Priapism - what is it and how to treat it to a man?
|ICD-10||N 48.3 48.3|
|ICD-10-KM||N48.30 and N48.3|
|eMedicine||med / 1908|
Priapism consists in a long, usually painful erection, not associated with sexual arousal.
With priapism, an erection is permanent and often accompanied by painful sensations. An erection with priapism differs from the usual one in that:
- not related to sexual arousal,
- only cavernous (cavernous) bodies of the penis are filled with blood, and the head remains soft,
- the blood pressure in the penis is usually higher, as a result of which it bends toward the stomach.
- after a few hours painful
- does not pass after ejaculation
Priapism leads to stagnation of blood and inflammatory processes. Gangrene may develop.
The causes leading to priapism are poorly understood and represent a complex set of factors, but the main ones can be distinguished. Non-ischemic priapism usually develops after injuries of the penis, when the isolation between the arteries passing through it and the cavernous bodies is violated.
The causes of ischemic priapism are: inflammatory processes, alcohol or drug abuse (often its occurrence is associated with the use of cocaine), blood diseases (in particular sickle cell anemia), cancer, side effects of drugs, complications of sexually transmitted diseases, spinal cord injuries.
In October 2017, doctors removed the penis to a 52-year-old Taiwanese after a weekly erection. The cause of this condition was bladder cancer.
Pseudo-priapism is a temporary (usually nocturnal) erection and has nothing to do with true priapism.
Priapism is a pathologically persistent erection that occurs regardless of sexual desire and does not disappear after intercourse. Priapism is a rather rare condition that occurs in approximately 0.2% of urological patients of a wide age range (mainly 20-50 years). Priapism was first described in 1616 by Petraens, and pathology got its name from the ancient deity of fertility and voluptuousness of Priapus, the main attribute of which was a giant erect phallus. In urology and andrology, priapism refers to urgent conditions requiring emergency medical care.
Diagnosis of priapism
Diagnosing priapism is not particularly difficult. As soon as the doctor finds out about an erection, which lasts for several hours, but sexual desire is not observed, the diagnosis becomes clear. With an ischemic form of priapism, the patient also complains of pain in the penis and the womb. But in order to finally determine the type of disease, a number of instrumental and laboratory studies are carried out. One way to diagnose priapism is the results of fluorography of the penis. To do this, a contrast agent is injected into the cavity of the cavernous body using a thin needle. If the x-ray shows that the contrast medium extends beyond the borders of the penis, they diagnose a non-ischemic form of priapism, since blood does not flow from the vascular system of the penis. If the contrast medium seeps beyond the borders of the penis, then the diagnosis is ischemic priapism, because the cause of the disease will be a poor venous inflow to the penis. For the diagnosis of priapism, clinical blood tests are necessary. Also determine the gas composition of the blood of the cavernous bodies of the penis. To do this, while piercing the penis with a puncture needle, blood is taken from the cavernous bodies. The test results determine the concentration of oxygen in the penis and show the type of tissue deficiency of the penis. To clarify the diagnosis, puncture cavernous bodies. With non-ischemic priapism with good blood supply, the blood has a red color. With ischemic priapism, the blood is dark in color. Additionally, they diagnose diseases that could cause the development of determining symptoms of priapism. A pelvic examination is performed. The patient must undergo a full X-ray examination of the muscular and bone apparatus of the pelvis. The presence of disturbances in the activity of the central nervous system is also checked. Sensitive reflexes of the genitals and thigh skin are examined. A decrease in sensitivity indicates the presence of disorders of the nerve endings of the genitals, which may have caused priapism. A patient with priapism requires additional examinations of a hematologist, proctologist, neurologist.
