Nephrology for the Family Physician - O.I. Bakaliuk 2003

Emergency Uro-Nephrology
Priapism

Priapism is a prolonged, pathological erection of the Penis that is unrelated to sexual intercourse.

Common causes of priapism include (R.B. Teflor, 1995): genitourinary disorders (phimosis, urolithiasis, thrombosis of peri- and paraprostatic Veins, penile tumors and trauma, pelvic Hemorrhage), Brain AND SPINAL cord diseases (encephalitis, multiple sclerosis, tumors), hematological disorders (Sickle Cell anemia, leukemias, coagulopathies, multiple myeloma, hyperfibrinogenemia), endogenous Intoxication syndrome associated with occupational hazards (carbon dioxide, lead, strychnine), exposure to toxins and medications (antihypertensives, anticoagulants, Sex Hormones, glucocorticoids, acute alcohol or marijuana poisoning, uremia, fetal alcohol syndrome, Liver failure), as well as specific physiological and psychological states (hysteria, psychoneurosis driven by erotic fantasies, non-physiological types of coitus, etc.).

The so-called intermittent nocturnal priapism, which occurs much more frequently, is underpinned by disruptions in cortico-subcortical interactions, typically seen in individuals prone to hysterical reactions.

It is unquestionable that all forms of priapism are rooted in venous stasis, which may ultimately lead to Thrombosis of the deep dorsal vein of the penis and the periprostatic veins.

Diagnosing this condition is straightforward. It is essential to differentiate true priapism from intermittent nocturnal priapism.

Emergency management of priapism aims to restore normal local Blood Circulation.

Conservative Treatment involves the topical application of cold compresses and ice, the oral and parenteral administration of tranquilizers (sibazon, seduxen), antispasmodics (halidor, no-shpa, papaverine), and analgesic antispasmodics (baralgin, maxigan, trigan, tempalgin, spazmalgon). Nitrous oxide anesthesia is recommended in selected cases. Various Types of Nerve blocks (penile ROOT block, spinal anesthesia, ischiorectal block) are widely employed.

If treatment yields no effect within 24–36 hours of onset, urgent surgical intervention is indicated, including forceful penile massage, incisions of the tunica albuginea, aspiration of blood clots followed by irrigation, creation of corporeal shunts, ligation of the penile Arteries, or saphenous-cavernous shunting.

When Surgical treatment is not feasible, indirect anticoagulants (neodicoumarol: 0.2 three times daily on the first day, twice daily on the second day, and once daily for the subsequent 7–8 days) and direct anticoagulants (heparin: 5,000–15,000 IU/day) are administered.

Subsequent management includes The Use of low-molecular-weight heparins (fraxiparine at 0.3–0.6 ml/day for 10–14 days) and aspirin (0.125–0.250 g/day).