What is priapism in men. Priapism (pathological erection) - information and treatment methods

Priapism is a disease characterized by involuntary erection, which can last more than 4 hours in the absence of sexual stimulation and is accompanied by pain.

Priapism can appear at any age, but most often occurs in boys between 5 and 10 years old and men between 20 and 50 years old.

Priapism is a rare disease, as evidenced by official medical statistics of such diseases - priapism occurs in 0.2 percent of cases sexual disorder. However, although the prevalence is not very high, almost no one is immune from the disease priapism, so even this extreme rare disease However, priapism requires quick and high-quality treatment under the supervision of a physician.

Reasons for appearance

The main reason why priapism occurs is associated with impaired blood flow to the cavernous bodies of the penis. These violations can lead to increased influx arterial blood, in this case, non-ischemic priapism occurs. If there is a deterioration in venous outflow, blood stagnates and its properties change, then the matter concerns ischemic priapism.

In addition, the development of the disease can be caused by taking drugs of various groups and prescriptions during treatment for other diseases:

Erection enhancing drugs, such as Viagra.
Drugs injected directly into the penis.
Anticoagulants.
Anti-anxiety drugs.
Various psychotropic drugs.

In addition to taking medications, priapism can occur against the background of other diseases and have different shapes, among which are the following:

Idiopathic priapism, which can occur in quite healthy men who have no health problems.
Psychotraumatic priapism, which occurs as a result of exposure to a severe stressful or shock situation. An example would be suddenly interrupted sexual intercourse due to sudden external irritating factors (strong sound). The change occurs in the cerebral cortex, where a mechanism is established that leads to a sharp decline in the blood vessels of the genital organ during blood supply.
Priapism that occurs during mental or neurological diseases. A similar erection can be observed in schizophrenia, epilepsy or neurosis. In addition, priapism can occur in people who have suffered spinal cord or brain injuries, tumors nervous system, encephalitis.
Priapism also occurs in diseases associated with blood, especially when its coagulability and viscosity are impaired.
The medicinal form of priapism (also called intoxication) can occur when exposed to animal poisons (for example, spiders), taking psychotropic substances or alcohol.

Symptoms of the disease

The most important signs of priapism are prolonged erection, associated unpleasant sensations or pain syndrome. In especially severe cases, priapism is accompanied by an erection, which can last more than three days, causing great discomfort to the patient.

Among the most common symptoms of priapism is pain that is comparable to swelling of the legs. The head of the penis is soft, but it may seem that it hangs down a little. Priapism leads to the fact that the body of the genital organ is in a tense state, sometimes it bends in an arc towards the abdomen.

Over time, the pain intensifies and becomes frequent. The pain does not go away until the erection disappears. Priapism leads to the appearance of piercing pain at the root of the organ, which can radiate to groin area or rectum. During the next attack of priapism, the patient will not experience sexual arousal, and any thought about sexual intercourse is disgusting to him. If sexual intercourse takes place, then ejaculation does not occur, the pain does not go away, and the penis remains erect. Priapism deprives a man of pleasure, so during sexual intercourse he will experience discomfort.

There are varieties of the disease, one of which is nocturnal priapism. The symptoms of this type of disease are as follows: during sleep, the penis becomes tense, the head, as during daytime attacks, is soft. This is explained by the fact that blood fills only the cavernous bodies.

In addition, there is intermittent priapism, which manifests itself at night. It is characterized by the short-term appearance of an erection, which is also accompanied by painful sensations. Intermittent priapism may appear rarely, increasing in frequency over time, while pain increases. This type of priapism can occur several times in one night, however, after morning bowel movements Bladder and rectal disease subsides. In addition, after active walking and movement, taking sleeping pills, nocturnal priapism declines and subsides.

Making a diagnosis is easy not only for the doctor, but also for the patient himself, who can determine priapism himself. For a long time an erect penis clearly indicates that the cause of this inconvenience is the disease priapism. But in order to finally ensure the correctness of the diagnosis and options for further treatment, since the disease priapism exists in several types, an examination by a doctor is still required.

