eMedicine Specialties > Emergency Medicine > Genitourinary

Priapism: Follow-up

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
Coauthor(s): Allison J Richard, MD, Assistant Professor of Emergency Medicine, Keck School of Medicine, University of Southern California; Associate Director, Division of International Medicine; Attending Physician, Los Angeles County-University of Southern California Hospital Emergency Department; Martin J Carey, MD, MB, BCh, MPH, FACEM, FRCS, Program Director, Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences
Contributor Information and Disclosures

Updated: Nov 17, 2009

Follow-up

Further Inpatient Care

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

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.

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.

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.

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).

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.

Miscellaneous

Medicolegal Pitfalls

  • Intervention for vaso-occlusive erections lasting greater than 4 hours duration should be initiated as soon as possible.
  • Failure to warn patients of the long-term incidence of impotence is a major concern.
  • Careful monitoring of patients at risk of complications due to the use of vasoactive medications should be instituted. Alpha-agonists may cause significant systemic hypertension.

Special Concerns

  • Priapism in females is extremely rare but has been described.
  • No single therapy has been shown to be effective. Consider terbutaline in the first instance and consultation with a urologist.
  • Congenital neonatal priapism may result from birth trauma or other conditions at birth.
  • Stuttering or recurrent priapism may occur in patients with sickle cell trait or disease. Usually self-limiting in nature, over time episodes may lead to erectile dysfunction.
 
Acknowledgments

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



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References
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References

  1. Cherian J, Rao AR, Thwaini A, et al. Medical and surgical management of priapism. Postgrad Med J. Feb 2006;82(964):89-94. [Medline].

  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].

  3. Tran QT, Wallace RA, Sim EH. Priapism, ecstasy, and marijuana: is there a connection?. Adv Urol. 2008;193694. [Medline].

  4. Quan D, Ruha AM. Priapism associated with Latrodectus mactans envenomation. Am J Emerg Med. Jul 2009;27(6):759.e1-2. [Medline].

  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].

  9. Brock G, Breza J, Lue TF, Tanagho EA. High flow priapism: a spectrum of disease. J Urol. Sep 1993;150(3):968-71. [Medline].

  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].

  11. Foda MM, Mahmood K, Rasuli P, Dunlap H, Kiruluta G, Schillinger JF. High-flow priapism associated with Fabry's disease in a child: a case report and review of the literature. Urology. Dec 1996;48(6):949-52. [Medline].

  12. Harmon WJ, Nehra A. Priapism: diagnosis and management. Mayo Clin Proc. Apr 1997;72(4):350-5. [Medline].

  13. Hatzichristou D, Salpiggidis G, Hatzimouratidis K, et al. Management strategy for arterial priapism: therapeutic dilemmas. J Urol. Nov 2002;168(5):2074-7. [Medline].

  14. Ilkay AK, Levine LA. Conservative management of high-flow priapism. Urology. Sep 1995;46(3):419-24. [Medline].

  15. Jiva T, Anwer S. Priapism associated with chronic cocaine abuse. Arch Intern Med. Aug 8 1994;154(15):1770. [Medline].

  16. Lee M, Cannon B, Sharifi R. Chart for preparation of dilutions of alpha-adrenergic agonists for intracavernous use in treatment of priapism. J Urol. Apr 1995;153(4):1182-3. [Medline].

  17. Lowe FC, Jarow JP. Placebo-controlled study of oral terbutaline and pseudoephedrine in management of prostaglandin E1-induced prolonged erections. Urology. Jul 1993;42(1):51-3; discussion 53-4. [Medline].

  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].

  20. Mulhall JP, Honig SC. Priapism: etiology and management. Acad Emerg Med. Aug 1996;3(8):810-6. [Medline].

  21. Ramos CE, Park JS, Ritchey ML, Benson GS. High flow priapism associated with sickle cell disease. J Urol. May 1995;153(5):1619-21. [Medline].

  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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Further Reading

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Keywords

priapism, priapism causes, priapism treatment, painful erection, erectile dysfunction, intracavernous injection, arterial high-flow priapism, veno-occlusive priapism, painful erection of the penis, sickle cell disease, impotence

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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, University of Southern California; Associate Director, Division of International Medicine; Attending Physician, Los Angeles County-University of Southern California Hospital Emergency Department
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.

Medical Editor

Lance W Kreplick, MD, MMM, FAAEM, FACEP, 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, MMM, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

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.

 
 
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