Priapism is classified as a persistent, usually painful erection that is not accompanied by sexual desire.
Types of Priapism
Depending on the cause is divided into:
1. Primary (idiopathic)
Also, notice the:
1. Ischemic type (or low flow priapism) and
2. Non-ischemic type (or high flow priapism).
The ischemic type, which is the most dangerous, have prolonged obstruction of the venous system, thus requiring immediate attention.
In the non-ischemic type, blood is arterial and therefore the treatment may be delayed slightly, without consequences for the patient. In this case, rapid drainage of blood through the cavernous bodies is performed along with deep dorsal vein of the penis.
Although it occurs in approximately 1/3 of the cases the cause remains unknown.
Depending on the event identified as:
1. Thromboembolic – Observed in patients with sickle cell anemia, leukemia and fatty infarction. It is estimated that 4-6.5% of patients with sickle cell anemia exhibit priapism. The treatment of these patients includes alkalization, analgesia, hydration and transfusions such that the hemoglobin is above 10mg% and hemoglobin S at a density of less than 30%.
2. Traumatic – Occurs after trauma, genital and / or perineum. The injuries of this type may cause thrombosis, bleeding and swelling of the penis, which lead to low flow priapism. Instead, if the injury to the cavernous artery, it can be observed high flow priapism.
3. Nervosa – In lesions of the spine, to autonomic neuropathy and after anesthesia during surgery.
4. Cancerous – Observed in malignant tumors and is caused by obstruction of venous drainage or partial replacement of the cavernous sinus by the tumor. Treatment is palliative and includes analgesics, antibiotics (to possible infection), radiation and / or chemotherapy to treat metastatic disease.
5. Pharmaceutical – Some drugs, such as antihypertensives hydralazine and prazosin and some antipsychotics such as chlorpromazine, implicated potential challenge priapism.
6. In total parenteral nutrition – Priapism has been observed low flow after intravenously 20% fat solution.
7. After intracavernous injection drugs. In approximately 5%, as a complication endopeikis substances for the treatment of erectile dysfunction. Are the most common cause of priapism.
• Priapism is a result of the relaxation mechanism.
• The pressure in the corpora cavernosa is steadily increasing and ranges from 80-120 mmHg.
• The degree of ischemia induced is proportional to the extent and duration of venous occlusion.
• Sometimes the cavernous tissue becomes thick, edematous and fibrotic, resulting in erectile dysfunction.
A. Non-specific measures
1. Ice packs
4. Tubal penis
B. intracavernous injection of alpha-adrenergic drugs
These types of drugs cause vasoconstriction. Such drugs are etilefrini, phenylephrine, epinephrine, ephedrine and norepinephrine. The injection of the drug is within the corpus cavernosum and may be repeated after 5 min.
C. Puncture and emptying the contents of cavernosal
Used needle 21G butterfly which serves to remove the blood from the corpus cavernosum. Inserted vertically into the corpus cavernosum and the aspiration of blood is to achieve relaxation of the penis.
It must be emphasized that when PRIAPISMOS ADDRESSED WITHIN THE FIRST TIME PATIENTS OFTEN HAVE GOOD WEATHER AND NOT appear erectile dysfunction. BUT IF THE SOLUTION THEN DELAYS DUE TO FAILURE OF erectile tissue TREATMENT SHOULD BE SURGERY.
It may be:
• Communication between the corpus cavernosum and glans.
• Communication between cancellous and cavernous body.
• Communication between the corpus cavernosum and saphenous vein.