priapism

Introduction

Persistent erection of the penis (> 2 hours).

Etiology

• sickle cell anemia
• pharmaceuticals
  • trazodone (most common) < 0.1%
  • antipsycotics
  • anticoagulants
  • antihypertensives

Pathology

• results from pathologic condition, rather than any sexual desire

Clinical manifestations

• pain
• tenderness

Laboratory

• complete blood count for leukocytosis, anemia, or thrombocytosis
• reticulocyte count for patients with sickle cell anemia
• hemoglobin electrophoresis if sickle cell anemia suspected
• urine toxicology useful only if medications suspected as cause

Radiology

• ultrasound
• penile angiography if high-flow priapism to confirm fistulas identified by ultrasound

Management

• intravenous fluids
• adequate oxygenation
• pain control
• urgent urologic consultation
  • local aspiration
  • irrigation
• unproven therapies
  • pseudoephedrine
  • beta-2 receptor agonists: albuterol
  • alpha-blockers
  • erythrocyte transfusion (sickle cell disease)

More general terms

• sign/symptom
• penile disorder