Priapism Diagnosis
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Updated on 16 April, 2024
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What Is Priapism?
Priapism is a medical condition characterized by an uncontrolled erection or persistent erections that lasts longer than four hours without sexual arousal or stimulation – it essentially is a painful erection. It is a rare condition but can have serious implications if not diagnosed and treated promptly. Priapism can occur in males of all ages, including newborns, children, and adults.
The diagnosis is crucial in determining the underlying cause and providing appropriate medical treatment.
Symptoms of Priapism
The main symptom includes a prolonged erection that lasts for more than four hours. This erection is often painful and not associated with sexual arousal or stimulation. Other symptoms may include swelling of the penis, tenderness, and the inability to achieve or maintain an erection in the future.
Types of Priapism
There are two types of priapism: low-flow (ischaemic priapism) and high-flow (nonischemic priapism)
- Low-flow priapism, also known as ischaemic priapism, is the most common type and occurs when blood is trapped in the penis, leading to a lack of oxygen to the tissues. It is also the most painful and gets more painful as the time passes.
- High-flow priapism, also known as nonischaemic priapism, is less common and occurs when there is too much blood flow to the penis, often due to an injury.
Diagnosis Of Priapism
Priapism is diagnosed through a physical exam, medical history, and laboratory tessting. During a physical exam, the doctor will check for signs of swelling, pain, or redness in the genital area. They may also check for any signs of infection, injury, or other medical conditions that may be causing the priapism. The doctor may also ask questions about the patient’s medical history, sexual history, and current medications.
What to Expect During Diagnosis?
Medical or Clinical Histories
A comprehensive history is one of the most critical components of diagnosis. A detailed history of the patient’s medical and sexual history can provide essential clues to the underlying cause of the priapism. The doctor will typically ask the following questions:
Duration and onset: The doctor will ask the patient about the duration and onset of the priapism. Acute priapism lasts less than 72 hours, or chronic, lasting more than 72 hours. Acute priapism is usually idiopathic or related to trauma, while chronic priapism is usually related to underlying medical conditions.
Medical history: The doctor will ask the patient about their medical history, including any chronic medical conditions such as sickle cell disease, leukemia, or diabetes – which are known to cause this condition.
Medications: The doctor will ask the patient about any medications they are taking, including prescription and over-the-counter medications. Medications such as anticoagulants, antidepressants, and antihypertensive agents are known to cause this condition.
Recreational Drug and alcohol use: The doctor will ask the patient about their sexual history, including their sexual orientation, frequency of sexual activity, and any history of sexually transmitted infections. They would also check with the patient for any history of substance use. Illicit drugs such as cocaine and marijuana have been linked to the condition.
AdvertisementsSexual history: The doctor will ask the patient about their sexual history, including their sexual orientation, frequency of sexual activity, and any history of sexually transmitted infections.
Trauma/Injury history: The doctor will ask the patient about history of any injury or trauma.
Surgical history
Laboratory Diagnostic Tests
These tests may include a complete blood count, urinalysis, blood glucose test, and tests to check for sexually transmitted infections. The doctor may also perform imaging tests, such as an ultrasound or MRI, to check for any abnormalities in the blood vessels or tissues in the penis.
If a patient is experiencing priapism, they should seek immediate medical attention. The doctor will perform a physical exam and ask questions about the patient’s medical history and symptoms. They may also order laboratory tests and imaging tests to help diagnose the condition.
During the physical exam, the doctor will check for any signs of swelling, pain, or redness in the genital area. They may also check for any signs of infection, injury, or other medical conditions that may be causing the priapism. The doctor may also ask questions about the patient’s sexual history, including any recent sexual activity or use of erectile dysfunction medications.
Physical examination
After obtaining a detailed medical history, the doctor will perform a physical examination. The physical examination typically involves the following:
Inspection of the penis: The doctor will visually inspect the penis to assess its size, color, and any signs of trauma or infection.
Palpation of the penis: The doctor will gently palpate the penis to assess for any areas of tenderness or induration.
Neurological examination: The doctor will perform a neurological examination to assess for any abnormalities in sensation or reflexes.
Assessment of the perineum: The doctor will assess the perineum for any signs of swelling or tenderness.
Blood Tests
Blood tests are typically performed to evaluate the blood cell count, electrolyte levels, and renal and hepatic function. These tests can help identify any underlying medical conditions that may be contributing to the priapism, such as sickle cell disease, leukemia, or liver disease. Additionally, blood tests can help determine the oxygen levels in the penis, which can aid in determining the type of priapism.
Imaging Tests
Imaging tests such as ultrasound, MRI, or CT scans may be used to evaluate the blood flow to the penis and identify any blockages or abnormalities in the blood vessels. Ultrasound is often the preferred imaging modality due to its non-invasive nature and ability to provide real-time imaging of blood flow.
Aspiration and analysis of penile blood
If the type of priapism is unclear, aspiration and analysis of penile blood can help differentiate between ischaemic and nonischaemic priapism. A needle is inserted into the penis to aspirate the blood, which is then analyzed for pH levels, oxygenation, and the presence of abnormal blood cells.
Ischaemic priapism typically has low pH levels and low oxygenation, whereas nonischaemic priapism has normal or high pH levels and normal oxygenation.
Dynamic infusion cavernosometry and cavernosography (DICC)
DICC is an invasive test that involves the injection of medication into the penis to induce an erection. This is followed by the insertion of a catheter to measure the pressure in the penis and evaluate the blood flow. Cavernosography involves the injection of a contrast dye into the penis to visualize the blood vessels and identify any abnormalities or blockages.