In rare cases, priapism can be resolved without the help of a doctor. Sometimes an erection with priapism persists for several hours, then gradually passes, pain decreases, the density of cavernous bodies decreases. But often due to altered tissues of the corpora cavernosa in the penis, the ability to erection is partially or completely lost. Most often, with the first symptoms of priapism, a man with a pathological erection needs urgent medical attention. Conservative treatment of priapism gives good results only in the first hours after the onset of symptoms of priapism. To stop priapism, they take sedentary cold baths, hot water bottles are applied to the penis. Also, relief of the attack is facilitated by presacral and procaine blockades. Sometimes hirudotherapy (staging leeches) is applied to the area of the root of the genital organ. One of the most effective ways to stop an attack of priapism is considered to be aspiration-irrigation therapy with the introduction of intracavernosal alpha-adrenergic agonists. This method increases the likelihood of stopping a pathological erection in 60% of cases. Often, sedatives and anticoagulants are used to treat priapism. To stop priapism using aspiration-irrigation therapy, it must be carried out for at least an hour. If the cause of priapism is blood disease, then a pathological erection is eliminated by treatment of the underlying disease. During conservative treatment of priapism, control of heart rate and blood pressure is required.
In the absence of improvements in priapism, urgent hospitalization and subsequent treatment in a hospital are needed. If conservative treatment of priapism is ineffective, surgical intervention is necessary. The principle of surgical treatment of priapism is the normalization of venous blood drainage from the cavernous bodies of the genital organ. A common method for surgical treatment of priapism is percutaneous shunting. Using this method, a fistula is formed between the spongy body and the cavernous bodies. Using a scalpel or biopsy needle, puncture the cavernous bodies in the apical zone. This procedure is performed under local anesthesia. Another method for surgical treatment of priapism is open shunting. The doctor provides access to the cavernous bodies and their apical departments. Access is performed on the dorsal surface of the glans penis parallel to the coronary sulcus. Next, a hole with a diameter of five mm is formed and the cavernous bodies are washed with sodium heparin solution. During the procedure, the patient is under general anesthesia. If the application of spongiocavernous fistula is ineffective, proximal bypass surgery is performed. With this method, the albuminous membrane of the corpora cavernosa is isolated. For this, a urethral catheter is pre-installed with a crotch or transverse scrotal incision. In the spongy body and in the white membrane of the corpora cavernosa, the doctor forms ellipsoidal windows. Then the cavernous bodies are washed and a spongiocavernous fistula is formed. This type of shunting is performed under general anesthesia. Surgical intervention with priapism can cause a temporary violation of erectile function, a decrease in sexual desire.
Additionally, they diagnose and treat those diseases that caused priapism. Patients with blood diseases often need chemotherapy. Patients with sickle cell anemia need exchange blood transfusion, oxygenation, and erythrophoresis to normalize their hemoglobin levels.
What is priapism?
The main symptom that characterizes priapism in men is a stable erection, not associated with sexual arousal. With the help of sexual intercourse or masturbation it is impossible to cope with it. This condition is quite rare - less than 1% among urological patients.
The disease is classified depending on the development mechanism:
- Non-ischemic, also called venous. It occurs due to a violation of the mechanism of blood inflow and outflow. Excessive arterial inflow leads to fluid accumulation in the cavernous bodies of the penis. Most often develops against a background of damage to the penis or perineum,
- Ischemic, or veno-inclusive. It is associated with inferior venous blood excretion due to the high viscosity of the composition, stagnation or the presence of blood clots. Causes tissue damage called ischemia. It is characterized by high pain.
An acute and chronic course of the disease can be observed. In addition, clinicians identify a condition called nocturnal priapism, or pseudo-priapism. The main diagnostic signs are the occurrence of an erection several times during the night. Sometimes it manifests itself in the daytime, if a man has a habit of sleeping during this period. It is accompanied by a feeling of heaviness and severe pain that does not allow you to fall asleep.
How to treat priapism in a man?
Turning to the doctor in the first hours of the development of the disease, you can quickly diagnose priapism. Treatment in this case is prescribed conservative, without the use of surgical intervention. The non-ischemic form is best amenable to puncture under local anesthesia:
- Cavernous bodies pierce
- Excess blood is removed
- Rinsing is carried out - until the water turns red.
An attack of ischemic priapism immediately after the onset is sometimes removed by sitting bathtubs or cold compresses. Perhaps the use of hirudotherapy (treatment with leeches).
