Priapism in Emergency Medicine Follow-up

  • Author: Colin M Dougherty, MD; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Nov 17, 2009
 

Further Inpatient Care

  • Patients with refractory priapism should be admitted to the hospital under the care of a urologist.
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Further Outpatient Care

  • Ensure adequate follow-up care with a urologist if therapy in the emergency department is successful.
  • Consider the use of oral alpha-adrenergic agonists for 3-5 days to help prevent recurrent episodes.
  • Some patients may have recurrent priapism. These patients may have a home supply of terbutaline. Instruct these patients on how to self-administer this medication either as a 5-mg tablet or a 0.25-0.5 mg SC prior to presentation. Patients with sickle cell disease may also benefit from IM leuprolide (Lupron) injections prescribed by a urologist.
  • A small study by Abern and Levine describes successful use of ketoconazole and prednisone for treatment of recurrent priapism.[7] This therapy should be initiated by a urologist because testosterone measurements may be necessary to monitor therapy.
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Transfer

  • If a urologist is not available at the presenting institution, transfer patients with priapism who do not respond to ED maneuvers to an appropriate tertiary care center where a urologist is available.
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Complications

  • A major complication of priapism is long-term impotence. Warn all patients of this possible complication. The fact that this warning was given should be recorded in the chart and clearly written on the discharge instruction sheet. In general, vaso-occlusive priapism has a higher risk of impotence than high-flow arterial priapism.
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Prognosis

  • Most patients respond to therapeutic measures.
  • In high-flow priapism, patients may require surgical intervention to correct the problem.
  • Deaths in patients with priapism are usually related to complications from the underlying problem (eg, leukemia, sickle cell disease).
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Patient Education

  • Warn patients with a predisposing condition for priapism of the symptoms and signs of the condition. Instruct them to report to the nearest ED should priapism develop.
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Contributor Information and Disclosures
Author

Colin M Dougherty, MD  Staff Physician, Department of Emergency Medicine, Tri-City Medical Center; Staff Physician, Department of Emergency Medicine, Kaiser-Permanente, San Diego Medical Center/Kaiser Foundation Hospital

Colin M Dougherty, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Allison J Richard, MD  Assistant Professor of Emergency Medicine, Keck School of Medicine of the University of Southern California; Associate Director, Division of International Medicine, Attending Physician, Department of Emergency Medicine, LAC+USC Medical Center

Disclosure: Nothing to disclose.

Martin J Carey, MD, MB, BCh, MPH, FACEM, FRCS  Program Director, Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences

Martin J Carey, MD, MB, BCh, MPH, FACEM, FRCS is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, British Medical Association, and Fellowship of the Australasian College for Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Lance W Kreplick, MD, FAAEM, MMM  Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC

Lance W Kreplick, MD, FAAEM, MMM, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH  Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the medical review of this article by Tyson Pillow, MD.

References

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  2. Eland IA, van der Lei J, Stricker BH, Sturkenboom MJ. Incidence of priapism in the general population. Urology. May 2001;57(5):970-2. [Medline].

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  5. [Guideline] Erectile Dysfunction Guideline Update Panel. The management of priapism. [reviewed and validated by AUA 2008]. Baltimore (MD): American Urological Association Inc. 2003;[Full Text].

  6. Roberts JR, Price C, Mazzeo T. Intracavernous epinephrine: a minimally invasive treatment for priapism in the emergency department. J Emerg Med. Apr 2009;36(3):285-9. [Medline].

  7. Abern MR, Levine LA. Ketoconazole and prednisone to prevent recurrent ischemic priapism. J Urol. Oct 2009;182(4):1401-6. [Medline].

  8. Bastuba MD, Saenz de Tejada I, Dinlenc CZ, et al. Arterial priapism: diagnosis, treatment and long-term followup. J Urol. May 1994;151(5):1231-7. [Medline].

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  10. Emond AM, Holman R, Hayes RJ, Serjeant GR. Priapism and impotence in homozygous sickle cell disease. Arch Intern Med. Nov 1980;140(11):1434-7. [Medline].

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  18. Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction and priapism. In: Walsh PC, et al, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders Co; 1997:1157-79.

  19. Miller ST, Rao SP, Dunn EK, Glassberg KI. Priapism in children with sickle cell disease. J Urol. Aug 1995;154(2 Pt 2):844-7. [Medline].

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  22. Siegel JF, Rich MA, Brock WA. Association of sickle cell disease, priapism, exchange transfusion and neurological events: ASPEN syndrome. J Urol. Nov 1993;150(5 Pt 1):1480-2. [Medline].

 
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Priapism. Corporeal relaxation causes external pressure on the emissary veins exiting the tunica albuginea, trapping blood in the penis and causing erection.
 
 
 
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