When the first symptoms and pain appear, it is recommended not to hesitate to visit a doctor. The main mistake of most patients is not timely appeal see a specialist for help. This reveals the character of most men who tend to ignore their problem and quickly forget about it. However, priapism does not seem to recede, intensifying every day, which causes great discomfort. That's why main advice, which can be given to the patient - as soon as priapism begins to manifest itself, it is necessary to urgently call an ambulance and begin treatment as soon as possible.

The diagnosis is made by a urologist, andrologist or surgeon upon examination of the patient. The patient is prescribed comprehensive examination, since against the background of priapism there may be others hiding no less unpleasant diseases. By inserting a thin needle into the genital organ and then drawing a certain amount of blood, the type of priapism is determined. This procedure called a blood gas test. If the blood is light red in color, then ischemic priapism is not manifested, but if the blood is dark in color, then the patient should be treated for ischemic (venous) type of priapism.

Basically, the principles of the survey are as follows:

History and installation clinical picture diseases.
Palpation of the genital organ.
Rectal examination.
Conducting a general analysis of urine and blood.
Measurement of partial and intracavernous pressure of blood gases in the cavernous bodies.
If the patient arterial form priapism, then angiography or duplex Doppler ultrasound is prescribed.

Treatment and prevention

If the disease priapism was discovered late and treatment was started late, the consequences can be very serious. The development of non-ischemic priapism, which leads to a number of consequences, poses serious problems. The most common and unpleasant complication in the absence of treatment for this type of priapism - inflammation of the cavernous bodies, which occurs due to infection entering the organ. In this case, the head of the penis is not damaged. Most severe consequences has ischemic priapism, which can lead to necrosis of organ tissue, and especially severe cases- the occurrence of gangrene or amputation of the penis.

Therefore, in order to prevent the situation from worsening, you should consult a doctor in a timely manner, since treating priapism at home is unacceptable. After visiting a doctor and examination, treatment begins. At the first stage, the doctor freezes the penis using heating pads cold water or ice, performs a puncture, during which excess blood is removed from the organ.

After this procedure, the doctor flushes with saline until the blood turns bright red. Upon completion of the procedure, the patient is given a drug that prevents the recurrence of priapism - phenylephrine. The blood is sent for testing, and after detection main reason When priapism occurs, the doctor prescribes further treatment or a series of procedures.

If this method of treating priapism is ineffective, surgery is used. Operating method is a last resort that may lead to complications such as impotence, erectile dysfunction, or infectious complications. Therefore, in order not to bring the situation to a critical point, timely contact with the appropriate institution and subsequent treatment of priapism is the main task of the patient. It is not recommended to get rid of the disease on your own, nor is it recommended to self-medicate. In case of priapism, treatment is carried out only by the attending physician, carrying out all necessary procedures.

Like any other disease, priapism can be avoided. For this there are a number preventive measures, allowing not only to stop the development of the disease, but also to avoid the appearance of priapism. To do this, it is necessary to avoid injuries in the pelvic area and undergo frequent medical examination, stop taking medications that stimulate erection. In addition, priapism can occur when drinking alcohol, so alcohol should be removed from your life. In this case, priapism will be just a scary fairy tale, and not a harsh reality.

About 0.2% of cases of sexual problems in men are due to such a complex, rare and painful condition as priapism. What is priapism? This is persistent long lasting erection, occurs regardless of erotic arousal, causes pain to a man and requires urgent medical intervention. Priapism can affect both children aged 5 to 10 years and adult men aged 20 to 50 years. Priapism is observed extremely rarely in women; it is associated with increased blood flow to the clitoris.

The first mention of this pathological condition was in medical practice date back to 1616. The name of the disease has ancient roots and is associated with the name of the god of fertility Priapus, whose penis was always erect. Priapism can be caused by two development paths; as a result, there are two main types of priapism: ischemic and non-ischemic or arterial.

Non-ischemic priapism is caused by an increased flow of arterial blood to the cavernous (cavernous) bodies and their overflow. This condition often occurs after trauma to the penis and is a more benign form of priapism. An erection does not cause pain, the penis is not ischemic, that is, tissue necrosis or its death is not typical for this type of priapism.