Medication includes intravenous and intramuscular administration of Relanium or drugs designed to improve blood counts. In some cases, they resort to novocaine blockade. If more than 6 hours have passed after the occurrence of an erection, then injections of Mesatone or Phenylephrine are necessary, which reduce swelling and blood pressure in the vessels. The funds will work if you give an injection in the first 24 hours after the onset of the attack.
If a continuous erection was the result of a somatic disease, then the therapy of the underlying disease begins. In the case of late treatment, conservative methods are ineffective. In this case, an operation is required, which is also prescribed if the disease reappears. To eliminate the pathological condition, they resort to one of the surgical techniques:
- Installation of a shunt in the area of the cavernous bodies and the head of the genital organ,
- Shunting between the spongy and cavernous bodies, is unilateral and bilateral,
- The discovery of additional blood flow between the vein and the cavernous body, a similar technique is resorted to in exceptional cases.
An important point in the treatment of the disease is rehabilitation, especially for adolescents who have once had an attack. Perhaps the development of a stable complex of fears and anxiety reactions associated with the intimate side of life. It is important to provide the young man with the support and counseling of an experienced psychologist specializing in sexual trauma as soon as possible.
One of the unpleasant consequences of surgery is temporary impotence, which lasts up to several months. In some cases, priapism can cause prolonged erectile dysfunction of both organic and psychological origin.
Priapism at night
Therapy of the form of the disease, called in clinical practice intermittent priapism, it is also nocturnal, for the most part differs from the treatment regimen for other types of ailment. The very first step is to cover the genital organ with cold warmers, but this approach only helps to remove a momentary attack, without affecting the root cause.
According to studies, nocturnal priapism is a consequence of developed depression and, accordingly, the reasons lie exclusively in the field of psychology and neurology. Thus, the impact on the background of the disease is carried out using:
- Antipsychotics and antidepressants,
- Visits to psychotherapeutic sessions,
- Carrying out auto-training.
In some cases, hypnosis is indicated to eliminate neurotic disorders.
It is difficult to fully prevent the disease, because the prerequisites for the development of an attack are not fully understood. However, there is a small list of recommendations to help reduce the risk of a disease:
- Avoid injuries to the genitals, spine, perineum,
- Timely undergo treatment for inflammatory diseases of the genitourinary system,
- Visit your urologist regularly for early diagnosis of tumors and subsequent treatment,
- To treat diseases of a neurological and hematological nature,
- Stop drinking alcohol and drugs,
- Take medications strictly for medical purposes, and immediately report any negative changes to your doctor.
Painful penile tension, which is not accompanied by sexual desire and arousal and does not end with the release of seminal fluid during coitus, is called priapism in medicine.
Pathology got its name from the Latin word “priapismus” after the ancient Greek deity Priapus (Priapus) - the son of Dionysus and Aphrodite, the god of fields and vineyards (in all paintings he is depicted with an erect penis, a symbol of fertility).
The basis of morphological changes in priapism is a violation of blood circulation in the vessels of the penis and cavernous (cavernous) tissue, which can occur against the background of a decrease in venous outflow or an increase in arterial blood flow to the cavernous bodies.
Cavernous bodies are called two structurally longitudinally located erectile units, which together with the spongy body form the stem of the penis. The main function of the corpora cavernosa is the blood filling of the penis, which underlies the mechanism of the occurrence of an erection in men. When overfilling of the cavernous tissue with blood occurs, a prolonged and painful erection occurs, which is called priapism.
The pathogenesis of priapism in most cases is represented by the following changes:
- filling the cavernous bodies with thick dark blood,
- the formation of blood clots (blood clots) in the vessels of the penis,
- irreversible metabolic disturbances in the cavernous tissue, preceding partial or complete necrosis of the affected areas,
- the accumulation of inflammatory and tumor (if any) infiltrates according to the type of small-point infiltration.
With long-term acute or chronic priapism in the penis, sclerotic changes occur.This means that the organ tissue is gradually replaced by dense fibrous (connective tissue) fibers, which ultimately leads to fatty degeneration of the affected tissue and the loss of its physiological functions.
