or substitution urethroplasty using grafts or flaps. The document provides details on various surgical techniques and factors that influence treatment outcomes.
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Urinary Bladder anomalies congenital
The document describes the embryological development of the urinary tract and various congenital anomalies that can occur. It discusses the formation of the urogenital sinus, cloaca, trigone, and bladder. It then categorizes and describes anomalies in number (agenesis, duplication), size (hypoplasia, megacystis), and form (exstrophy epispadias complex, diverticula, fistulas). Specific anomalies like complete duplication, sagittal septum, and classic bladder exstrophy are explained in detail.
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This document discusses ureteroceles, which are cystic dilations of the distal ureter that may be associated with defects in ureteral maturation. Ureteroceles can be intravesical, extending into the bladder, or extravesical/ectopic, extending beyond the bladder neck. They are usually associated with the upper renal moiety in a duplex system. Clinical presentations include infections, incontinence, pain, or being found incidentally. Diagnostic imaging includes ultrasound, IVU, VCUG, nuclear medicine scans, and cystoscopy. Management goals are preserving renal function, eliminating obstruction/reflux, and continence. Treatment depends on individual factors and may include observation, acute decomp
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Bladder outlet obstruction
This document discusses bladder outlet obstruction (BOO) and its causes such as benign prostatic hyperplasia (BPH). It describes the primary and long term effects of BOO on the bladder, including decreased urinary flow rates and increased voiding pressures. For BPH, it notes the causes include hyperplasia of the prostate gland that typically begins in the third decade. The document outlines the diagnosis, evaluation and treatment of BOO, including medical management with medications like alpha blockers and 5-alpha reductase inhibitors, as well as surgical treatments like transurethral resection of the prostate (TURP).
Urethral Tramua
Urethral injuries can be caused by blunt trauma such as motor vehicle accidents or falls, or penetrating injuries near the urethra. Injuries are classified as either posterior injuries involving the membranous or prostatic urethra, often associated with pelvic fractures, or anterior injuries distal to the membranous urethra from blunt perineal trauma. Diagnosis involves retrograde urethrography to detect extravasation of contrast at the injury site. Treatment depends on injury location and patient stability, often initially involving suprapubic catheter placement, with delayed repair of posterior injuries once hematomas resolve and associated injuries stabilize. Proper early management can lead to good long-term outcomes while
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This document provides an overview of the principles of managing hypospadias. It discusses the history of hypospadias management from the first descriptions by ancient surgeons to modern techniques. It also covers the embryology, incidence, classification, complications and management of hypospadias. The history section outlines key developments in hypospadias repair techniques from the 19th century to present day. It shows how techniques have evolved from early amputation procedures to modern one-stage repairs using local skin flaps or grafts.
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The document provides tips for using a PowerPoint presentation (PPT) for active learning sessions on medical topics. It recommends:
1) Freely editing, modifying, and adding your name to the PPT.
2) Noting that half the slides are blank except for the title to elicit student responses.
3) Showing blank slides, asking students what they know, and then showing the content slide.
4) Repeating this process of blank slide + student response + content slide at the end for reinforcement.
5) This active learning approach can be repeated over three sessions for effective learning.
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This document provides an overview of obstructive uropathy. It begins by defining obstructive uropathy as the functional or anatomic obstruction of urine flow at any level of the urinary tract. It then discusses the prevalence of obstructive uropathy and how it can be classified based on factors like duration and site of obstruction. Potential causes of obstructive uropathy are then reviewed for different parts of the urinary tract. The pathophysiology and hemodynamic changes that occur with obstruction are explained. Cellular and molecular changes that can lead to fibrosis and tubular cell death are described. Management of patients is discussed including diagnostic imaging, issues in patient care like hypertension and pain management, and considerations for surgical intervention.
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The document describes urodynamic evaluation (UDE) performed in the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides an introduction to UDE. It then describes the various components of UDE including uroflowmetry, cystometry, pressure flow studies and videourodynamics. It outlines the procedure for setting up and performing UDE, and analyzes storage and voiding phases and parameters measured.
Hypospadias
The document discusses various topics related to hypospadias including:
1) The embryology of penile development and role of androgens and 5α-Reductase.
2) Diagnosis and classification of hypospadias and chordee.
3) Timing of hypospadias surgery, typically between 6-12 months.
4) Preoperative hormonal stimulation to increase penile size for proximal cases.
Priapism
The document discusses priapism, beginning with definitions and epidemiology. It then covers etiology, natural history, pathology, pathophysiology, classification, diagnosis, treatment, and complications of priapism. The key points are that priapism can be ischemic (low flow) or nonischemic (high flow) and treatment involves relieving the ischemia through aspiration or shunting for ischemic priapism or selective arterial embolization for nonischemic priapism.
