emDocs - August 25, 2016 - Authors: End B and Conroy M
Edited by: Koyfman A and Alerhand S
"Background
While an uncommon presenting complaint, priapism is a urologic emergency requiring fast and effective management by emergency physicians to prevent significant morbidity. Defined as a persistent, painful erection lasting greater than four hours beyond, or in the absence of, sexual stimulation, priapism was first documented as a case by Tripe in 1845 [1]. In the following write-up, we will examine the initial evaluation and management of patients presenting to the emergency department...
Pearls
- Ischemic priapism is a time-sensitive diagnosis and urologic emergency, time is tissue and erectile function!
- History and physical exam may help delineate ischemic vs. non-ischemic, but cavernous blood gas is paramoun
- Remember to provide adequate analgesia, either with oral medications or through local anesthesia/penile block (https://www.youtube.com/watch?v=3p0qEfISggs)
- Aspiration should be performed laterally to avoid damage to the dorsal neurovascular bundle (https://www.youtube.com/watch?v=KWf5MAobWoM)
- A stepwise approach (aspiration, injection of vasoactive agent, emergent urologic consultation for shunt) is the key to success
Pitfalls
- Not obtaining a cavernous blood gas sample to differentiate between ischemic and non-ischemic priapism
- Aspiration at the dorsum of the penis (avoid the neurovascular bundle!)
- Only one attempt at vasoactive injection (may repeat at 5-10 minute intervals until detumescence is achieved)"