Priapism and Postpriapism Erectile Dysfunction

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Priapism may be defined as an involuntary erection that lasts for more than 4–6 h. The condition may be spontaneous or secondary to intracavernous pharmacotherapy. Spontaneous priapism may be idiopathic or associated with blood disorders such as sickle cell anemia, leukemia or other malignancies (Figure 34).

After 4–6 h, a persistent erection usually becomes painful, but late presentation is not uncommon because of embarrassment.

Initial therapy involves corporeal aspiration and injection of adrenergic vasoconstrictor substances such as phenylephrine or metaraminol (Aramine®). Because these potent vasoactive agents frequently enter the circulation after intracorporeal injection, blood pressure should be carefully monitored during therapy.

Vasculogenic Causes of ED
Neurogenic Causes of ED
Endocrinological Causes of ED
Priapism and Postpriapism ED
Psychogenic Causes of ED

Although pharmacotherapy with aspiration and injection of vasoactive agents is often successful within 6–12 h of onset of priapism, beyond that time period the efficacy of any therapy is rapidly diminished.

Initial high-flow priapism is followed by lower flow and progressive deoxygenation of the corpora. In these later cases, aspiration of the corpora reveals dark deoxygenated blood. Progressive ischemia to the intracorporeal smooth muscle renders the helicine arteries and walls of the trabecular spaces progressively less capable of developing sufficient vasoconstriction necessary to restore and maintain flaccidity.

The consequence of untreated priapism or priapism unresponsive to therapy is the development of corporeal fibrosis. This results in erectile dysfunction which is difficult, and sometimes impossible, to treat. Even insertion of a penile prosthesis may be technically difficult in such cases because the fibrosis renders dilatation of the corporeal space problematical.

RELATED STORIES:
Penile Vascular Surgery   Psychogenic Causes of Erectile Dysfunction   Erectile Dysfunction - Intracavernous Injection   Pathophysiology of erectile dysfunction   Physical Examination - Diagnosis of erectile dysfunction   Erectile Dysfunction Transurethral Therapy   Nonsurgical Treatment of Erectile Dysfunction   Phosphodiesterase (PDE) Inhibitors   Erectile dysfunction: Investigating a patient   Male Sexual Dysfunction Epidemiology   Diagnosis of erectile dysfunction   Diagnosis of ED: Second Level   Erectile Dysfunction Surgical Therapies   Male Sexual Dysfunction Introduction   Endocrinological Causes of Erectile Dysfunction

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About 9-10 months ago i experienced a priaprism secondary to medication i was prescribed, and was a current inpatient. I notified the staff within an hour of awakening and discovering the issue.... I immediatly began trating with ice, and was sent to the Emergency department. Once there i was treated for pain and given IM Terbutaline, after 6-7 hours of this not working and no Urologist on call at this facility, they transported me by Van Balance 3 hour away for treatment instead of 1.1 mile away to the neiboring Hospital. I recieved treatment around 11 hours after awaking and discovering the issue, and have subsequently been having more issue developing erections to the point of minimal if any response. Any idea what might be the best next step? Thanks for any information, or prognosis. I know the facility usually does a great job of caring for its patients, I use to work there as a Nurse. But this time the VA didn’t do me any favors, and i was so medicated i really didn’t have a clear idea of the timeframe until the next day.

posted by Greg on 09/13/2008 at 9:45 pm -08:00