STUDY - Technical - New Dacian's Medicine
Priapism
(Classical / Allopathic Medicine)
A
urologic emergency, priapism is a persistent, painful
erection that's unrelated to sexual excitation. This
relatively rare sign may begin during sleep and appear to
be a normal erection; however, it may last for several
hours or days. It's usually accompanied by a severe,
constant, dull aching in the penis. Despite the pain, the
patient may be too embarrassed to seek medical help and
may try to achieve detumescence through continued sexual
activity.
Priapism
occurs when the veins of the corpora cavernosa fail to
drain correctly, resulting in persistent engorgement of
the tissues. Without prompt treatment, penile ischemia and
thrombosis occur. In about one-half of all cases, priapism
is idiopathic and develops without apparent predisposing
factors. Secondary priapism may result from a blood
disorder, neoplasm, trauma, or the use of a particular
drug.
ALERT:
If the patient has priapism:
- apply ice packs to his penis
- administer an analgesic
- insert an indwelling catheter to relieve urine retention.
When the patient's condition permits, perform a focused assessment.
If the patient has priapism:
- apply ice packs to his penis
- administer an analgesic
- insert an indwelling catheter to relieve urine retention.
When the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient when the priapism began. Ask him if it's continuous or intermittent.
Ask the patient whether he has had a prolonged erection in the past. If so, what did he do to relieve it? How long did he remain detumescent?
Ask the patient if he experiences pain or tenderness when he urinates.
Ask the patient if he has noticed changes in sexual function.
Review the patient's medical history. If there's a history of sickle cell anemia, ask the patient about factors that could precipitate a crisis, such as dehydration and infection. Also, ask the patient if he has recently suffered genital trauma.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient when the priapism began. Ask him if it's continuous or intermittent.
Ask the patient whether he has had a prolonged erection in the past. If so, what did he do to relieve it? How long did he remain detumescent?
Ask the patient if he experiences pain or tenderness when he urinates.
Ask the patient if he has noticed changes in sexual function.
Review the patient's medical history. If there's a history of sickle cell anemia, ask the patient about factors that could precipitate a crisis, such as dehydration and infection. Also, ask the patient if he has recently suffered genital trauma.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Examine the patient's penis, noting its color and temperature. Check for loss of sensation, and look for signs of infection, such as redness or drainage.
Take the patient's vital signs, particularly noting fever.
Examine the patient's penis, noting its color and temperature. Check for loss of sensation, and look for signs of infection, such as redness or drainage.
Take the patient's vital signs, particularly noting fever.
SPECIAL
CONSIDERATIONS:
If the patient requires surgery, keep his penis flaccid postoperatively by applying a pressure dressing. At least once every 30 minutes, inspect the glans for signs of vascular compromises, such as coolness or pallor.
If the patient requires surgery, keep his penis flaccid postoperatively by applying a pressure dressing. At least once every 30 minutes, inspect the glans for signs of vascular compromises, such as coolness or pallor.
PEDIATRIC
POINTERS:
In neonates, priapism can result from hypoxia but is usually resolved with oxygen therapy.
Priapism is more likely to develop in children with sickle cell disease than in adults with the disease.
In neonates, priapism can result from hypoxia but is usually resolved with oxygen therapy.
Priapism is more likely to develop in children with sickle cell disease than in adults with the disease.
PATIENT
COUNSELING:
Encourage patients with sickle cell anemia to report episodes of priapism. Quick treatment is necessary to preserve normal sexual function.
Encourage patients with sickle cell anemia to report episodes of priapism. Quick treatment is necessary to preserve normal sexual function.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.