Emergency Department Management Of Priapism
Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents. Evidence-based management and appropriate urologic follow-up of nonischemic and recurrent ischemic priapism maximizes patient outcomes and resource utilization.
Key words: priapism, ischemic, recurrent, stuttering, low flow, high flow, nonischemic, erection, penis, sickle cell disease, hemoglobinopathy, phosphodiesterase type 5 inhibitor, PDE5, ultrasound, prosthesis
- There are 3 main types of priapism: ischemic (“low-flow”), nonischemic (“high-flow”) and recurrent ischemic (“intermittent” or “stuttering”).
- Ischemic priapism accounts for 95% of all cases. It is primarily caused by sickle cell disease, but is also caused by other blood dyscrasias, penile intracorporeal injections, and medications (eg, antihypertensives, antipsychotics, antidepressants, oral phosphodiesterase type 5 [PDE-5] inhibitors).
- Ischemic priapism is a compartment syndrome and a true urologic emergency.
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- » Authors And Peer Reviewers
- » Case Presentations & Case Conclusions
- » Introduction
- » Critical Appraisal Of The Literature
- » Etiology And Pathophysiology
- » Differential Diagnosis
- » Prehospital Care
- » Emergency Department Evaluation
- » Diagnostic Studies
- » Treatment
- » Special Populations
- » Controversies And Cutting Edge
- » Disposition
- » Summary
- » Time- And Cost-Effective Strategies
- » Clinical Pathway For The Management Of Priapism
- » Tables And Figures
- » References
- » Evidence-Based Management Of Sickle Cell Disease In The Emergency Department (FREE) - Emergency Medicine Practice - August 2011
- » An Evidence-Based Approach To Male Urogenital Emergencies (FREE) - Emergency Medicine Practice - February 2009