Ireneusz Ostrowski 1, Artur A. Antoniewicz 2
- 1 Oddziału Urologii Szpitala Miejskiego w Puławach
Ordynator oddziału: lek. med. Tadeusz Palec
2 Oddział Urologii Centralnego Szpitala Kolejowego w Warszawie
Ordynator oddziału: prof, dr hab. Andrzej Borówka
penis, penile erection, ischaemic priapism, non-ischaemic priapism
- Priapism is a pathologic persistent penile erection that may last over 4-6 hours and does not subside even when an orgasm and ejaculation have been achieved. When the haemodynamic conditions occuring in a penis are taken into consideration, two types of priapism can be distinguished: low-flow priapism and high-flow priapism. It is essential to establish an accurate diagnosis as the therapeutic management in cither of the two types of priapism is significantly different. Low-flow priapism (ischaemic). unlike high-flow priapism (hyperaemic) is considered urgent in urology. The ethiology of persistent penile erection of the low-llow type is heterogenous. The mosl frequent cases are idiopathic, less common ones depend on the kind of medication that has been received and occur in the course of neoplastic and haematologi-cal diseases (sickle cell anaemia, various types of leukaemia) or occur as a consequence of intracavemous injections (ICI) of medications thai are administered in the treatment of penis erectile disfunction. Hyperaemic priapism usually arises in the aftermath of a perineum injury which results in artcriocavernous fistula. Priapism of this type does not require quick diagnosis or urgent intervention. The differentiation of priapism is based on an accurate anamnesis, proper physical examination, carrying out a suitable laboratory investigation and image diagnosis (ultrasound imaging with Doppler ultrasound imaging available: angiography). The main objective of the hyperaemic priapism treatment is lo eliminate hyperaemia of cavernous bodies of the penis and to counteract the occurrence of necrosis of these organs which causes irreversible impotence. As there is a wide variety of conservative therapy methods to employ (physiological saline irrigation of cavernous bodies, intracavemous injections ol\'cc-adrenomimetic drugs, among other things), surgical treatment is considered to be a final, ultimate step. A patient who has been described with persistent penile erection of the high-flow type caused by arteriocavernous fistula can be subjected lo observation. Selective embolization of an injured artery is a recommended method of treatment of priapism of this type. It should be emphasised that further course of this uncommon disease is determined by the first physician a patient has got contact with, regardless of whether this is a primary care physician or a urologist.
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