Priapism refers to extensive erection which lasts at least 4 hours and is not accompanied by sexual drive.
There are two types of priapism:
Ischemic or low flow or venous priapism:
It is caused by an obstruction in the vascular plexus of the penis, and results in the accumulation of blood in the spongy parts of the organ.
It constitutes an emergency which, if left untreated for a long time, can cause ischemia and necrosis in the spongy bodies of the penis and result in erectile dysfunction.
Non-ischemic or high flow or arterial priapism:
It is characterized by uncontrollable flow of arterial blood within the spongy bodies of the penis.
It usually is the result of perineal or penile damage.
Causes of priapism
Priapism may be due to:
- Central nervous system disorders
- Injury in the urethra or perineal damage
- Neoplastic infiltration in the area
- Thromboembolic episodes
- Blood diseases, intracavernosal injections and anesthetic drugs
Low flow priapism is an emergency which must be immediately treated by a urology consultant.
To avoid permanent damage, consultation must be made within 4 to 6 hours from symptom onset.
The treatment includes:
- Blood specimen from the spongy bodies
- Intrapenile administration of vasoactive substances
- Should the above fail, the blood is surgically diverted into the circulatory system
Arterial priapism, unlike ischemic priapism, is not a medical emergency.
62% of cases recover spontaneously.
In cases where intervention is deemed necessary, selective embolization of the pudendal artery is carried out.