Penile and Scrotal Urologic Emergencies

1

What is priapism?

A prolonged erection lasting for more than 4 hours, beyond or unrelated to sexual activity or stimulation.

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Why is priapism an emergency?

Prolonged ischemia to the penis results in corporal body fibrosis and future erectile dysfunction.

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What are the three types of priapism?

Ischemic (low flow), nonischemic (high flow), and stuttering (intermittent). In ischemic priapism the corpora cavernosa are typically fully rigid and painful. In contrast, the penis is not typically fully rigid or painful in nonischemic priapism. Patients with nonischemic priapism may relay a history of prior perineal trauma. Stuttering priapism is associated typically with hematologic malignancies and sickle cell disease.

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What laboratory tests should be obtained for a priapism patient?

• a.

  Corpus cavernosum blood gas testing: Ischemic priapism has dark hypoxic blood typically with a pO ₂ <30 mm Hg, pCO ₂ >60 mm Hg, and pH <7.25. Nonischemic priapism has oxygenated red blood with blood gas similar to serum.

• b.

  Complete blood count (CBC): Sickle cell anemia, platelet dysfunction, and leukemia may all result in priapism and can be identified by CBC.

• c.

  Consider a urine toxicology test: Illegal and psychoactive drugs may result in priapism.

• d.

  Hemoglobin electrophoresis testing for sickle cell or reticulocyte count may be considered in the appropriate clinical situation.

5

What is the treatment of ischemic priapism?

Injection of phenylephrine and irrigation and evacuation of corporal body blood. If this fails to work, surgical shunting is required.

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What is the treatment of nonischemic priapism?

Observation. Many cases will spontaneously resolve. Embolization may be performed in cases that do not spontaneously resolve, with surgery typically reserved as a last resort.

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