Priapism in Emergency Medicine

Author: Colin M Dougherty, MD; Chief Editor: Robert E O'Connor, MD, MPH more...

Updated: Mar 12, 2012

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Background
Pathophysiology
Epidemiology
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Background

Priapism is the presence of a persistent, usually painful, erection of the penis unrelated to sexual stimulation or desire. It is a true urologic emergency that may lead to permanent erectile dysfunction and penile necrosis if left untreated. Priapism is frequently idiopathic in etiology but is associated with a number of important medical conditions and pharmacologic agents.^[1]

Pathophysiology

Priapism is the result of persistent engorgement of the corpora cavernosa of the penis, originating from a disturbance in the mechanisms that control normal penile detumescence, depicted in the image below. In most cases, the ventral corpora spongiosum and glans penis remain flaccid.

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

Two types of priapism are generally described.^[2]Arterial high-flow priapism usually is secondary to a rupture of a cavernous artery and unregulated flow into the lacunar spaces. This rare type of priapism is usually not painful and results from penetrating penile trauma or a blunt perineal injury. Low-flow priapism is usually due to full and unremitting corporeal veno-occlusion where venous stasis and deoxygenated blood pools within the cavernous tissue. Prolonged veno-occlusive priapism results in fibrosis of the penis and a loss of the ability to achieve an erection. Significant changes at the cellular level are noted within 24 hours in veno-occlusive priapism, whereas arterial priapism is not associated with fibrotic change.

Frequency

United States

In one study, 38-42% of adult patients with sickle cell disease reported at least one episode of priapism.

International

The overall incidence of priapism is 1.5 cases per 100,000 person-years, which increases to 2.9 cases per 100,000 person-years for men older than 40 years.^{[3, 2]}

Mortality/Morbidity

Deaths have been reported in patients with sickle cell disease presenting with priapism, but the cause of death usually is not related to the priapism per se but to complications from the underlying disease process.
Morbidity is related to long-term impotence, primarily with veno-occlusive priapism, when diagnosis and therapy have been delayed.

Race

No racial predilection exists. Sickle cell disease, which predisposes to the development of priapism, occurs more frequently in the African American population.

Sex

Priapism is primarily a disease of males. Priapism of the clitoris has been reported but is extremely rare.

Age

Priapism has been described at nearly all ages, from infancy through old age. A bimodal distribution between 5 and 10 years in children and 20-50 years in adults is noted.^[2]
Younger groups are more often associated with sickle cell disease, while older groups tend to be secondary to pharmacologic agents.

Proceed to Clinical Presentation

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 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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