Important! Only 10-22% of men with this disease manage to achieve partial restoration of sexual abilities after appropriate surgical correction. The maximum chances of recovery are at an early stage, when there are no manifestations of thrombosis and sclerosis. With a later visit to the doctor, serious complications may develop, including impotence, necrosis of the cavernous tissue, followed by decay (gangrene of the penis), as well as blockage of the penis vessels with blood clots.
Priapism, caused by local pathological changes in the structure of the penis, is called idiopathic. It can cause penile injuries, various tumor processes (including metastasis), inflammation of the cavernous tissue (cavernitis) and thrombosis of the corpus cavernosum of the organ.
Idiopathic priapism can occur in two forms: ischemic (the more common name is venous) and arterial. In both cases, the pathophysiological changes are based on overfilling of blood vessels, but the mechanism of development of stagnant processes and pathology symptoms differ significantly depending on the type of hemodynamic disorders.
Idiopathic priapism: types and symptoms
|Blood in the cavernous bodies stagnates as a result of an acute violation of the venous outflow. Intracavernous pressure (pressure inside the cavernous body) is usually significantly less than or equal to systolic values. The blood flow through the arteries is impaired, the pathology has pronounced clinical symptoms.||Symptoms of ischemic priapism are pronounced and allows you to visually diagnose pathology at the stage of primary diagnosis even without the use of specialized hardware and instrumental methods.|
Typical symptoms for this type of disorder are edema and hyperemia of the penis, severe pain during an erection, cyanosis (cyanosis).
Separately, experts also distinguish a drug (drug) form of priapism that develops against the background of local injection of vasoactive drugs into the cavernous space of the penis. Medicinal priapism is usually short-term, proceeds with mild or moderate symptoms and has a reversible course, that is, it passes completely after the cancellation of the provoking factor.
Important! General diseases, for example, severe infectious diseases or various poisonings, can also provoke a prolonged erection in men.
One of the frequent factors for the development of priapism in men from different age groups are blood diseases (leukemia, sickle cell anemia) and sexually transmitted diseases.
Chronic intoxication of the body with toxic and toxic substances: ethanol, tobacco smoke, drugs (mainly cocaine) can also cause erectile dysfunction in the form of spontaneous and painful erections.
Some urologists are at increased risk for men with chronic and recurring diseases of the urinary tract, as well as severe kidney disease.
We recommend that you read the article "Impotence in men." In this article, you will learn all about the causes of impotence, symptoms, treatment and preventative measures. Remember: a problem is always easier to prevent than to treat.
Features of the disease
When a man really wants to have sexual contact, complex processes are launched in his body that lead to excitement. An erection occurs after the smooth muscles of the penis are completely relaxed and arterial blood enters its cavernous bodies. As a result, the penis increases in size and acquires hardness.
In the excited state, the penis will remain until the cavernous bodies squeeze the veins, interfering with the outflow of blood. The logical conclusion to sexual intercourse is ejaculation and orgasm, after which the cavernous bodies stop blocking the outflow of blood through the veins. The penis shrinks and becomes soft.
With priapism, the outflow of blood from the cavernous bodies of the penis is impaired, the erection persists for a long time. Soon it becomes painful, and the penis acquires a bluish tint.
The manifestations of the disease may differ slightly from the type of pathology:
- Ischemic priapism - the outflow of blood from the penis is completely absent. In this case, an erection lasts at least 4 hours. It is not connected with the sexual desires of men, continues even after sexual intercourse. The body of the penis is very hard, and the head is soft, because of the difference in pressure, the penis bends towards the stomach. The ischemic form of the disease can be recurrent or irreversible. In the first case, a prolonged erection occurs from time to time, its duration is less than 3 hours. The irreversible form of priapism is especially dangerous and requires immediate medical attention.
- Non-ischemic priapism, characterized by the presence of a slight outflow of blood. An erection in this case will be just as long, but the penis is not painful and softer than with an ischemic form of the disease.
In addition, there is a false priapism. So called involuntary nocturnal erection, which has nothing to do with true priapism, which is a serious disease.
You can get more detailed information about this problem from the video, where experienced specialists talk about the characteristics of the disease and modern methods of treatment.
