An FY2 in your department has asked your advice about a 19 year old patient who has had priapism for the last hour. He has a history of sickle cell disease, known to your hospital and has attended previously with a minor episode which resolved spontaneously. He is in a lot of pain.
-Primary (Idiopathic) -Secondary: o Hematologic (sickle cell anemia, leukemia, thalassemia, multiple myeloma, thrombotic thrombocytopenic purpura) o Neurologic (spinal shock) o Tumors (metastatic cancers) o Perineal, pelvic or penile trauma o Iatrogenic (intracavernous injections) o Drugs (anticoagulants, anti-hypertensives, anti-depressants, PDE5 inhibitors, intracavernous injections, alpha-blockers, cocaine) o Infection (malaria, spider toxins) o Metabolic disorders (gout, hemodialysis, high lipid content, total parenteral nutrition, diabetes, amyloidosis)
o Analgesia – potentially opiate sc/iv. Consider sedation 5-10mg diazepam. o Iv Hydration and Bloods including reticulocyte count and cross match. o Consider oral etilefrine o Consider penile block. o Aspiration of 20-50ml blood from corpus cavernosus o Alpha adrenergic intracavernosal injection. o exchange transfusion.
Stroke, Acute chest syndrome, splenic sequestration crisis, pulmonary hypertension, Rena failure, depression.