1) Priapism is defined as an erection lasting over 4 hours without sexual stimulation and can be caused by various medical conditions and medications. 2) It is classified as either ischemic (low blood flow) or non-ischemic (high blood flow) and ischemic priapism can lead to tissue damage due to acidosis and hypoxia if not properly treated. 3) Treatment depends on whether it is ischemic or non-ischemic, with ischemic priapism requiring drainage of blood from the penis and non-ischemic often resolving with observation or minimally invasive procedures.

1. PRIAPISM:PATHOPHYSIOLOGY AND
TREATMENT
CHAIRMAN :DR .VIDYADHAR KINHAL
PRESENTER:DR.HARISH PATEL B N
VIMS BALLARI

2. PRIAPISM DEFINITION:
• Erection lasting for more than 4 hrs that is
not associated with sexual stimulation.
• Incidence is bimodal – 5-10 yrs and 20-50 yrs.
• Classification
– Ischemic
– Non ischemic
•
• Incidence is 0.84 to 1.1 cases/100000 person
years

3. • Ischemic(low flow)
• - Etiology
• * 50% idiopathic
• * Intracavernous theraphy (papaverine,
• phentolamine, alprostadil)
• * Psychiatric drugs (Chlorpromazine,
• phenothiazine, clozapine)
• * Sickle cell disease, leukemia
• * Metastasis to corpora cavernosa

4. PATHOPHYSIOLOGY:
• Prolonged relaxation of intracavernosal SM.
• Failure to metabolize neurotransmitters.
•
• Anatomical obstruction to venous outflow.
•
• Acidosis and tissue ischemia,hyper carbia.

6. • Non ischemic(high flow)
• - Etiology
• * Trauma (rupture of branches of
cavernosal artery)
• - Unregulated increased arterial inflow.
• - No acidosis no pain

7. • Evaluation
• - History and physical examination
• - Aspiration of penile blood and analysis
• - Duplex ultrasonography
Ph PO2 Pco2
ischemic <7.25 <30 >60
Non ischemic >7.3 >50 <40

13. Winter shunt

15. • Management of non ischemic priapism
• - Observation
• - Angiographic embolisation
• - Surgical ligature of ruptured artery

16. • Recurrent (stuttering ) priapism
• - Sickle cell trait, following an episode of priapism of
any etiology.
• - Each episode must be managed accordingly.
• - Prevention of further episodes
* Oral alpha adrenergic medications
* Self intracavernosal injection of alfa adrenergics
* Antiandrogen or gonadotropin releasing hormone
Agonist
* Oral Baclofen

17. • THANK YOU

18. THANK YOU