Cases of prolonged painful agitation can also be observed in women. Female priapism is manifested in an increase in the clitoris (up to 2 cm), it becomes painful, changes color. Even in the absence of physical or psychological stimulation, the clitoris does not decrease in size. This condition can last from several minutes to several days.
The female type of pathology and male priapism have similar sources of occurrence - pathological processes that cause impaired blood flow in the human genitals.
The main cause of painful and prolonged erections is stagnation of blood in the cavernous bodies of the penis. The blood circulation process may be impaired due to the negative effects of various factors. One of them is inflammation of the prostate.
The prostate gland is responsible for:
- sperm quality. In the prostate gland, prostatic juice is synthesized - this fluid forms the basis of sperm,
- actively involved in the process of ejaculate ejection during intercourse,
- directly responsible for bringing the penis into an excited state and getting an orgasm,
- controls the blood supply to the penis and other organs of the urogenital system of a man,
- forms the hormonal balance of a man, since it is in the prostate that testosterone becomes active.
Inflammatory processes occurring in the prostate gland are commonly called prostatitis. Usually this disease leads to the fact that a man has difficulty with an erection. Due to circulatory disorders, the cavernous bodies of the penis are not filled with enough blood, and, therefore, an erection does not occur.
But sometimes inflammatory processes in the prostate block blood flow in such a way that the cavernous bodies filled with blood cannot be emptied, and the penis remains in an excited state for several hours.
Other causes of priapism
Priapism can occur at any age. Cases of this pathology were noted in boys 5-6 years old, as well as in mature people, whose age is 45-50 years. Such factors can provoke a disease:
- Injuries affecting the base of the penis.
- Oncological diseases.
- Pathological processes that have a negative effect on the blood vessels that are located in the lower back and tailbone.
- Blood diseases.
- Intoxications of various nature, including drug overdose, alcohol abuse, etc.
- Infectious diseases, such as rabies and typhoid.
- Decompensated renal failure.
- Forced sexual arousal for a long time.
Priapism can develop against the background of psychoemotional trauma received by a man during intercourse. Some medications can lead to this condition. Among them are strong psychotropic drugs, antidepressants, sedatives, anticoagulants with indirect effects, as well as drugs that can help achieve a temporary erection.
Classification of Priapism
Depending on the mechanism of development, non-ischemic (arterial, High-flow type) and ischemic (veno-occlusive, Low-flow type) priapism are distinguished. The basis of non-ischemic priapism is an excess flow of arterial blood into the cavernous bodies with undisturbed venous outflow. In this case, ischemia of the tissues of the penis does not develop, and the erection itself proceeds painlessly. Ischemic priapism occurs due to inferior venous outflow from the penis caused by increased blood viscosity, thrombosis, venous congestion, etc. This is the most unfavorable form of priapism, leading to ischemic damage to the tissues of the penis. According to the clinical course, priapism can be acute and chronic (intermittent, intermittent).
Prediction and prevention of priapism
Delaying a visit to a doctor and attempts to independently eliminate priapism can lead to serious complications - persistent erectile dysfunction, necrosis and penis gangrene. Competent and timely treatment can completely eliminate the problem and preserve the man's full sexual function. The prevention of priapism attacks is facilitated by the avoidance of trauma to the genitals, treatment of neurological, urological, hematological pathologies, and the administration of medicines strictly prescribed by a doctor. The quality of life of patients and the threat of the recurrence of attacks of priapism to a large extent depend on the course of the underlying disease.
Types and causes of priapism
Priapism can be true or false. In urology, two fundamentally different types of true priapism are distinguished: ischemic and non-ischemic. In both cases, the cause is impaired circulation. With false priapism, blood flow is not changed. This form is usually caused by psychogenic factors. Idiopathic priapism also occurs, the causes of which cannot be determined.
Ischemia is a lack of blood supply, due to which the tissue or organ lacks nutrition. With a normal erection, the mechanism of neuromuscular regulation is triggered: the vessels of the body of the penis relax and are intensely filled with blood. Upon reaching a certain volume, receptors are turned on, which cause the surrounding protein membrane (tunic) to contract and squeeze the diverting veins (veno-occlusive mechanism). As a result, a certain amount of blood is temporarily turned off from the general circulation. After ejaculation, the tunic relaxes, blood flows through the veins.
