PRIAPISM

WHAT IS PRIAPISM?
Priapism is a persistent, usually painful, erection not accompanied by sexual desire .

WHAT KINDS OF PRIAPISM ARE THERE?
3 types of priapism exist:
1) ischemic type (or low flow priapism or veno-occlusive)
2) Non-ischemic type (or high-flow priapism or non veno-occlusive)
3) Recurrent type
In the ischemic type, the more dangerous, we have prolonged occlusion of the venous system, thus requiring immediate treatment . Delayed medical management will result in permanent damage to the erectile function of men
In non-ischemic type, blood is rich in oxygen and so the treatment can be delayed for a while, without consequences for the patient.

WHAT CAUSES PRIAPISM?
The causes of priapism include:
1) Primary
Although it appears about 1/3 of cases the causes remains unknown.
2) Secondary
Thromboembolic.
In patients with blood disorders such as sickle cell anemia, leukemia, etc. It is estimated that 5-7% of men with sickle cell anemia will experience at least one episode of priapism. The treatment of these patients comprising in addition to the general treatment alkalinisation pain, hydration and blood transfusion.
Traumatic.
Listed after trauma to the perineum (the region between the genitals and the anus). Priapism usually occurs 2-3 weeks after the injury and is usually non-ischemic priapism formula. Apply pressure and ice packs in the region is the initial step.
Neurogenic.
In spinal injuries in autonomic neuropathy and rarely after anesthesia during surgery can occur priapism.
Neoplastic.
It is observed in various types of cancer and is due to obstruction of the venous drainage or partial replacement of the cavernous sinus cancer.
Pharmaceutical.
Medications such as hydralazine, prazosin and antipsychotics such as chlorpromazine, have been implicated in causing priapism.
After intracavernous injection drugs.
Priapism occurs in about 5%, as a complication of intracavernous administration of substances (eg. Prostin) for the treatment of erectile dysfunction.

WHAT IS THE TREATMENT OF PRIAPISM?
The urgent search of medical assistance is a necessary condition to address the priapism episode. The treatment is divided into:
A. First and nonspecific measures.
- Pack.
- Excercise.
- Masturbation.
- Cold showers.

B. A-adrenergic drugs intracavernous injection.
Drugs such as phenylephrine, epinephrine and norepinephrine used in ischemic and recurrent priapism.
C. Puncture and evacuation of the content of the corpora cavernosa
Removing blood with a needle from the corpora cavernosa is a first line therapy in ischemic priapism.
D. Surgery
If the above measures do not yield there is a variety of surgical procedures under local and general anesthesia in order to resolve the priapism. Last option is the intracavernous intention.
E. Treating recurrent priapism
Each episode of recurrent priapism can be treated by evacuation or intracavernous injections. In the context of prevention of incidents anti-androgens and PDE-5 inhibitors can be used with dubious results.