The development of ischemic priapism is facilitated by a decrease in the outflow of venous blood from the penis, which causes stagnation of blood and a change in its rheological (fluidity and viscosity) properties. Unlike arterial priapism, this type of pathology is painful for the patient. Violation of the venous outflow of blood leads to reduced arterial saturation of the penis, resulting in ischemia. Clinically, two more forms of priapism are distinguished: acute or true and chronic or intermittent.

Depending on the factors causing male priapism. large groups of reasons were identified. These include:

Disorders of the central nervous system or neurogenic disorders, such as multiple sclerosis, brain tumors, complications after encephalitis and myelitis, as well as traumatic brain injury;
Psychoneurological disorders due to schizophrenia, neuroses and epilepsy, as well as severe fear during sexual intercourse and its subsequent interruption;
Traumatic injury to the genitals or perineum;
Excess of toxic substances - narcotic and psychotropic drugs, alcohol, antidepressants, antihypertensive drugs and the poison of some insects;
A side effect of anti-impotence drugs is the introduction of vasoactive drugs into the penis;
Blood diseases are accompanied by disorders rheological properties blood, which entails an increase in blood viscosity. This leads to impaired venous outflow and priapism, and also causes thrombus formation. Sickle cell anemia causes ischemic priapism in 65% of boys and 25% of men. Against the background of leukemia, only 1% of cases of priapism occur;
Tumor neoplasms genitourinary system with metastases to the cavernous can impede venous outflow from the penis.

About 30–60% of patients cannot associate priapism with any of the identified causes; this type of priapism is called idiopathic, occurring spontaneously, for no apparent reason.

Each form of priapism has its own set of symptoms. Ischemic or veno-occlusive priapism with impaired outflow of venous blood is characterized by:

Long-term erection from four hours to several days;
An erectile state appears regardless of a man’s arousal and does not disappear after sexual intercourse or masturbation, there is no ejaculation;
The shaft of the penis is hard, its head is flabby and soft due to insufficient blood supply;
Severe pain at the root of the penis and perineum, aggravated by sexual intercourse;
Swelling of the penis and its foreskin;
Arc-shaped curvature of the penis towards the abdomen.

Non-ischemic or arterial priapism is characterized by the same symptoms, but there is a slightly different picture:

Unsteady penis due to unchanged blood flow;
There is no pain.

The type of priapism can be determined not only by differences in symptoms, but also by using a blood gas test. Blood is taken from the penis using a thin needle. Dark blood indicates ischemic priapism, and non-ischemic.

The symptoms of true priapism also differ from intermittent priapism. Determining the type of priapism based on the signs of the disease is essential for determining the necessary treatment tactics. True priapism begins unexpectedly and suddenly, most often at night, during sleep. Suddenly the penis becomes hard, but this does not affect urination. The base of the penis and perineum are tested severe pain, the foreskin and penis swell. Sexual intercourse and masturbation do not relieve pain, but only intensify it.

Intermittent or nocturnal priapism is accompanied by periodic short-term painful erections. Most often they appear in a dream and wake up the patient. Over time, the pain and incidence of priapism increases. Distinctive feature This type of priapism is that an erection when urinating, waking up, taking sedatives and sleeping pills weakens.

Treatment of priapism and its diagnosis

When faced with the problem of priapism for the first time, you need to contact ambulance. An andrologist, urologist or surgeon will examine, clarify and confirm the diagnosis. IN diagnostic purposes carry out:

X-ray examination - cavernosography after injection of a contrast agent into the digestive or cavernous bodies;
Ultrasound examination (ultrasound);
Dopplerography of penile vessels;
Gasometry of blood from the corpus cavernosum;
Biopsy of the penis.

Priapism requires urgent care medical care and treatment. The sooner it is provided, the fewer complications will arise. On early stage, less than a day from the moment of the onset of an attack of priapism, it is possible to cope with the following methods:

A cool bath, which must be taken in a sitting position;
Novocaine perirenal blockades;
Hirudotherapy (leeches) in the area of the root of the penis;
Removal (aspiration) of excess, accumulated blood from the cavernous bodies;
Drug therapy with anticoagulants, adrenergic drugs (phenylephrine, mezaton, adrenaline) intracavernously.

