eMedicine Specialties > Urology > Common Problems of the Penis

Priapism: Differential Diagnoses & Workup

Author: Hosam S Al-Qudah, MD, Assistant Professor of Urology, Department of General Surgery, Jordan University of Science and Technology, Irbid, Jordan
Coauthor(s): Osama Al-Omar, MD, Director of Urology, Warren General Hospital; Monica Parraga-Marquez, MD, Consulting Staff, Department of Emergency Medicine, Metropolitan Hospital Center; Clinical Assistant Professor, Department of Emergency Medicine, New York Medical College; Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction; Paul S Wahlheim, MD, Staff Physician, Department of Emergency Medicine, Metropolitan Hospital, New York Medical College
Contributor Information and Disclosures

Updated: Mar 3, 2008

Differential Diagnoses

Sickle Cell Anemia

Other Problems to Be Considered

The diagnosis of priapism is straightforward, depending on the physical findings. Pathologic states associated with priapism give rise to the differential diagnosis. Some of the major considerations are as follows:

Intracavernosal agents used to treat impotence
Oral agents used to treat impotence
Sickle cell disease (SCD)
GU trauma
Medications
Cocaine
Spinal stenosis
High spinal cord injury

Workup

Laboratory Studies

  • Complete blood cell count: This is performed to determine if the patient has anemia, leukocytosis, or thrombocytosis.
  • Plasma thromboplastin or activated partial thromboplastin time: Priapism may require surgical intervention if medical treatment fails.
  • Blood type and hold: Exchange transfusion may be necessary to treat underlying sickle cell disease (SCD).
  • PBG measurement  
    • Test results allow differentiation between high- and low-flow priapism.
    • Low-flow PBG findings may include a pH of less than 7.0, a PCO2 of greater than 60 mm Hg, and a PO2 of less than 30 mm Hg. Variation depends on duration.
    • High-flow PBG findings should reflect normal arterial values.

Imaging Studies

  • Perform penile duplex Doppler ultrasonography to help identify and locate a fistula in patients with high-flow priapism.
  • Perform pelvic angiography to help confirm the fistula location, followed by embolization in patients with high-flow priapism.
  • Perform chest radiography or CT scanning if the history is consistent with a malignant or metastatic condition.

Other Tests

  • Perform an ECG if the patient is older than 55 years, has a history of cardiac disease, or is a possible surgical candidate.

More on Priapism

Overview: Priapism
Differential Diagnoses & Workup: Priapism
Treatment & Medication: Priapism
Follow-up: Priapism
Multimedia: Priapism
References
Further Reading
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References

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Further Reading

For more information, see Medscape’s Erectile Dysfunction Resource Center.

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Keywords

priapism, cavernosal shunts, Ebbehoj procedure, El-Ghorab procedure, erectile dysfunction, ED, erection, Grayhack shunt, prolonged erection, Quackel shunt, Quackel's shunt, sexual dysfunction, sickle cell disease, SCD, Winter procedure, low-flow priapism, ischemic priapism, high-flow priapism, nonischemic priapism, pathologic erection, permanent impotence, impotence, penile injury, penile trauma, penis trauma, penis injury, persistent erection, pseudopriapism

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Contributor Information and Disclosures

Author

Hosam S Al-Qudah, MD, Assistant Professor of Urology, Department of General Surgery, Jordan University of Science and Technology, Irbid, Jordan
Disclosure: Nothing to disclose.

Coauthor(s)

Osama Al-Omar, MD, Director of Urology, Warren General Hospital
Osama Al-Omar, MD is a member of the following medical societies: American Medical Association, American Urological Association, Michigan State Medical Society, National Arab American Medical Association, and Society for Fetal Urology
Disclosure: Nothing to disclose.

Monica Parraga-Marquez, MD, Consulting Staff, Department of Emergency Medicine, Metropolitan Hospital Center; Clinical Assistant Professor, Department of Emergency Medicine, New York Medical College
Monica Parraga-Marquez, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Richard A Santucci, MD, FACS, Chief of Urology, Detroit Receiving Hospital; Specialist-in-Chief of Urology, Detroit Medical Center; Chief of Urologic Trauma Surgery, Sinai Grace Hospital; Director, The Center for Urologic Reconstruction
Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)
Disclosure: Nothing to disclose.

Paul S Wahlheim, MD, Staff Physician, Department of Emergency Medicine, Metropolitan Hospital, New York Medical College
Paul S Wahlheim, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf, Jr, MD, FACS, David A Bloom Professor of Urology, Director, Division of Minimally Invasive Urology, Department of Urology, University of Michigan Medical Center
J Stuart Wolf, Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Terumo Corporation Consulting fee Consulting; Omeros Corporation Consulting fee Consulting

Chief Editor

Stephen W Leslie, MD, FACS, Founder and Medical Director of the Lorain Kidney Stone Research Center, Clinical Assistant Professor, Department of Urology, Medical College of Ohio
Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, National Kidney Foundation, and Ohio State Medical Association
Disclosure: Nothing to disclose.

 
 
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