Two fundamentally different forms
- Ischemic (low-flow) priapism is the most common. Blood does not flow out of the cavernous bodies, oxygen starvation of tissues develops. The penis is hard and painful, the head is soft. This is an emergency
- Non-ischemic (high-flow) priapism - occurs when an artery is damaged, usually after trauma to the perineum or penis. The blood inflow is excessive, but the outflow is preserved. Erection is incomplete and painless. The condition is not an emergency and often resolves on its own
- Intermittent (recurrent) priapism - repeated episodes characteristic of sickle cell anemia; require preventive treatment
Различить формы принципиально важно: при ишемическом приапизме нужна экстренная помощь в первые часы, при неишемическом — наблюдение и плановая тактика. Отличить их помогает анализ газов крови, взятой непосредственно of пещеристых тел, и УЗДГ.
Reasons
- Drugs for the treatment of erectile dysfunction, especially intracavernosal injections, are one of the most common causes of ischemic priapism.
- Sickle cell anemia and other blood diseases: leukemia, thalassemia, myeloma
- Psychotropic drugs: some antidepressants and antipsychotics
- Blood pressure medications and anticoagulants
- Drugs, cocaine, alcohol abuse
- Trauma to the perineum and penis - the cause of the non-ischemic form
- Tumors with invasion or metastases into the penis
- Neurological diseases, spinal cord injuries
- Bites of some insects and spiders are a rare exotic cause
- Idiopathic priapism, when the cause cannot be determined
Why can't you wait?
In the ischemic form, blood stagnates in the cavernous bodies and ceases to supply the tissue with oxygen. A process similar in mechanism to a heart attack develops: smooth muscle cells die and are replaced by connective tissue.
- In the first hours, the changes are reversible, and restoration of function is most likely
- With each hour of delay, the likelihood of maintaining a normal erection decreases.
- With prolonged priapism, fibrosis of the cavernous bodies develops with irreversible erectile dysfunction
- In severe cases, the only option for restoring sexual function is penile prosthesis
- Skin necrosis, infectious complications and deformation of the penis are also possible.
That is why the main message of this section is simple: constraint is too expensive. Treatment in the first hours fundamentally changes the prognosis.
Diagnostics
- Examination and assessment of the nature of the erection: in the ischemic form, the cavernous bodies are hard and painful, the head is soft
- Determination of the gas composition of blood aspirated from the cavernous bodies is the main method for distinguishing forms
- Ultrasound scanning of the vessels of the penis - assessment of blood flow
- Complete blood count, if suspected - testing for sickle cell anemia and other hematological diseases
- Toxicological examination for suspected drugs
- Detailed collection of data on medications taken
- MRI for suspected tumor or thrombosis
Treatment
- Aspiration of blood from the cavernous bodies with washing is the first and most effective step in the ischemic form
- Injection of drugs that constrict blood vessels directly into the cavernous bodies under the control of pressure and pulse
- Pain relief
- Repeated procedures if the effect is insufficient
- Surgical bypass - creating a connection between the cavernous bodies and other vascular structures for the outflow of blood; used when conservative measures are ineffective
- Early penile replacement for long-term priapism with already developed fibrosis is considered as a way to maintain the possibility of sexual activity
- In the non-ischemic form - observation, cold, compression; if preserved - embolization of the damaged artery
- Treatment of the underlying disease: hematological, oncological, neurological
- Review of medications taken
Prevention of recurrent episodes
- Strict adherence to the dosage of intracavernosal drugs and training in the technique of their administration
- It is mandatory to consult a doctor if an erection after an injection persists longer than the prescribed time.
- Treatment and control of sickle cell anemia with a hematologist
- Review of psychotropic medications with the prescribing physician
- Quitting drugs and alcohol abuse
- Drinking enough and avoiding hypothermia if you have sickle cell anemia
- For recurrent episodes, preventive therapy as prescribed by an andrologist
Where to contact in Tashkent
Priapism requires urological care in the coming hours: aspiration, administration of drugs and, if necessary, surgery.
In Tashkent, such care is provided at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If an erection lasts longer than four hours and is accompanied by pain, contact us immediately. For a urologist, this is a standard clinical situation, and delay due to awkwardness can cost sexual function. Clinic contacts are below.