Priapism
Penile erection begins with relaxation of smooth muscle in the penis which increases blood flow in and decreases flow out. Nitric oxide plays a role in prolonged erections known as priapism. Medications that inhibit an enzyme called PDE can prevent breakdown of cGMP and block the effects of nitric oxide, thereby inhibiting smooth muscle relaxation in the penis.
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Hypospadias
This document discusses hypospadias, a congenital defect where the urethral opening is on the underside of the penis. It has an incidence of about 1 in 300 male newborns. The document covers the definition, causes, diagnosis, classification, surgical techniques like single-stage and two-stage procedures, timing of surgery, complications and goals of repairing hypospadias. It analyzes the demographics, procedures and complications from cases at the author's medical center, finding the most common were fistulas, meatal stenosis and neourethral strictures, and emphasizes the high technical difficulty and complication rates of hypospadias surgery.
Priapism 2015
1) Priapism is defined as an erection lasting over 4 hours without sexual stimulation and can be caused by various medical conditions and medications.
2) It is classified as either ischemic (low blood flow) or non-ischemic (high blood flow) and ischemic priapism can lead to tissue damage due to acidosis and hypoxia if not properly treated.
3) Treatment depends on whether it is ischemic or non-ischemic, with ischemic priapism requiring drainage of blood from the penis and non-ischemic often resolving with observation or minimally invasive procedures.
Penis priapism
This document provides information about the department of urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, including lists of moderators and professors. It then discusses the history, physiology, definition, subtypes, etiology, examination, investigations, and treatment of priapism. The treatment section focuses on approaches for ischemic vs non-ischemic priapism, including aspiration, drug injection, surgical shunting, and arterial embolization. Outcomes and algorithms for treatment are also presented.
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This document discusses urethral stricture disease, including its definition, risk factors, presentation, diagnosis, and various treatment options. It provides details on endoscopic treatments like dilation and urethrotomy, as well as surgical options like urethroplasty repairs using grafts, flaps, and anastomoses. Five case examples are presented and management options discussed. Key points covered include techniques for anastomotic repairs, the use of buccal mucosa grafts, and monitoring after treatment. Current controversies regarding urethroplasty utilization and outcomes are also noted.
Priapism
Priapism is an abnormal, persistent erection unrelated to sexual stimulation. There are two types - low-flow (ischemic) and high-flow (non-ischemic). Low-flow priapism is more common and results from failure of venous outflow, trapping blood in the penis. If not treated promptly, it can lead to fibrosis and erectile dysfunction. Causes include sickle cell disease, medications, and trauma. Treatment involves differentiating the type and using medical or surgical methods to resolve the erection like irrigation, drugs, or shunt placement. Prognosis depends on duration, with early intervention providing the best chance of functional recovery.
Management of stricture urethra
This document discusses the management of urethral strictures. It defines urethral strictures and describes their etiology, including congenital causes and acquired causes like infection, inflammation, trauma, and iatrogenic factors. Treatment options for urethral strictures include instrumentation methods like dilation and internal urethrotomy as well as open reconstruction techniques like excision and anastomosis or substitution urethroplasty using grafts or flaps. The document provides details on various surgical techniques and factors that influence treatment outcomes.
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The document discusses circumcision procedures for children at Ramayya Pramila Urology Hospital. The hospital applies dressings after circumcision that disconnect automatically within a few hours, making the postoperative recovery painless. Children are usually back to normal within 24 to 48 hours after the procedure due to the hospital's superior and compassionate care.
Urinary Bladder anomalies congenital
The document describes the embryological development of the urinary tract and various congenital anomalies that can occur. It discusses the formation of the urogenital sinus, cloaca, trigone, and bladder. It then categorizes and describes anomalies in number (agenesis, duplication), size (hypoplasia, megacystis), and form (exstrophy epispadias complex, diverticula, fistulas). Specific anomalies like complete duplication, sagittal septum, and classic bladder exstrophy are explained in detail.
Ureterocele,
This document discusses ureteroceles, which are cystic dilations of the distal ureter that may be associated with defects in ureteral maturation. Ureteroceles can be intravesical, extending into the bladder, or extravesical/ectopic, extending beyond the bladder neck. They are usually associated with the upper renal moiety in a duplex system. Clinical presentations include infections, incontinence, pain, or being found incidentally. Diagnostic imaging includes ultrasound, IVU, VCUG, nuclear medicine scans, and cystoscopy. Management goals are preserving renal function, eliminating obstruction/reflux, and continence. Treatment depends on individual factors and may include observation, acute decomp
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Presentation covering hypospadias, epispadias and bladder exstrophy, basic embryology, developmental defects, management principles, surgical techniques and associated complications.
