Priapism
Priapism: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
A urologic emergency, priapism is a persistent, painful erection that’s unrelated to sexual excitation. This relatively rare sign may begin during sleep and appear to be a normal erection, but it may last for several hours or days. It’s usually accompanied by a severe, constant, dull aching in the penis. Despite the pain, the patient may be too embarrassed to seek medical help and may try to achieve detumescence through continued sexual activity.
Priapism occurs when the veins of the corpora cavernosa fail to drain correctly, resulting in persistent engorgement of the tissues. Without prompt treatment, penile ischemia and thrombosis occur. In about half of all cases, priapism is idiopathic and develops without apparent predisposing factors. Secondary can priapism result from a blood disorder, neoplasm, trauma, or use of certain drugs.
Emergency Interventions
If the patient has priapism, apply an ice pack to the penis, administer an analgesic, and insert an indwelling urinary catheter to relieve urine retention. Procedures to remove blood from the corpora cavernosa, such as irrigation and surgery, may be required.
History and physical examination
If the patient’s condition permits, ask him when the priapism began. Is it continuous or intermittent? Has he had a prolonged erection before? If so, what did he do to relieve it? How long did he remain detumescent? Does he have pain or tenderness when he urinates? Has he noticed any changes in sexual function?
Explore the patient’s medical history. If he reports sickle cell anemia, find out about any factors that could precipitate a crisis, such as dehydration and infection.Ask if he has recently suffered genital trauma, and obtain a thorough drug history. Ask if he has had any drugs injected or objects inserted into his penis.
Examine the patient’s penis, noting its color and temperature. Check for loss of sensation and signs of infection, such as redness or drainage. Finally, take his vital signs, particularly noting fever.
Medical causes
Granulocytic leukemia (chronic)
Priapism is an uncommon sign of this disorder. More characteristic signs and symptoms include fatigue, weakness, malaise, lymphadenopathy, pallor, dyspnea, tachycardia, and bleeding tendencies. Hepatosplenomegaly, bone tenderness, low-grade fever, weight loss, and anorexia may also occur.
Penile cancer
Cancer that exerts pressure on the corpora cavernosa can cause priapism. Usually, the first sign is a painless ulcerative lesion or an enlarging warty growth on the glans or foreskin, which may be accompanied by localized pain, a foul-smelling discharge from the prepuce, a firm lump near the glans, and lymphadenopathy. Later findings include bleeding, dysuria, urine retention, and bladder distention. Phimosis and poor hygiene have been linked to the development of penile cancer.
Penile trauma
Priapism can occur with other signs and symptoms of injury, such as bruising, abrasions, swelling, pain, and hematuria.
Sickle cell anemia
With this congenital disorder, painful priapism can occur without warning, usually on awakening. The patient may have a history of priapism, impaired growth and development, and increased susceptibility to infection. Related findings include tachycardia, pallor, weakness, hepatomegaly, dyspnea, joint swelling, joint or bone aching, chest pain, fatigue, murmurs, leg ulcers and, possibly, jaundice and gross hematuria.
With sickle cell crisis, signs and symptoms of sickle cell anemia may worsen and others, such as abdominal pain and low-grade fever, may appear.
Spinal cord injury
With this condition, the patient may be unaware of the onset of priapism. Related effects depend on the extent and level of injury and may include autonomic signs, such as bradycardia.
Stroke
A stroke may cause priapism, but sensory loss and aphasia may prevent the patient from noticing or describing it. Other findings depend on the stroke location and extent but may include contralateral hemiplegia, seizures, headache, dysarthria, dysphagia, ataxia, apraxia, and agnosia. Visual deficits include homonymous hemianopsia, blurring, decreased acuity, and diplopia. Urine retention or incontinence, fecal incontinence, constipation, and vomiting may also occur.
Thrombocytopenia
This disorder uncommonly produces priapism. More typical characteristics include blood-filled bullae in the mouth and local bleeding, such as epistaxis, ecchymosis, and hematuria. Central nervous system bleeding may cause decreased level of consciousness. Fatigue, weakness, and lethargy may occur.
Other causes
Drugs
Priapism can result from the use of a phenothiazine, thioridazine, trazodone, an androgenic steroid, an anticoagulant, or an antihypertensive.
Special considerations
Prepare the patient for blood tests to help determine the cause of priapism. If he requires surgery, keep his penis flaccid postoperatively by applying a pressure dressing. At least once every 30 minutes, inspect the glans for signs of vascular compromise, such as coolness or pallor.
Pediatric pointers
In neonates, priapism can result from hypoxia but is usually resolved with oxygen therapy. Priapism is more likely to develop in children with sickle cell disease than in adults with the disease.
Patient counseling
Encourage patients with sickle cell anemia to report episodes of priapism. Quick treatment is necessary to preserve normal sexual function.
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Scrotal swelling (Professional Guide to Signs & Symptoms (Fifth Edition))
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