PRIAPISM:PATHOPHYSIOLOGY AND TREATMENT

CHAIRMAN :DR .VIDYADHAR KINHALPRESENTER:DR.HARISH PATEL B N

VIMS BALLARI

PRIAPISM DEFINITION:

• Erection lasting for more than 4 hrs that is not associated with sexual stimulation.

• Incidence is bimodal – 5-10 yrs and 20-50 yrs.• Classification– Ischemic– Non ischemic

• • Incidence is 0.84 to 1.1 cases/100000 person

years

• Ischemic(low flow)• - Etiology• * 50% idiopathic• * Intracavernous theraphy (papaverine, • phentolamine, alprostadil)• * Psychiatric drugs (Chlorpromazine, • phenothiazine, clozapine)• * Sickle cell disease, leukemia• * Metastasis to corpora cavernosa

PATHOPHYSIOLOGY:

• Prolonged relaxation of intracavernosal SM.• Failure to metabolize neurotransmitters.• • Anatomical obstruction to venous outflow.• • Acidosis and tissue ischemia,hyper carbia.

• Non ischemic(high flow)• - Etiology• * Trauma (rupture of branches of

cavernosal artery)• - Unregulated increased arterial inflow.• - No acidosis no pain

• Evaluation• - History and physical examination• - Aspiration of penile blood and analysis

• - Duplex ultrasonography

Ph PO2 Pco2

ischemic <7.25 <30 >60

Non ischemic >7.3 >50 <40

Winter shunt

• Management of non ischemic priapism• - Observation• - Angiographic embolisation• - Surgical ligature of ruptured artery

• Recurrent (stuttering ) priapism• - Sickle cell trait, following an episode of priapism of any

etiology.• - Each episode must be managed accordingly.• - Prevention of further episodes * Oral alpha adrenergic medications * Self intracavernosal injection of alfa adrenergics * Antiandrogen or gonadotropin releasing hormone Agonist * Oral Baclofen

• THANK YOU

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