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ULY CLINIC

29 Oktoba 2026, 11:47:32

Priapism

Priapism is a urologic emergency defined as a persistent, painful penile erection that is unrelated to sexual stimulation. It may begin during sleep, mimic a normal erection, but persist for hours or days, often accompanied by a constant dull ache.

Without prompt treatment, venous congestion of the corpora cavernosa can lead to penile ischemia, thrombosis, and permanent erectile dysfunction.

Emergency interventions

Apply ice packs to the penis.
Administer analgesics for pain relief.
Insert an indwelling urinary catheter if urine retention occurs.
Surgical intervention may include corporal irrigation or shunt procedures to remove trapped blood.

History and Physical Examination

Onset and Pattern

Determine when priapism began and whether it is continuous or intermittent.
Ask about previous episodes, self-relief attempts, pain during urination, and changes in sexual function.

Medical History

Investigate sickle cell disease, including precipitating factors like dehydration or infection.
Ask about recent genital trauma.
Obtain a drug history, including injected substances or intracorporeal medications.

Physical Examination

Inspect the penis for color, temperature, swelling, or signs of infection (redness, discharge).
Assess sensation and vital signs, particularly fever.

Medical causes

Cause	Clinical Features	Notes
Idiopathic	Onset without clear predisposing factors	~50% of cases
Sickle cell anemia	Painful priapism, often on awakening, history of priapism, pallor, tachycardia, hepatomegaly, joint/bone pain, leg ulcers, jaundice, fatigue	Episodes may worsen during a sickle cell crisis
Penile cancer	Pressure on corpora cavernosa, painless ulcerative lesion or warty growth, localized pain, foul-smelling discharge, lymphadenopathy, dysuria, bladder distention	Risk factors include phimosis and poor hygiene
Spinal cord injury	Priapism may occur without awareness, autonomic changes such as bradycardia	Depends on level and extent of injury
Stroke	Priapism may go unnoticed due to sensory deficits or aphasia; may have contralateral hemiplegia, seizures, dysphagia, visual deficits, urinary or fecal incontinence	Depends on stroke location
Drugs	Phenothiazines, thioridazine, trazodone, androgenic steroids, anticoagulants, antihypertensives, papaverine injections	Drug-induced priapism

Special considerations

Prepare the patient for blood tests to identify underlying causes.
Post-surgical care includes keeping the penis flaccid with a pressure dressing.
Monitor the glans every 30 minutes for signs of vascular compromise (coolness or pallor).

Patient counseling

Explain the cause of priapism and the importance of early treatment.
Advise patients with sickle cell anemia to report episodes immediately.
Discuss pain management and follow-up care after surgical or medical interventions.

Pediatric pointers

In neonates, priapism may result from hypoxia, often resolving with oxygen therapy.
Children with sickle cell disease are at higher risk compared to adults.
Prompt evaluation is essential to prevent permanent erectile dysfunction.

References

Buttaro, T. M., Tybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2008). Primary Care: A Collaborative Practice (pp. 444–447). St. Louis, MO: Mosby Elsevier.
Lehne, R. A. (2010). Pharmacology for Nursing Care (7th ed.). St. Louis, MO: Saunders Elsevier.
Sommers, M. S., & Brunner, L. S. (2012). Pocket Diseases. Philadelphia, PA: F.A. Davis.

Disclaimer: The information on this website is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional for medical concerns or emergencies.