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This document provides an overview of bladder anatomy, function, and bladder outlet obstruction. It describes the key parts of the bladder including relations to other organs. Normal micturition and factors that assist storage are explained. Causes of bladder outlet obstruction include anatomical and functional issues. Common symptoms include hesitancy, weak stream, and urinary tract infections. Investigations help locate the site of obstruction and assess kidney and bladder function.
Bladder outlet obstruction
This document discusses bladder outlet obstruction (BOO) and its causes such as benign prostatic hyperplasia (BPH). It describes the primary and long term effects of BOO on the bladder, including decreased urinary flow rates and increased voiding pressures. For BPH, it notes the causes include hyperplasia of the prostate gland that typically begins in the third decade. The document outlines the diagnosis, evaluation and treatment of BOO, including medical management with medications like alpha blockers and 5-alpha reductase inhibitors, as well as surgical treatments like transurethral resection of the prostate (TURP).
Urethral Tramua
Urethral injuries can be caused by blunt trauma such as motor vehicle accidents or falls, or penetrating injuries near the urethra. Injuries are classified as either posterior injuries involving the membranous or prostatic urethra, often associated with pelvic fractures, or anterior injuries distal to the membranous urethra from blunt perineal trauma. Diagnosis involves retrograde urethrography to detect extravasation of contrast at the injury site. Treatment depends on injury location and patient stability, often initially involving suprapubic catheter placement, with delayed repair of posterior injuries once hematomas resolve and associated injuries stabilize. Proper early management can lead to good long-term outcomes while
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This document provides an overview of the principles of managing hypospadias. It discusses the history of hypospadias management from the first descriptions by ancient surgeons to modern techniques. It also covers the embryology, incidence, classification, complications and management of hypospadias. The history section outlines key developments in hypospadias repair techniques from the 19th century to present day. It shows how techniques have evolved from early amputation procedures to modern one-stage repairs using local skin flaps or grafts.
Urinary bladder trauma.pptx
The document provides tips for using a PowerPoint presentation (PPT) for active learning sessions on medical topics. It recommends:
1) Freely editing, modifying, and adding your name to the PPT.
2) Noting that half the slides are blank except for the title to elicit student responses.
3) Showing blank slides, asking students what they know, and then showing the content slide.
4) Repeating this process of blank slide + student response + content slide at the end for reinforcement.
5) This active learning approach can be repeated over three sessions for effective learning.
Urologic symptoms and examination
Urological symptoms can involve pain, changes to urination, changes in urine appearance, or abnormalities of the male genitalia. A complete history divides into chief complaint, history of present illness, past medical history, family history, and review of systems. Physical exam includes inspection and palpation of the abdomen with specific examination of the kidneys, bladder, and genitalia. Common urological complaints involve sites of pain, irritative urinary symptoms, obstructive symptoms, incontinence, hematuria, and sexual or genital abnormalities.
Obstructive uropathy
This document provides an overview of obstructive uropathy. It begins by defining obstructive uropathy as the functional or anatomic obstruction of urine flow at any level of the urinary tract. It then discusses the prevalence of obstructive uropathy and how it can be classified based on factors like duration and site of obstruction. Potential causes of obstructive uropathy are then reviewed for different parts of the urinary tract. The pathophysiology and hemodynamic changes that occur with obstruction are explained. Cellular and molecular changes that can lead to fibrosis and tubular cell death are described. Management of patients is discussed including diagnostic imaging, issues in patient care like hypertension and pain management, and considerations for surgical intervention.
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This document discusses undescended testis (cryptorchidism). It provides definitions of key terms like cryptorchidism, retractile testis, and vanishing testis. It discusses the epidemiology, including a prevalence of 1-9% in full term and 1-45% in preterm males. Risk factors include low birth weight and prematurity. Testicular descent occurs in two phases and is influenced by hormones like testosterone and INSL3. Clinical features may include absence of one or both testes or groin swelling. Diagnosis involves careful examination in different positions and confirmation of incomplete descent under anesthesia. Treatment involves orchidopexy surgery before age 1 to lower cancer risk.
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The document describes urodynamic evaluation (UDE) performed in the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides an introduction to UDE. It then describes the various components of UDE including uroflowmetry, cystometry, pressure flow studies and videourodynamics. It outlines the procedure for setting up and performing UDE, and analyzes storage and voiding phases and parameters measured.
Hypospadias
The document discusses various topics related to hypospadias including:
1) The embryology of penile development and role of androgens and 5α-Reductase.
2) Diagnosis and classification of hypospadias and chordee.
3) Timing of hypospadias surgery, typically between 6-12 months.
4) Preoperative hormonal stimulation to increase penile size for proximal cases.
