genitourinary disorders
Priapism
Evaluation of Priapism
Priapism requires urgent treatment to prevent chronic complications (primarily Erectile Dysfunction ). Evaluation and treatment should be done simultaneously. History of present illnessshould cover the duration of erection, presence of partial or complete rigidity, presence or absence of pain, and any recent or past genital trauma. The drug history should be reviewed for offending drugs, and patients should be directly asked about the use of recreational drugs and medications used to treat erectile dysfunction. should seek symptoms suggesting a cause, including Dysuria ( should identify known conditions associated with priapism (see table Some Causes of Priapism ), particularly hematologic disorders. Patients should be asked about a family history of hemoglobinopathies ( A focused genital examination should be done to evaluate extent of rigidity and tenderness and determine whether the glans and corpus spongiosum are also affected. Penile or perineal trauma and signs of infection, inflammation, or gangrenous change should be noted. The general examination should note any psychomotor agitation, and the head and neck examination should look for pupillary dilation associated with stimulant use. The abdomen and suprapubic area should be palpated to detect any masses or splenomegaly, and a digital rectal examination should be done to detect prostatic enlargement or other pathology. Neurologic examination is useful to detect any signs of lower-extremity weakness or saddle paresthesias that might indicate spinal pathology. The following findings are of particular concern: Pain Priapism in a child Recent trauma Fever and night sweats Perineal and/or lower extremity neurologic manifestations In most cases, the clinical history reveals a history of drug treatment for Erectile Dysfunction , illicit drug use, or a history of In patients with ischemic priapism, physical examination typically reveals complete rigidity with pain and tenderness of the corpus cavernosa and sparing of the glans and corpus spongiosum. By contrast, nonischemic priapism is painless and nontender, and the penis may be partially or completely rigid. If the cause is not obvious, screening is done for hemoglobinopathies, Overview of Leukemia , Complete blood count Urinalysis and culture Hemoglobin electrophoresis in Black people and men of Mediterranean descent Many clinicians also do drug screening, intracavernosal arterial blood gas testing, and Variations of Ultrasonography . Penile duplex ultrasonography will show little or absent cavernosal blood flow in men with ischemic priapism and normal to high cavernosal blood flow in men with nonischemic priapism. Ultrasonography may also reveal anatomic abnormalities, such as cavernous arterial fistula or pseudoaneurysm, which usually indicate nonischemic priapism. Occasionally, MRI with contrast is useful to demonstrate 