Dr. M.J. Bazos, MD.
Patient Handout
PRIAPISM
About Your
Diagnosis
Priapism is persistent
erection of the penis. This disorder is most common among patients with sickle
cell disease, infants or adults. The specific cause is unknown. There is
speculation that once the erection is present, the abnormal red blood cells of
sickle cell anemia perpetuate the episode. It is also known that once these
cells are trapped inside the penis, the amount of oxygen on the blood also
decreases. Acute attacks often begin during sleep, and a full bladder usually is
an associated factor. Some episodes begin after sexual activity. However, there
is frequently no identifiable event or
cause.
Living With Your
Diagnosis
There are three basic types
of priapism, as follows:
1. Stuttering
priapism is characterized by repeated erections that are usually reversible but
painful. They come and go, do not last long, and cause no problem with sexual
function once resolved. This is very common and occurs among 40% of
patients.
2. Acute, prolonged priapism can
last for several hours, but typically lasts for several days or weeks. The
erection is painful, and induration may develop after the episode. This may
cause impotence and necessitate a doctor’s
intervention.
3. Persistent priapism can
last for weeks to years and usually develops after an acute attack as described
in number 2. Persistent priapism is usually painless. It is characterized by
enlargement or induration of the penis. It may also lead to partial or complete
impotence.
Treatment
1.
Stuttering priapism is often managed at home. The patient is encouraged to drink
plenty of fluids and to empty his bladder frequently once the attack begins.
Warm baths and exercise also are recommended. If the episode does not resolve in
3 hours, the patient should seek medical
attention.
2. Acute, prolonged priapism
necessitates hospitalization. Intravenous fluids and narcotics usually are
prescribed to decrease the pain. The doctor may start blood transfusions
immediately or opt to do a more complicated procedure called exchange
transfusion. In this procedure a machine is connected to the patient that
exchanges fresh blood with the patient’s old blood. This may take one or
two days to work; if it does not work, a surgical procedure may be indicated.
The operation usually is performed with local anesthesia. The blood in the penis
is drained through a small needle; the needle is removed, but the blood
continues to drain until the patient experiences some relief. Transfusion and
surgical treatment may decrease the incidence of loss of erection from 80% to
25% to 50%.
3. There is no standard
treatment for persistent priapism. Patients usually are not in pain, but
erection is impaired. Use of inflatable or fixed prostheses may have
complications, but some patients have had good results. Some patients adjust to
altered sexual function with the support of a partner, because ejaculation,
orgasm, and fertility remain intact.
The DOs