Delayed referral of patients with ischemic priapism for medical help is fraught with severe complications and forced surgical intervention, since drug therapy is no longer effective. Such patients undergo shunt surgery to create an additional route of venous outflow from the penis.

If irreversible disorders begin to develop in the penis, such as tissue necrosis due to ischemia, then resort to the only way out– phallus prosthetics. This usually occurs 2 days after the onset of the attack. Non-ischemic and intermittent forms of priapism often resolve spontaneously. Cold applied to the perineal area helps improve the patient's condition.

Complications

Priapism affects the most important organ male body, therefore requires immediate assistance medical care. 6 out of 10 men delay seeing a doctor or self-medicate, which leads to serious consequences:

Erectile dysfunction or impotence;
Necrosis or necrosis of penile tissue;
Infectious inflammation of the penis;
Thrombosis of the penile veins due to blood stagnation;
Cavernous fibrosis;
Gangrene of the penis.

Timely consultation with a doctor and timely treatment of priapism helps the patient avoid irreversible consequences below the belt and lead a full sexual life.

Characteristics of the causes, symptoms and treatment of priapism in men

What is priapism? own experience only 0.2% of men in our country know. The number is small, the disease appears quite rarely. However, all men should be aware of the symptoms and causes of this disease, since an attack can appear suddenly and you need to know how to behave. Unfortunately, due to the fact that the disease is quite delicate, most victims try to wait until the symptoms go away on their own, and this is a fatal mistake - in the absence timely assistance may appear very serious complications, which threaten impotence and even removal of the genital organ.

What is it and how does it arise?

Priapism in men is a pathology in which a man without sexual desire experiences a painful erection and does not go away for a long time (a couple of hours or even several days). An erection is accompanied by severe discomfort and pain. There is no age-related predisposition to priapism - cases have been recorded both among pre-pubertal boys and among adult men who are sexually active.

Involuntary painful erection without sexual desire occurs due to poor circulation in the cavernous bodies of the genital organ. There are arterial and venous types. In the first case, there is an excess of arterial blood entering the penis, but the venous blood flow remains normal - this type of disorder is also called non-ischemic priapism.

The symptom is accompanied painful sensations and swelling.

In the second case, the venous outflow from the penis is disrupted, and blood stagnation occurs. Another name for this phenomenon is ischemic priapism. It is considered more unfavorable because it is accompanied by severe pain and, as a rule, does not go away on its own - urgent medical attention is required.

Why does it appear

There are more than 50 factors that provoke the occurrence of priapism. All reasons can be combined into several groups:

neurogenic causes are associated with dysfunction of the male nervous system. This could be multiple sclerosis, brain cancer or spinal cord, complications of encephalitis and meningitis, traumatic brain injuries;
psychogenic causes are associated either with mental disorders (schizophrenia, epilepsy) or with experiences psychological stress- for example, severe fear that occurred during sexual intercourse. Due to fear it happens sharp spasm vessels of the erect penis, and the erection does not go away;
trauma group - the causes of priapism in a man can be an injury to the genital organ, which causes vascular damage;
metastatic group - in clinical practice there are cases of priapism caused by diseases of the prostate, bladder, kidneys, and intestines;
hematology group unites the causes of priapism in men due to various diseases blood - sickle cell anemia, leukemia, vasculitis.
Intoxication causes are associated with toxic poisoning, drugs, alcohol, animals or plant poison. It may occur as a reaction to taking a strong drug (usually psychotropic drugs), or adverse reaction on taking drugs that stimulate erection;
when the causes remain unidentified, doctors call the disease idiopathic. 60% of all recorded cases belong to this group.

How it manifests itself

The causes of the disease can be either traumatic or pathological.

The main manifestation of priapism is an unreasonable, continuous erection after ejaculation. Lasts from 2-3 hours to several days. The symptoms will be as follows:

the head of the penis is not filled with blood and remains soft to the touch;
numbness occurs (feels similar to what a person experiences when their legs become numb from long stay in one position);
The pain and aching tension begins. The pain gradually increases and radiates to the stomach;
sexual intercourse ends with ejaculation, but the man experiences pain;
urination is not impaired;
the skin of the penis turns red, and if the erection is too long, cyanosis may appear.

