What is the difference between low-flow and high-flow priapism?

What is the difference between low-flow and high-flow priapism?

Low-flow priapism: This is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but it also affects men with sickle-cell disease, leukemia (cancer of the blood) or malaria. High-flow priapism: This is rarer and is usually not painful.

How is low-flow priapism treated?

Treatment of low-flow priapism should progress in a stepwise fashion, starting with therapeutic aspiration, with or without irrigation, followed by intracavernous injection of a sympathomimetic agent. Repeated injection of a sympathomimentic agent should be performed before considering surgical intervention.

What does ischemic priapism look like?

Ischemic priapism Signs and symptoms include: Erection lasting more than four hours or unrelated to sexual interest or stimulation. Rigid penile shaft, but the tip of penis (glans) is soft. Progressively worsening penile pain.

What is nonischemic priapism?

Abstract. Introduction: Non-ischemic or high-flow priapism is derived from unregulated arterial inflow within the penis, which is significantly less common and, therefore, less well characterized than ischemic or low-flow priapism.

Can priapism go away on its own?

If you have high-flow priapism, immediate treatment may not be necessary. This type of priapism often goes away on its own. Your doctor may check your condition before prescribing a treatment. Cold therapy with ice packs can get rid of an involuntary erection.

Why is discriminate between high-flow and low flow priapism important?

During the initial evaluation, it is critical to differentiate high-flow and low-flow etiologies because the pathophysiology and treatment are different. Patients with low-flow priapism must be treated emergently because of the high risk of complications.

How do you fix priapism?

Treatment

1. Aspiration decompression. Excess blood is drained from your penis using a small needle and syringe (aspiration).
2. Medications. A medication, such as phenylephrine, might be injected into your penis.
3. Surgery or other procedures.

Can priapism resolve itself?

Treatment of Non-ischemic Priapism This condition does not require urgent treatment and in some cases, the condition may resolve itself spontaneously after days or months, at which point erectile capacity returns to normal.

Which nerve is responsible for erectile dysfunction?

The dorsal penile nerve (pudendal nerve) is responsible for reflex erections. Damage to the pudendal nerves (that is, Alcock syndrome) leads to erectile dysfunction.

How is ischemic priapism treated?

Ischemic priapism

1. Aspiration decompression. Excess blood is drained from your penis using a small needle and syringe (aspiration).
2. Medications. A medication, such as phenylephrine, might be injected into your penis.
3. Surgery or other procedures.

Can priapism cause infertility?

Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Impotence and infertility are major problems in male sickle cell disease patients, and priapism has been implicated as a cause of impotence and infertility.

How do you reverse priapism?

Nonischemic priapism often goes away with no treatment. Because there isn’t a risk of damage to the penis, your doctor might suggest a watch-and-wait approach. Putting ice packs and pressure on the perineum — the region between the base of the penis and the anus — might help end the erection.

What are the causes of low flow priapism?

Low-flow priapism, the more common type, results from malfunction of normal penile outflow, and its causes include malignancy; hypercoagulable and thrombophilic states, such as sickle cell disease; spinal cord disorders; and medications ( 57, 59 ).

What is the pathophysiology of priapism?

Priapism (rarely penile priapism, to differentiate from the very rare clitoral priapism) is a prolonged erection that persists beyond or is not related to sexual stimulation. Imaging, particularly Doppler ultrasound, can help distinguish between ischaemic (low-flow) priapism, which is a urologic emergency, and non-ischaemic (high-flow) priapism.

Which imaging modalities are used in the assessment of priapism?

Imaging modalities available for the assessment of priapism include a penile Doppler study (PDS), pelvic/penile angiography and MRI. Table 1 The role of the radiologist

What is the difference between nonischemic and ischemic priapism?

The ischemic category usually arises as a result of thrombosis of the corpora cavernosa, and is associated with patients who have sickle cell disease (as in this case). Nonischemic priapism results from high flow through the cavernosa, such as may happen with an AV fistula after perineal or penile trauma.