PRIAPISM

This unfortunate condition may be humorous to everyone but the one who is “blessed” with it. The common causes are few, and the mnemonic MINT is an easy method for recall of these. M—Malformation suggests phimosis and other deformities of the penis. I—Inflammationand intoxicationsuggest posterior urethritis, prostatitis, and cystitis, as well as aphrodisiac drugs such as sildenafil citrate, alcohol, cannabis, indica, camphor, and damiana. N—Neoplasms suggest two common causes of priapism—chronic lymphatic or myeloid leukemia and nasal polyps. The N also suggests neurologic disorders such as neurosyphilis, multiple sclerosis, and diabetic neuropathy. T—Trauma recalls not only direct trauma to the penis producing a local hematoma but also trauma to the spinal cord with fractures or contusion.

Approach to the Diagnosis

The diagnosis of priapism usually depends on the association of other symptoms and signs (e.g., boggy prostate), but a blood smear or bone marrow examination may be necessary to exclude leukemia. A careful history of the patient’s sexual activities to rule out too-frequent masturbation or sexual excesses may be indicated.

Other Useful Tests

1. CBC (leukemia, sickle cell anemia)
2. Coagulation studies (blood dyscrasias)
3. Prostatic massage and examination of the discharge (prostatitis)
4. Urine culture (cystitis, pyelonephritis)
5. Serum protein electrophoresis (macroglobulinemia)
6. MRI of the brain (tumor, cerebrovascular accident [CVA], multiple sclerosis)
7. MRI of spinal cord (multiple sclerosis, space-occupying lesion)
8. Spinal tap (multiple sclerosis, neurosyphilis)
9. Neurology consult
10. Urology consult

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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