Separately, intermittent nocturnal pseudopriapism is distinguished (it is also called sleepy). It occurs only during sleep. The man wakes up due to painful sensations. The erection lasts up to several hours. Intermittent nocturnal pseudopriapism initially occurs 2-3 times a month; If treatment for priapism is not started, the condition will worsen, painful erections will occur several times a night. As a rule, intermittent nocturnal pseudopriapism is provoked by concussion, concussion, or traumatic factors.

If symptoms appear, you should urgently contact a urologist, andrologist or surgeon and begin treatment for priapism. Unfortunately, many men are ashamed of this sensitive issue and wait for the long and painful erection to go away on its own. Is it dangerous. Ischemia of the genital organ can lead to irreversible consequences - cavernous fibrosis, impotence, cavernitis and even gangrene of the penis.

How to treat

Symptoms of priapism that appear are usually treated with conservative methods. They allow you to immediately remove stagnation of venous or arterial blood in the penis and eliminate painful erections. For this, the doctor prescribes novocaine paranephric or presacral blockades. If such treatment does not help and the symptoms do not go away, then a puncture is performed with aspiration of blood and irrigation of the cavernous bodies with anticoagulants and adrenergic solutions.

If the patient seeks help too late (with an erection lasting more than a day), surgical treatment is required to relieve symptoms. The operation will consist of the following: the surgeon will make an incision and create an artificial outflow of stagnant blood through venous system corpus spongiosum or great saphenous vein of the thigh. If an attack of priapism in a man lasts more than two days, then most likely he will need shunt surgery or endophalloprosthetics, since over such a long period the functionality of smooth muscles is impaired.

If you do not contact a doctor promptly, you will need to surgery.

All the described procedures relieve an attack of priapism, but do not guarantee that the disease will not recur. To exclude repetitions, it is necessary to find out the factors that provoked an involuntary erection. For example, if we are talking about priapism caused by hematological causes, then the patient is administered intravenously alkaline solutions, they carry out a decrease in the level of pathological hemoglobin S in the blood, rehydration, plasmapheresis and other necessary procedures. For psychogenic causes, a course of treatment is prescribed by a psychiatrist.

The most important thing is that if symptoms of the disorder occur, do not wait for the erection to go away on its own, but seek help from a doctor and begin treatment for priapism. The longer the blood stagnation continues, the more disastrous consequences are waiting for a man (fibrosis, necrosis, gangrene, in which the affected organ will need to be removed). If you seek help in the first hours after the onset of pathology, relief from the symptoms of priapism will be quick without the need for surgical intervention.

Few people know what priapism in men is, since it is quite rare disease, amounting to 1.5 cases per year per 100,000 population. The term goes back to the name of Priapus, the god of fertility in ancient greek myths, who had a huge phallus in a state of constant erection.

When asked what priapism is, doctors note that this is a very serious disorder consisting of causeless erection. which does not depend in any way on sexual stimulation. Its duration can be more than 4 hours and is accompanied by pain and a change in the color of the penis, even cyanotic. This condition requires urgent medical advice.

The disease can develop at any stage, but more often it occurs in boys 5–10 years old and men 20–50 years old.

Priapism in men

Types of priapism

In men, the following types of pathology are distinguished:

ischemic. Sometimes called venous priapism. It is caused by a deterioration in the outflow of blood from the cavernous bodies. This is the most common and dangerous option diseases. This form of priapism is painful. The penis thickens, becomes denser, and a feeling of pain arises. At further development disease, the penis is practically cut off from the blood supply;
the non-ischemic form (arterial priapism) in men manifests itself due to an increased flow of arterial blood to the cavernous bodies with undisturbed venous blood flow. This is a more favorable type of priapism, according to the prognosis of cure, which is less common. The patient does not feel severe pain and discomfort; such priapism goes away on its own. It is usually formed as a result of injuries to the perineum and penis. Pain may occur due to pinching of the genitofemoral nerve;
true priapism occurs unexpectedly, usually during sleep. But the penis remains erect even after waking up. Penis tension is accompanied by a feeling of pain at the root and radiates to the perineum. Swelling of the penis may occur;
intermittent nocturnal priapism (pseudopriapism, sleepy) is characterized by short exacerbations of painful erections of the male penis at night during sleep. At first, awakenings due to such erections are rare, but gradually more and more often, attacks last for 3 hours with breaks, bringing more and more suffering. The erection stops after waking up, going to the toilet, walking, or applying ice.

