All are indications for penile angiography except
Correct Answer: Painful priapism
Description: Priapism Priapism means a persistent erection lasting longer than 4 hours and it is a surgical emergency. There are two main types of priapism. ISCHAEMIC PRIAPISM Ischaemic or venogenic priapism is the commoner and is due to venous congestion, with consequent thrombosis and ischaemia. The penis remains erect and becomes painful. This is a pathological erection and the glans penis and corpus spongiosum are not involved. The condition is most commonly seen as a side effect of medication, most notably antipsychotic medication and intracavernosal injections, but it can also arise as complication of a hypercoagulable blood disorders such as sickle cell disease or leukaemia. A tiny propoion of cases are caused by malignant disease in the corpora cavernosa or the pelvis. The clinical features are of a painful erection not involving the glans penis. Blood taken from the penis shows hypoxia, hyercapnoea and acidosis, while Doppler scanning shows an absence of blood flow within the penis. An underlying cause should be excluded and the patient should be referred for specialist urological care. Treatment is an emergency, since delay beyond 6 hours results in progressive, irreversible damage to the corpus cavernosal tissue with subsequent fibrosis and ED. Aspiration of the sludged blood in the corpora cavernosa is the first-line therapy but if this fails, then intracavernosal injection of phenylephrine (an alpha adrenoceptor agonist) is the next line of therapy. If that proves ineffective, it may be necessary to decompress the penis by creating a shunt between the corpus cavernosum and either the glans penis or the corpus spongiosum. Treatment initiated after 24-36 hours rarely restores normal erectile function. NON-ISCHAEMIC PRIAPISM This rarer form of priapism arises as a consequence of traumatic damage to the central penile aery, usually as a consequence of blunt perineal trauma. A fistula develops between the aery and the sinusoidal space, which results in a persistent erection that is painless, in contrast to the ischaemic priapism. Blood gas analysis shows the characteristics of aerial blood and Doppler scanning and selective aeriography will demonstrate the fistula. Treatment is not an emergency, since there is no ischaemia, and is most appropriate achieved by selective aerial embolisation. Ref: Bailey and love 27th edition Pgno : 1491
Category:
Surgery
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