Priapism is a urologic emergency characterized by a persistent, painful penile erection that is unrelated to sexual stimulation. It may begin during sleep and initially resemble a normal erection but can persist for hours or days. Patients often experience a severe, constant, dull ache. Embarrassment may delay presentation, and patients may attempt self-relief.

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

Pathophysiology

Priapism occurs when venous outflow from the corpora cavernosa is impaired, leading to persistent engorgement of erectile tissues:

• Idiopathic: Approximately 50% of cases have no identifiable cause.

• Hematologic disorders: Sickle cell anemia causes vaso-occlusion and impaired venous drainage.

• Neoplasms: Penile or pelvic tumors may compress the corpora cavernosa.

• Neurologic injury: Spinal cord injury or stroke can disrupt autonomic control.

• Drug-induced: Phenothiazines, thioridazine, trazodone, androgenic steroids, anticoagulants, antihypertensives, or intracorporeal papaverine injections.

Emergency interventions

• Apply an ice pack to the penis.

• Administer analgesics for pain relief.

• Insert an indwelling urinary catheter if urinary retention occurs.

• Surgical interventions such as corporal irrigation or shunt procedures may be required to remove trapped blood.

History and Physical Examination

Onset and Pattern

• Determine when the priapism began and whether it is continuous or intermittent.

• Ask about previous episodes, self-relief attempts, pain with urination, and sexual function changes.

Medical History

• Investigate sickle cell anemia and precipitating factors (dehydration, infection).

• Ask about recent genital trauma.

• Obtain a comprehensive drug history, including injected substances.

Physical Examination

• Inspect the penis for color, temperature, swelling, or signs of infection (redness, discharge).

• Assess sensation and vital signs, particularly fever.

Medical causes

Special Considerations

• Prepare for blood tests to identify underlying causes.

• Post-surgery, keep the penis flaccid with a pressure dressing.

• Inspect the glans every 30 minutes for vascular compromise (coolness, pallor).

Patient Counseling

• Explain the cause of priapism and the importance of early treatment.

• Advise patients with sickle cell anemia to report episodes promptly.

• Discuss pain management and follow-up care after medical or surgical interventions.

Pediatric Pointers

• In neonates, priapism may result from hypoxia, often resolving with oxygen therapy.

• Children with sickle cell disease are at higher risk than adults.

• Prompt evaluation is essential to prevent permanent erectile dysfunction.

References

1. Buttaro, T. M., Tybulski, J., Bailey, P. P., Sandberg-Cook, J. Primary Care: A Collaborative Practice (pp. 444–447). St. Louis, MO: Mosby Elsevier; 2008.

2. Lehne, R. A. Pharmacology for Nursing Care (7th ed.). St. Louis, MO: Saunders Elsevier; 2010.

3. Sommers, M. S., Brunner, L. S. Pocket Diseases. Philadelphia, PA: F.A. Davis; 2012.