Causes of priapism

The main cause of the pathology is still unknown.

Diseases circulatory system

diseases of the circulatory system that impair its coagulation (most often sickle cell anemia);
injuries and diseases of the male genital organs;
disturbances in the functioning of the nervous system;
poisoning of the body;
splenectomy;
taking hormonal medications;
metabolic disease;
malaria and spotted fever;
thrombosis;
taking drugs;
chronic renal failure;
inflammation of the urethra;
venereal diseases.

Symptoms of priapism

Lower abdominal pain

The main manifestation of this disorder is a pathological erection that occurs without arousal and continues after sexual intercourse. Lasts from 3–4 hours to several days. The symptoms will be as follows: erection is accompanied by pain, numbness of the penis occurs, cutting, aching compression of the penis begins, pain in the lower abdomen, the skin of the penis turns red, if the erection is too long, cyanosis may appear, the penis is arched, the head “looks” at the stomach.

Diagnostics

Priapism is an urgent disease. If the pain in the lower abdomen is unbearable, then it is better to call an ambulance.

Examination for priapism includes a whole complex diagnostic procedures, since sometimes this ailment is a sign of more serious illnesses. Treatment is carried out by a urologist, andrologist and surgeon.

The doctor will resort to the following methods diagnostics:

collection of a detailed medical history (sexual life, presence of chronic and infectious diseases, presence in the family of relatives with a similar disease);
general blood analysis;
blood chemistry;
examination of the penis;
examination of the abdomen (pain in the lower abdomen can be signs of very serious diseases);
coagulogram;
angiography;
cavernosography (x-ray diagnostic method with the introduction of contrast into the cavernous body);
dopplerography;
toxicological study;
blood gas analysis to determine the type of priapism;
examination of the prostate gland.

Timely contact with a specialist greatly simplifies the treatment of priapism. But, nevertheless, it is performed on an outpatient basis. Doctors prescribe a course of drugs to dilate blood vessels and painkillers, since pain in the lower abdomen is a mandatory symptom of priapism.

With non-ischemic priapism, doctors often adhere to a wait-and-see approach, because this condition does not bring severe pain and discomfort to the man. Attacks and pain in the lower abdomen are relieved with cold lotions, but in any case it is necessary to regularly see a doctor. In most cases, non-ischemic priapism resolves spontaneously over time.

Offered long-term treatment priapism with antidepressants, neuroleptics, hypnotics and sedatives, tranquilizers. Hypnosis and auto-training, hirudotherapy, and acupuncture may be prescribed. Can be used female hormones, but libido decreases. In addition, the effect of using testosterone drugs is temporary.

Ischemic and intermittent nocturnal priapism in the early stages of development requires the introduction of metazone into the cavernous bodies. On late stages these actions are no longer enough, and it is necessary to perform a puncture (puncture of the penis in order to get rid of excess blood, which brings a feeling of compression of the penis) and washing of the cavernous bodies with saline solution.

In cases where drug treatment Priapism does not have the desired effect; surgical intervention is required. The surgeon's task is to create a drainage vessel between the veins of the penis and the other veins in order to increase blood flow from the penis.

Several techniques are used surgical intervention:

T-shunting (Winter technique). Under local anesthesia a thick needle is inserted into the cavernous bodies of the penis. The needle passes through the head of the penis and drains excess blood.
"El Gorab" method. The method is aggressive and open. A hole is created in tunica albuginea distal part of the cavernous body and a shunt is applied.
Kvakel technique. Performed from the perineum. Vascular prosthesis(shunt) is placed between the spongy and cavernous bodies. Shunting can be either unilateral or bilateral.
Greyhack bypass. This procedure is rarely used due to the large number of contraindications. This is a subcutaneous cavernous vein bypass.

