View source for Priapism

{{Infobox_Disease |
  Name           = {{PAGENAME}} |
  Image          = |
  Caption        = |
  DiseasesDB     = 25148 |
  ICD10          = {{ICD10|N|48|3|n|40}} |
  ICD9           = {{ICD9|607.3}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = med |
  eMedicineTopic = 1908 |
  MeshID         = D011317 |
}}
{{Search infobox}}
{{SCC}}

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==Overview==

'''Priapism''' is a potentially harmful medical condition in which the [[erection|erect]] [[penis]] does not return to its flaccid state (despite the absence of both physical and psychological stimulation) within about four hours.  It is often painful. Priapism is considered a [[medical emergency]], which should receive proper treatment by a qualified medical practitioner.

The name comes from the Greek god Priapus, referring to the myth that he was ironically punished by the other gods for attempting to rape a goddess, by being given a huge (but useless) set of wooden genitals. 

==Causes==

The causative mechanisms are poorly understood but involve complex neurological and vascular factors. 
Priapism may be associated with [[hematology|haematological]] disorders, especially [[sickle-cell disease]], and other conditions such as [[Leukemia|leukemia]], [[thalassemia]], and [[Fabry's disease]], and [[neurology|neurologic disorders]] such as spinal cord lesions and spinal cord trauma (priapism has been reported in hanging victims; see [[death erection]]).

Priapism can be caused by medications.  The most common medications that cause priapism are intra-cavernous injections for treatment of [[erectile dysfunction]] ([[papaverine]], [[alprostadil]]). Other groups reported are [[antihypertensives]], [[antipsychotic]]s (e.g [[chlorpromazine]], [[clozapine]]), [[antidepressant]]s (most notably [[trazodone]]), [[anticoagulants]], cantharides (''Spanish Fly'') and recreational drugs ([[alcohol]] and [[cocaine]]). [[PDE5 inhibitor|Phosphodiesterase type-5 (PDE5) inhibitors]] such as [[sildenafil]] (popularly [[Viagra]]), [[tadalafil]] and [[vardenafil]] have very rarely been implicated, and probably do not cause priapism. PDE-5 inhibitors have even been evaluated as preventive treatment for recurrent priapism.<ref>{{cite journal |author=Burnett AL, Bivalacqua TJ, Champion HC, Musicki B |title=Long-term oral phosphodiesterase 5 inhibitor therapy alleviates recurrent priapism |journal=Urology |volume=67 |issue=5 |pages=1043-8 |year=2006 |pmid=16698365 |doi=10.1016/j.urology.2005.11.045}}</ref><ref>{{cite journal |author=Burnett AL, Bivalacqua TJ, Champion HC, Musicki B |title=Feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent priapism |journal=The journal of sexual medicine |volume=3 |issue=6 |pages=1077-84 |year=2006 |pmid=17100941 |doi=10.1111/j.1743-6109.2006.00333.x}}</ref>

Female Priapism is a very rare disorder.

== Complications ==
Potential complications include [[ischemia|ischemia]], clotting of the blood retained in the penis ([[thrombosis]]), and damage to the blood vessels of the penis which may result in an impaired erectile function or [[Erectile dysfunction|impotence]].  In serious cases, the ischemia may result in [[gangrene]], which could necessitate [[Penectomy|penis removal]].

==Treatment==

Medical advice should be sought immediately for cases of erection beyond four hours. Generally, this is done at an emergency department. The therapy at this stage is to aspirate blood from the [[Corpus_cavernosum_penis|corpus cavernosum]] under local [[anaesthetic]]. If this is still insufficient, then intra-cavernosal injections of [[phenylephrine]] are administered. This should only be performed by a trained urologist, with the patient under constant [[hemodynamic]] monitoring, as [[phenylephrine]] can cause severe [[hypertension]], [[bradycardia]], [[tachycardia]], and [[arrhythmia]].

If aspiration fails and [[tumescence]] re-occurs, surgical shunts are next attempted. These attempt to reverse the priapic state by shunting blood from the rigid corpora cavernosa into the [[corpus spongiosum]] (which contains the [[Glans penis|glans]] and the [[urethra]]). Distal shunts are the first step, followed by more proximal shunts. 

Distal shunts, such as the Winter's, involves puncturing the glans (the distal part of the penis) into one of the cavernosa, where the old, stagnant blood is held. This causes the blood to leave the penis and return to the circulation. This procedure can be performed by a urologist at the bedside.

Proximal shunts, such as the Quackel's, are more involved and entail operative dissection in the [[perineum]] to where the corpora meet the spongiosum, making an incision in both, and suturing both openings together.<ref>{{cite journal |author=Montague DK, Jarow J, Broderick GA, ''et al'' |title=American Urological Association guideline on the management of priapism |journal=J. Urol. |volume=170 |issue=4 Pt 1 |pages=1318-24 |year=2003 |pmid=14501756 |doi=10.1097/01.ju.0000087608.07371.ca}}</ref>

==Female Priapism==
'''Female Priapism''' is very rare and normally goes undiagnosed or misdiagnosed. Emergency medical attention should be sought immediately. Treatment normally consists of medicinal pain management and hospital observation.

==Powerpoint Presentations==
[[Image:Priapism.ppt]]

==Footnotes==
<references/>

==References==
* Beers MH, Berkow R (Eds.) (1999). ''The Merck Manual of Diagnosis and Therapy'' (17 ed.). Whitehouse Station: Merck Research Laboratories. ISBN 0-911910-10-7
* Therapeutic Guidelines Limited (2001). ''Therapeutic Guidelines: Endocrinology'' (2 ed.). North Melbourne: Therapeutic Guidelines Limited. ISSN 1327-9505
* [http://www.auanet.org/guidelines/priapism.cfm/  Guidelines on management of priapism - American Urological Association website]
* Priapism Primer: [http://www.mediprimer.com/Urology/priapism/ Priapism]

{{Diseases of the pelvis, genitals and breasts}}
[[Category:Urology]]
[[Category:Andrology]]
[[Category:Medical emergencies]]
[[Category:Sexual health]]
[[Category:Penis]]
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[[bg:Приапизъм]]
[[ca:Priapisme]]
[[de:Priapismus]]
[[el:Πριαπισμός]]
[[es:Priapismo]]
[[fr:Priapisme]]
[[ko:지속발기증]]
[[id:Priapisme]]
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[[nl:Priapisme]]
[[no:Priapisme]]
[[pl:Priapizm]]
[[pt:Priapismo]]
[[ru:Приапизм]]
[[sv:Priapism]]
[[fi:Priapismi]]
[[vi:Chứng cương đau]]

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