Priapism

Priapism is a pathological erection of the penis, which is accompanied by painful sensations. Such an erection is a consequence of circulatory disorders in the cavernous bodies. Priapism is not characterized by increased sexual desire. Priapism is characterized by an erection that does not disappear after sexual intercourse.

The content of the article:
Causes of priapism
Symptoms of priapism
Diagnosis of priapism
Treatment of priapism
Priapism
Causes of priapism
Priapism occurs when blood flow is disrupted in the tissues of the penis. There are several forms of priapism that develop due to impaired blood flow to the penis. With an increased influx of arterial blood, a non-ischemic (arterial) form of priapism develops. When there is a worsened outflow of venous blood from the cavernous bodies, ischemic priapism develops. Ischemic (venous) priapism develops as a result of reduced oxygen pressure in the cavernous bodies and tissues of the penis. Blood diseases lead to the appearance of an ischemic form of priapism: oncological diseases, leukemia, sickle cell anemia, erythrocytosis. Psychotraumatic priapism occurs as a result of a severe shock or stressful situation experienced during sexual intercourse (natural disaster, explosion). During such situations, the mechanisms of sharp spasms of vessels and tissues of the penis are fixed at the level of the cerebral cortex. Priapism often affects patients with neurological or mental disorders (neuroses, schizophrenia, epilepsy). Priapism can develop due to neurological diseases of the brain or spinal cord, encephalitis, brain tumors. The cause of the disease is the use of a number of medications: antidepressants, anticoagulants and psychotropic drugs, which significantly increase the risk of priapism. In some cases, the cause of priapism is drugs that enhance erection or sexual desire, drugs for the treatment of impotence injected into the penis.

The reasons for the development of priapism can also include:

excessive alcohol consumption;
taking drugs;
diabetes mellitus;
chronic renal failure;
penile injuries;
swelling or inflammation of the penis;
injuries of the perineum and pelvic organs.
Symptoms of priapism
The main sign of an attack of priapism is a prolonged erection, which continues after sexual intercourse. An erection can last from 3 hours to several days.

At an early stage of development, attacks of priapism occur in a dream. Nocturnal priapism is characterized by a weakening of pain symptoms after emptying the bladder and rectum. With priapism, the penis is strained, an erection is accompanied by pain at the base of the penis and in the perineum. Piercing pain in the venous form of priapism gives to the rectum and groin. The pain continues after several hours of the appearance of an erection. There may be swelling of the penis, especially its extreme part. With an erection, the penis bends in an arc to the side of the abdomen. The head of the penis is soft, does not swell, since only the cavernous bodies are filled with blood. Characteristic of attacks of priapism is that the function of urination during erection is not disturbed, since the blood overflows only the cavernous bodies. But the difficulty in emptying the bladder with priapism is that the penis is raised up. The skin of the penis turns red, as priapism develops, it acquires a bluish hue due to stagnation.

Ischemic priapism is characterized by the development of penile cyanosis, prolonged pain. Cavernous pressure in priapism is equal to systolic. The inflow of arterial blood and the outflow of venous blood is reduced several times. With an attack of arterial priapism, there will be no cyanosis and swelling of the penis. Pain symptoms are also absent. Cavernous pressure is much higher than systolic pressure (sometimes reaches 380 — 400 mmHg). Increased sexual desire is not characteristic of priapism, ejaculation does not occur during sexual intercourse, the act itself can also be painful. Due to the absence of ejaculation, the pain increases. The presence of prolonged ischemia of penile tissues causes irreversible damage to the cavernous bodies.