In the case when the listed types of treatment for priapism do not help, erectile function can be restored or maintained in only one way - prosthetics.

The consequences of the disease can be very serious: gangrene, fibrosis, which can lead to impotence, thrombosis of the veins of the cavernous bodies and pelvic veins.

Prevention

Since the true cause is unknown, doctors suggest patients switch to healthy image life, that is, quit smoking, alcohol and narcotic substances. It is also necessary to avoid taking drugs or using methods that artificially increase potency or increase the size of the penis. Men must be sure to protect the groin area from possible injuries.

To refuse from bad habits

Despite the fact that the disease has long been known to doctors, it still remains a serious and at the same time rare and poorly understood urological problem.

What is priapism, how and why it manifests itself in men

The most common patients with priapism are boys 5-10 years old and men 20-50 years old. Children most often get sick when they inherit diseases of the circulatory system, such as sickle cell anemia.

2 Symptoms of the disease

To determine the symptoms of a disease, you should be guided by its type. There are ischemic and non-ischemic priapism. With the ischemic type, there is no outflow of blood from the penis, that is, there is only an influx that contributes to the continuation of an erection. The non-ischemic type is more loyal: there is an outflow of blood, but it is small, which also allows blood to fill the organ and prolongs the erect state of the penis.

Symptoms of ischemic priapism:

more than 4 hours of erection;
sexual intercourse does not relieve the problem, erection is not associated with sexual arousal of the man;
the penis is hard, and its head, on the contrary, is soft;
organ soreness.

This type tends to occur intermittently, meaning that sometimes the disease manifests itself and sometimes it does not. In this case, the erection is painful and lasts about 3 hours or less.

Non-ischemic priapism behaves somewhat differently: due to the small outflow of blood, the penis is not hard to the touch. Painful conditions not observed in this type.

Any type of disease is dangerous. It is based on these considerations that you need to contact a urologist if you detect any symptoms of the disease.

3 Symptoms

True priapism can begin quite suddenly and very often occurs during sleep. The penis becomes very tense. Typically, this condition does not affect urination, because the urethra, prostate and head of the penis are simply not involved in the process of priapism in men. This occurrence is accompanied by pain in the area of the root of the penis and perineum, and the foreskin swells. Sexual intercourse in the case of true priapism does not bring relief. The pain only intensifies, because ejaculation does not occur.

Nocturnal intermittent priapism is short-term painful erections that occur during sleep. An erection during sleep in this case can wake you up, but in the initial stage of the disease this happens quite rarely. Gradually, cases become more frequent and the pain intensifies. This type differs from true priapism in that the erection weakens during urination, active movements, awakening, or taking sleeping pills or sedatives.

4 Diagnostics

If the penis is erect for several hours, this is a good reason to consult a doctor. It is no secret that in the presence of diseases of the penis, men are tormented not only by the disease itself, but also by a feeling of shame. This is the most common reason late visit to the doctor. Priapism - emergency illness, so make an appointment immediately as soon as symptoms appear. Problems of this type are solved by doctors - a urologist, andrologist or surgeon. If a man still does not know which specialist to contact, it is best to call the well-known number 03 and call an ambulance. Before taking it, to alleviate the condition, you can try to cool the penis with cold water, but this does not eliminate the need to consult a specialist.

Examination for priapism includes a set of procedures, because there are often cases when there are more reasons behind this disease. serious illnesses. The type of priapism is determined by analyzing blood gases. A thin needle is inserted into the penis to draw blood: if the blood is light, it is most likely non-ischemic priapism. Dark blood indicates an ischemic type of disease. Will give a more accurate result lab tests blood gases.

The X-ray diagnostic method is cavernosography. An image of the organ is taken after the contrast agent is injected into the corpora cavernosa.

The doctor may also prescribe an ultrasound, Doppler ultrasound or ecg.

5 Treatment options

Depending on the type of disease detected, a conclusion is made about the choice of treatment. Priapism can be treated with medication and surgery. In the initial stages of the disease, in most cases they are used medical supplies, and the help of surgeons is resorted to only in case of unsuccessful treatment with medication.

It must be remembered that the earlier the treatment began, the more effective the result will be.