What Questions Should a Patient Have for Their Doctor?
If a patient is diagnosed with priapism, they may have questions about the condition, its causes, and medical treatment options. Some questions that a patient may want to ask their doctor include:
- What is priapism, and what causes it?
- How is priapism diagnosed, and what tests will I need?
- What are the treatment options for priapism?
- What are the risks and benefits of each treatment option?
- How long will treatment take, and what should I expect during treatment?
- What are the possible complications of priapism?
- What can I do to prevent priapism from occurring in the future?
- Are there any lifestyle changes that I should make to help manage my priapism?
- What follow-up care will I need after treatment?
It is important for patients to ask questions and communicate openly with their doctor to ensure that they understand their condition and treatment options.
Approach For Priapism Treatment
The treatment depends on the underlying cause of the condition. In cases of low-flow priapism, the healthcare provider may attempt to drain the blood from the penis using a needle or catheter. Medications, such as phenylephrine or epinephrine, may also be used to constrict the blood vessels and reduce blood flow to the penis.
In cases of high-flow priapism, the healthcare provider may attempt to block the blood vessels causing the excess blood flow. This can be done using a catheter or surgery.
In some cases, surgery may be necessary to treat priapism. Surgery can involve the placement of a shunt, which allows blood to flow out of the penis and relieve the pressure, or the removal of the blood clot causing the blockage.
The Importance of Prompt Diagnosis and Treatment
Prompt diagnosis and treatment are crucial in preventing complications and preserving erectile function. If left untreated, priapism can cause permanent damage to the tissues in the penis, leading to erectile dysfunction or other complications.
In addition to physical complications, the condition can also have a significant impact on a person’s emotional and psychological well-being. Men with priapism may experience anxiety, depression, or embarrassment, which can lead to a decrease in sexual confidence and intimacy. It is important to seek prompt medical attention. Delaying treatment can increase the risk of complications and decrease the effectiveness of treatment options.
Comprehensive List of Diseases or Disorders
Diagnosing the underlying cause of priapism can be complex as it may be associated with various diseases or disorders. A thorough evaluation and testing are essential to identify the root cause of priapism and initiate appropriate treatment.
- Sickle Cell Disease: Sickle cell disease is a genetic blood disorder that affects the shape and function of red blood cells. It is one of the most common causes of priapism, particularly in children and young adults with sickle cell trait or sickle cell anemia. In sickle cell disease, the abnormal sickle-shaped red blood cells can block the blood vessels in the penis, leading to priapism.
Diagnosis: A blood test to check for the presence of sickle hemoglobin (hemoglobin S) is typically performed. Additional tests, such as a complete blood count (CBC) and hemoglobin electrophoresis, may also be done to confirm the diagnosis.
- Leukemia: Leukemia is a type of cancer that affects the bone marrow and blood. Priapism can be a rare complication of leukemia, particularly in acute leukemia. The abnormal accumulation of leukemia cells in the blood vessels of the penis can disrupt normal blood flow and cause priapism.
Diagnosis: A complete blood count (CBC) with peripheral blood smear, bone marrow biopsy, and cytogenetic studies may be performed to confirm the diagnosis of leukemia.
- Hemophilia: Hemophilia is a rare genetic bleeding disorder in which the blood does not clot normally. Priapism can occur in individuals with hemophilia due to the accumulation of blood in the penis from impaired clotting.
Diagnosis: Blood tests to measure clotting factors VIII and IX, and a bleeding time test may be done to confirm the diagnosis of hemophilia.
- Malignant Tumors: Certain malignant tumors, such as prostate cancer or bladder cancer, can cause priapism by compressing the blood vessels in the pelvis or invading the nerves that control blood flow to the penis.
Diagnosis: Imaging studies, such as ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI), may be performed to detect the presence of tumors.
- Neurological Disorders: Various neurological disorders, including spinal cord injury, multiple sclerosis, and syphilis, can disrupt the normal nerve signals that regulate blood flow to the penis and result in priapism.
Diagnosis: Neurological examination, imaging studies, and blood tests may be conducted to evaluate the neurological function and identify the underlying disorder.
- Drug-induced Priapism: Certain medications, such as those used to treat erectile dysfunction (e.g., sildenafil, tadalafil), psychotropic drugs (e.g., trazodone), or blood thinners (e.g., heparin), can cause priapism as a side effect.
Diagnosis: A comprehensive review of the patient’s medication history and physical examination may help identify the medication responsible for priapism.
- Hormonal Disorders: Hormonal imbalances, such as testosterone deficiency or excess, can affect the normal erectile function and potentially result in priapism.
Diagnosis: Blood tests to measure hormonal levels, including testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin, may be performed to determine if a hormonal disorder is causing priapism.
- Infections: Certain infections, such as sexually transmitted infections (STIs) like syphilis, can lead to priapism by affecting the blood vessels or nerves in the penis.
Diagnosis: Blood tests, imaging studies, and specific tests for the suspected infection may be conducted to confirm the presence of an infection.
- Idiopathic Priapism: In some cases, the cause of priapism may remain unknown, and it is referred to as idiopathic priapism. It is important to thoroughly evaluate and rule out other potential causes of priapism before making a diagnosis of idiopathic priapism.
Diagnosis: Diagnosis of idiopathic priapism is based on excluding other known causes of priapism through comprehensive medical history, physical examination, and appropriate diagnostic tests.