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Penile erection begins with relaxation of smooth muscle in the penis which increases blood flow in and decreases flow out. Nitric oxide plays a role in prolonged erections known as priapism. Medications that inhibit an enzyme called PDE can prevent breakdown of cGMP and block the effects of nitric oxide, thereby inhibiting smooth muscle relaxation in the penis.
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Priapism
- 2. Definition • persistent erection not accompanied by sexual desire or stimulation • > 6 hours • Corpora cavernosa only • all age groups (including newborns) • peak incidence 20 to 50yrs • younger age group assoc with sickle cell • usually pain (except in non-ischaemic type)
- 3. Classification • Low flow or Ischaemic (veno-occlusive) – most common – Painful sec to tissue ischaemia and smooth muscle hypoxia (compartment syndrome) • Nonischaemic (arterial) – less common – upregulated cavernous inflow – usually not fully erect and painless
- 4. Low-flow priapism • Low flow or Ischaemic (veno-occlusive) – most common – Penis fully erect (sludging of blood within) – Painful tissue ischaemia and smooth muscle hypoxia (compartment syndrome) – blood gases from corpora - acidosis ↓ NO & prostacyclin – platelet aggregation and adhesion - thrombus formation and tissue damage
- 5. Causes of low-flow priapism • Intracavernosal pharmacotherapy – 21% of cases of priapism – extremely low incidence with oral agents • Drugs – cocaine, heparin withdrawal, trazadone, phenothiazines
- 6. Causes of low-flow priapism • Hyperviscosity syndromes (sickle-cell disease) – 28% of all cases of priapism (most common cause in children) – 42% incidence in adults with sickle-cell disease – 64% incidence in boys with sickle-cell disease – also affects with sickle-cell trait • Other haemoglobinopathies – thrombophilia – “stutter priapism” • Recurrent episodes of priapism can result in enlarged penis, fibrotic corpora and ED
- 7. Causes of low-flow priapism • Neurological causes – rare – lumbar disc lesions, spinal stenosis, seizure disorders, cerebrovascular disease • Post Trauma – perineum, groin or penis usually cause high flow priapism but can cause low flow sec to haematoma • Solid Tumours – malignant infiltration of corpora • Miscellaneous – TPN, amyloid
- 8. High-flow priapism • Nonischaemic (arterial) – less common – Penile, perineal or pelvic trauma – uncontrolled arterial inflow directly into the penile sinsoidal spaces – usually penis not fully erect and painless – often prolonged history – normal local blood gases – no risk of ischaemia and subsequent fibrosis
- 9. Causes of High-flow priapism • Trauma • Very rarely sickle-cell disease
- 10. Management of Priapism • Urological emergency • Treat causal factor where identified • goal is to abort the erection, thereby preventing permanent damage to the corpora (ED) and to relieve pain. • Longer duration implies greater risk of impotence • principle is to restore arterial inflow and venous outflow • clinical history and drug history • glans and corpus spongiosum rarely involved • urinalysis • haemoglobin S to outrule leukaemia • ? Local blood gas measurments • colour doppler ultrasonography
- 11. Medical management of low-flow priapism • aspiration of the corpora with a 21G butterfly needle followed by an injection of phenylephrine (α1 adrenergic agonist) every 5 minutes until detumescence – 10mg/ml phenylephrine in 19mls saline – 100% effective if within 12 hours • Oral terbutaline (β-adrenoceptor agonist) - 5-10mg – at best 36% response • Sickle-cell - prompt and conservative as it recurs – hydration, oxygenation, metabolic alkalinization – aspiration and injection (as above) • Stuttering priapism – self injection of α-adrenergic agent if sexually active (prophylactic digoxin) or oral α-adrenergic agent (Etilefrine) – antiandrogen if not to suppress nocturnal tumescence
- 12. Surgical management of low- flow priapism • Winter procedure using a Trucut needle – create a shunt between glans and corpora cavernosa • Ebbehoj procedure using a pointed scalpel blade • El-Ghourab procedure – excision of a piece of tunica albuginea • 30% of above techniques fail – direct cavernosal-spongiosum anastomosis – corpora-saphenous shunt
- 13. Management of High-flow priapism • Ice pack → arterial spasm • ?? spontaneous thrombosis • Most cases require arteriography and embolisation of the internal pudendal artery or a branch
- 14. Complications • Untreated low-flow priapism leads to corporal fibrosis and impotence • early complications: – acute hypertension, headache, palpitations, arythmias – bleeding, haematoma, infection and urethral injury • late complications: – fibrosis and impotence – related to duration of priapism and aggressivness of treatment – low-flow : high incidence of ED if not treated within 12 hours – high flow : good prognosis (20% rate of ED)