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CME

Priapism

General Information

Description

  • medical-urological emergency of a prolonged penile erection lasting > 4-6 hours in absence of sexual stimulation1,2

Types

  • ischemic (low-flow or veno-occlusive) priapism accounts for ≥ 95% of all cases, and is considered a medical emergency (similar to penile form of compartment syndrome) and requires prompt assessment and intervention1,2
    • characterized by persistent, markedly rigid, painful erection with absent or decreased venous outflow
    • aspirated blood from corpus cavernosum will have an abnormal blood gas analysis (hypoxia, hypercapnia, acidosis)
    • most cases are idiopathic, but etiologic factors may include medications (oral or intracavernosally injected) or blood disorders including sickle cell anemia (most common cause in children)
    • may result in permanent erectile dysfunction if left untreated for ≥ 48 hours from symptom onset
  • nonischemic (high-flow, arterial) priapism is rare, non-emergent, and often associated with history of perineal or penile trauma in preceding 2-3 weeks1,2
    • characterized by persistent painless, semi-rigid, non-sexual erection
    • normal blood gas values
    • typically results from unregulated arterial blood flow to corpora cavernosa due to trauma-induced arteriocorporal fistulas and occasionally pseudoaneurysm
    • not associated with erectile dysfunction
  • stuttering (intermittent, recurrent) priapism consists of intermittent, recurrent, and self-limited episodes of prolonged and painful erection similar to ischemic priapism2,3
    • reported to be common in patients with sickle cell disease, particularly children; may also be idiopathic or due to neurologic disorder
    • pathophysiology is typically similar to ischemic priapism, but cases of stuttering nonischemic priapism have been reported
    • duration is typically < 3 hours, but some episodes may persist and progress to emergent ischemic events requiring immediate attention
    • episodes may be nocturnal
  • partial priapism (idiopathic partial segmental thrombosis of the corpus cavernosum)1
    • very rare nonischemic condition of corporal thrombus
    • limited to a single crura (proximal portion of corpus cavernosum)
    • etiology is unknown but is associated with trauma, drug usage, sexual intercourse, congenital web within corpora cavernosa, and hematological disease
    • usually resolves spontaneously with analgesic treatment
  • malignant priapism is rare, and may be due to regional infiltration by tumor or metastasis 1
    • resultant priapism may be ischemic or nonischemic
    • usually secondary to genitourinary tumors
    • most common cause of priapism in children

References

General References Used

  1. Hatzimouratidis K, Giuliano F, Moncada I, et al. European Association of Urology (EAU) Guideline on Male Sexual Dysfunction. EAU 2018
  2. Shigehara K, Namiki M. Clinical Management of Priapism: A Review. World J Mens Health. 2016 Apr;34(1):1-8full-text
  3. Kousournas G, Muneer A, Ralph D, Zacharakis E. Contemporary best practice in the evaluation and management of stuttering priapism. Ther Adv Urol. 2017 Sep;9(9-10):227-238full-text

Recommendation Grading Systems Used

  • European Association of Urology (EAU) uses Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system
    • strength of recommendation
      • Strong or Weak based on:
        • overall quality of existing evidence
        • magnitude of effect (individual or combined effects)
        • certainty of results (including precision, consistency, heterogeneity, and other statistical or study-related factors)
        • balance between desirable and undesirable outcomes
        • patient values and preferences
        • certainty of patient values and preferences
    • levels of evidence
      • Level 1a - meta-analysis of randomized trials
      • Level 1b - ≥ 1 randomized trial
      • Level 2a - ≥ 1 well-designed controlled study without randomization
      • Level 2b - ≥ 1 other type of well-designed quasi-experimental study
      • Level 3 - well-designed nonexperimental studies; such as comparative studies, correlation studies, and case reports
      • Level 4 - expert committee reports or opinions or clinical experience of respected authorities
    • Reference - EAU guideline on male sexual dysfunction (EAU 2018)

Synthesized Recommendation Grading System for DynaMed Content

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    • Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
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  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T116934, Priapism; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T116934. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

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