A 25-year-old male presented with a painful, sustained erection for 2 days. His history included splenomegaly. Examination found an erect, tender penis and enlarged spleen. Tests found leukemia. He was treated for ischemic priapism by aspirating blood and injecting the penis to induce flaccidity. He was then referred to oncology for leukemia management.
2. 25 years old male no known comorbids, presented to
us in emergency with
c/o
Painful sustained erection for 2 days
Erection was spontaneous and severely painful. it did not relieved
with analgesics
There was no history of trauma to genitelia
No significant drug history
No significant addiction history
There was past history of splenomegaly
3. Young male of average height and built, well
oriented to time person and place
Vitals:
•Pulse = 97/min
•B.P = 120/90mmhg
•R/R = 18/min
•Temp = 98.6⁰F
Sub-vitals:
Anemia = absent
Jaundice = absent
Cyanosis = absent
Clubbing = absent
Dehyd: = absent
L/Nodes = N/P
Edema = absent
4. Abdominal examination:
◦ Spleen was palpable 3 finger breadth below the level of
umbilicus
◦ Rest of the examination was unremarkable
Local examination:
◦ Fully erect, congested and mildly tender penis
◦ No sign of trauma
6. Under G.A clotted dark blood aspirated from
cavernosa
distal shunts created between corpora cavernosa
and corpus spongiosum
Phenylephrine injected into the corpora until
penis became flaccid
Next morning pt shifted to Oncology for the
management of leukemia.
7. DEFINATION:
◦ Priapism is a full or partial erection that continues more
than 4 hours beyond sexual stimulation and orgasm or
is unrelated to sexual stimulation
TYPES:
◦ LOW FLOW(ISCHEMIC):
◦ HIGH FLOW(NONISCHEMIC)
8. Common than non-ischemic
Results from veno-occlusion
Its rigid and very painful
Blood flow will be decreased
Blood in cavernosa will show hypoxia,hypercarbia
and acidosis
9. Its post traumatic
Unregulated arterial blood flow
Semi-rigid and painless erection
Cavernosal blood shows arterial values
11. Detailed history (specially past medical history)
Examination
Investigation
◦ Full blood count and peripheral blood films
◦ ABGs of aspirated cavernous blood
Ischemic priapism hypoxia,hypercarbia and acidosis
Non ischemic priapism normal arterial or mixed arterial-
venous picture
◦ Duplex Doppler ultrasound of penis
Ischemic priapism Decreased flow
Non ischemic priapism Increased flow
◦ Urine and serum toxicology
12. Decompression by aspiration followed by
injection of sympathomimetics into corpora
cavernosa
Phenylephrine is the drug of choice
◦ Highly α1 selective without β-mediated ionotropic and
chronotropic effects
◦ Diluting it in N/S at concentration of 100 to 500 Ug/ml
and giving 1ml every 5 minutes
◦ maximum 1mg of Phenylephrine can be injected
◦ Serial monitoring of B.P and Pulse
18. Its not an emergency
Start expectant management with cool bathing
and ice packing vasospasm and thrombosis
Arteriography and selective embolisation of the
internal pudendal artery or its branches
Ligation of the site of fistulae