With ischemic priapism, venous outflow is practically absent. The danger lies in the fact that after four hours of such stagnation, severe pain occurs, the blood begins to change its composition, the tissues washed by it experience an acute deficiency of oxygen and nutrition. After some time, an infection may join, which will lead to inflammation of the corpora cavernosa (cavernitis). Symptoms: redness (hyperemia) and fever (hyperthermia) of the penis. General body temperature may rise.
After 12 hours, the fibrosis mechanism starts (sclerosing) - cavernous cavities are deformed and replaced by connective non-functional tissue (cavernous fibrosis). If the process is not stopped, then in about a day irreversible impotence will occur - cavernous bodies will no longer be able to fill with blood, a natural erection will never come. In this case, the only way out is falloprosthetics (implantation into a member of artificial cavernous bodies in the form of cylinders).
The worst outcome of priapism is gangrene, penile tissue death. The head first becomes raspberry, then purple, layers of skin (spongy tissue) descend in layers, dark patches of necrosis appear on the trunk of the penis.
Signs and Symptoms
The diagnosis of priapism is almost always established during the initial visit to a specialist, since the pathology has typical symptoms that are well recognized and visually determined. The main one is a painful erection, which persists for several hours and does not pass after coition (sexual intercourse). The pathological tension of the penis gives the man a lot of bodily and moral suffering, and in some cases the pain is so intense that it can only be removed with the help of emergency surgical intervention.
Other signs of priapism that accompany a pathological erection are also:
- lack of sexual attraction to a partner and sexual arousal,
In some cases, priapism at the beginning of the permanent course is not accompanied by pain, but after a few hours the erection becomes painful, and the penis swells, and signs of cyanosis appear on it.
Video - Urologist and sex therapist about priapism in men
Priapism is a rather rare disease that occurs only in 3-5% of men (without reference to the age criterion). Despite a favorable prognosis for life (with the exception of cases when priapism is a consequence of malignant diseases), with respect to the sexual function of a man, any treatment cannot be considered effective. In the vast majority of cases, after prolonged priapism, complete sexual extinction occurs, but even if doctors manage to maintain erectile function, the quality of intimate life after a disease has noticeably decreased. There is no specific prophylaxis of pathology, and timely treatment of any diseases (especially infectious and inflammatory pathologies of the urinary tract and blood diseases), balanced nutrition and sufficient motor activity are recommended as general measures to prevent priapism.
Causes, symptoms and traditional treatment of priapism
Priapism is a disease caused by prolonged persistent erection of the penis, which is in no way associated with sexual arousal and in most cases causes unpleasant pain. Priapism was first described in 1616, so today a lot is known about it.
It is known that the penis of a man consists of one spongy and two cavernous bodies. Normal erection occurs due to increased arterial blood flow in the two cavernous bodies and the relaxation of smooth muscles. Thus, cavernous bodies increase and begin to compress the veins running along the penis.Priapism is clearly visible in the photo.
Traditional medicine treatment
At the first stage of treatment, the patient is prescribed applying cold in the form of an ice bag or bubble with cold water on the penis. As for drug treatment, it is prescribed depending on the type of priapism and severity.
Highly often at the initial stage of treatment, puncture of the penis cavernous bodies is carried out using a special needle. This procedure is a suction of excess blood and is performed under local anesthesia.
Unfortunately, sometimes medications do not help to overcome this disease, therefore, in this case, doctors resort to urgent surgical intervention. During surgery between the veins of the penis and other veins, a separate drainage vessel is created to accelerate the outflow of blood. Cases were observed when the patients underwent impotence, but after some time the sexual function is restored and everything returned to normal.
Penile fracture is one of the most unpleasant and dangerous injuries for a man!
By following this link, you will learn how to improve potency with folk remedies.
In any case, this the disease is treated and does not irreversibly affect the sex life of a man. But, as experienced urologists say, even the most insignificant, but neglected disease can lead to unpredictable consequences, so a man himself must go in time not to see a doctor so that he does not repent of his delay for a long time.