Diagnosis of priapism
Diagnosing priapism is not particularly difficult. As soon as the doctor finds out about an erection that persists for several hours, but sexual desire is not observed, the diagnosis becomes clear. In the ischemic form of priapism, the patient also complains of pain in the penis and the area of the womb. But in order to definitively determine the type of disease, a number of instrumental and laboratory studies are carried out. One of the ways to diagnose priapism is the results of penile fluorography. To do this, a contrast agent is injected into the cavity of the cavernous body using a thin needle. If the X-ray image shows that the contrast agent goes beyond the boundaries of the penis, a diagnosis of a non-ischemic form of priapism is made, since blood does not flow from the vascular system of the penis. If the contrast agent seeps beyond the boundaries of the penis, then the diagnosis is ischemic priapism, since the cause of the disease will be poor venous flow to the penis. To diagnose priapism, it is necessary to do clinical blood tests. The gas composition of the blood of the cavernous bodies of the penis is also determined. To do this, during piercing with a puncture needle of the penis, blood is taken from the cavernous bodies. The results of the tests determine the concentration of oxygen in the penis and show the type of penile tissue deficiency. To clarify the diagnosis, a puncture of the cavernous bodies is performed . With non-ischemic priapism with good blood supply, the blood has a scarlet color. In ischemic priapism, the blood is dark in color. Additionally, the diagnosis of diseases that could cause the development of defining symptoms of priapism is carried out. A pelvic examination is performed. The patient must undergo a complete X-ray examination of the muscular and skeletal apparatus of the pelvis. The presence of disorders of the central nervous system is also checked. The sensitive reflexes of the genitals and the skin of the thigh are examined. A decrease in sensitivity indicates the presence of disorders of the nerve endings of the genitals, which may have caused the appearance of priapism. A patient with priapism requires additional examinations by a hematologist, proctologist, neurologist.

Treatment of priapism
In rare cases, priapism can be resolved without the help of a doctor. Sometimes an erection with priapism persists for several hours, then gradually passes, pain decreases, the density of the cavernous bodies decreases. But often, due to the altered tissues of the cavernous bodies in the penis, the ability to erect is partially or completely lost. Most often, at the first symptoms of priapism, a man with a pathological erection needs urgent medical care. Conservative treatment of priapism gives good results only in the first hours after the symptoms of priapism appear. To relieve priapism, sedentary cold baths are taken, hot water bottles with cold water are applied to the penis. Presacral and novocaine blockades also contribute to the relief of the attack. Sometimes hirudotherapy (setting of leeches) is applied to the root area of the genital organ. One of the most effective ways to stop an attack of priapism is considered aspiration-irrigation therapy with the introduction of intra-cavernous alpha-adrenomimetics. This method increases the probability of stopping a pathological erection in 60% of cases. Sedatives and anticoagulants are often used to treat priapism. To relieve priapism with the help of aspiration-irrigation therapy, it must be carried out for at least an hour. If the cause of priapism is a blood disease, then the pathological erection is eliminated by treating the underlying disease. During conservative treatment of priapism, monitoring of heart rate and blood pressure is mandatory.

In the absence of improvements in priapism, urgent hospitalization and subsequent hospital treatment are needed. If conservative treatment of priapism is ineffective, surgical intervention is necessary. The principle of surgical treatment of priapism is the normalization of venous blood drainage from the cavernous bodies of the genital organ. Percutaneous bypass surgery is a common method of surgical treatment of priapism. Using this method, a fistula is formed between the spongy body and the cavernous bodies. With the help of a scalpel or a biopsy needle, the cavernous bodies are punctured in the apical zone. This procedure is performed under local anesthesia. Another method of surgical treatment of priapism is open bypass surgery. The doctor provides access to the cavernous bodies and their apical divisions. Access is performed on the dorsal surface of the glans penis parallel to the coronal furrow. Next, a hole with a diameter of five mm is formed and the cavernous bodies are washed with a solution of sodium heparin. During the procedure, the patient is under general anesthesia. If the application of spongiocavernous fistula is ineffective, proximal bypass surgery is performed. With this method , the protein shell of the cavernous bodies is isolated . To do this, a urethral catheter is pre-installed with a perineal or transverse scrotal incision. In the spongy body and in the protein shell of the cavernous bodies, the doctor forms ellipsoid windows. Then the cavernous bodies are washed and a spongiocavernous fistula is formed. This type of bypass surgery is performed under general anesthesia. Surgical intervention in priapism can cause a temporary violation of erectile function, a decrease in sexual desire.

Additionally, diagnostics and treatment of those diseases that caused the occurrence of priapism are carried out. Patients with blood diseases often need chemotherapy. Patients with sickle cell anemia need metabolic hemotransfusion, oxygenation, erythropheresis to normalize the hemoglobin content in the blood.

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