On initial stage A puncture of the corpora cavernosa of the genital organ is taken. This is done using a special needle under local anesthesia. Excess blood in the penis is sucked out and the doctor gives injections vascular drugs. During blood sampling and injections, there is a high probability of touching other vessels, causing surges in blood pressure, and possible loss of consciousness. For this reason, such treatment of priapism can only be carried out in a hospital setting under the close supervision of a doctor.

There are times when medications do not have the intended effect in treating a disease. Then surgery is required. The surgeon's goal is to create a drainage vessel between the veins of the penis and the other veins to speed up the process of blood outflow from the penis.

There are several surgical techniques:

Winter technique. Under local anesthesia a thick or biopsy needle is inserted into the corpora cavernosa of the penis. The needle passes through the head and provides suction of blood.
El Khorab method. The method is open and more aggressive. A shunt is placed between a pair of corpora cavernosa and the glans penis.
Kvakel technique. A shunt is placed between the corpus spongiosum and the corpora cavernosa. If the “Winter” method is sufficient to apply on one side, then the “Kvakel” can be applied on both sides of the genital organ.
The Grayhack method. The method is used very rarely due to limited indications for surgery. Its general purpose is to apply a shunt between the corpus cavernosum and the great saphenous vein of the leg.

Do not be afraid of temporary impotence after treatment, both medicinal and surgical - the consequence is unpleasant, but completely common. There is no need to worry about this at all - after a while the function will be restored.

If the doctor has identified non-ischemic priapism, then his position in in this case It may turn out to be a wait-and-see approach, since there is no risk of tissue damage. This type of disease tends to go away on its own without treatment. Symptoms can be relieved by cooling the penis and perineum.

It also happens that treatment does not bring results, no matter what it is. This is typical for advanced cases of the disease. There is only one way out: implantation of a prosthetic genital organ.

In the later stages of the disease, you may experience:

thrombosis of the veins of the cavernous bodies with the risk of thrombus rupture;
gangrene with further necrosis and rejection of penile tissue, which sometimes ends in blood poisoning.

The consequences are truly terrible. Therefore, if you notice the slightest changes in the behavior of the genital organ, you must immediately visit a doctor. Then the disease will not cause any special problems, and dangerous complications can be avoided.

6 Prevention

If a man has sickle cell anemia, then there is no better prevention than timely treatment there is no such disease.

It is worth remembering that drug and alcohol abuse are common causes of priapism. Accordingly, this must be avoided.

Any erection problem should be addressed with a doctor. If you use drugs to increase the duration of an erection (Viagra) without consulting a doctor, this can lead to sad consequences in the form of priapism or other “male” diseases.

Diseases hormonal nature it is necessary to treat taking into account priapism, if any. It is imperative to inform the endocrinologist about the presence of priapism so that the selection of drugs is as effective as possible.

For any male disease You cannot be guided by your shyness or embarrassment.

Timely treatment of priapism will ensure a long and healthy, that is, a full-fledged male life.

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What is Priapism in men?

Priapism is an involuntary erection that is not associated with sexual arousal. Its duration can be from four to six hours, which is naturally accompanied by painful sensations and discoloration of the skin of the penis.

This condition requires immediate medical attention.

Although the development of priapism can occur at any age, it most often occurs in children between five and ten years of age and men between twenty and fifty.

Priapism is very rare condition, and patients suffering from this problem account for up to 0.2% of those who consult a doctor about the issue sexual disorders. You should immediately consult a doctor if an erection lasts more than four hours, or even less when it is accompanied by pain.

Priapism manifests itself when blood flow is disrupted in the cavernous (cavernous) bodies of the penis. In this case, there may be a noticeable increase in arterial blood flow, causing overflow of the cavernous bodies, which is usually associated with injuries to the penis. This is not ischemic priapism. In other cases, there is a deterioration in venous outflow, in which blood stagnation begins with a change in its properties. This is ischemic priapism.

Causes of Priapism

Priapism can accompany diseases such as:

spinal cord injuries;
brain tumors;
multiple sclerosis;
consequences of traumatic brain injury and other neurological pathologies;
sickle cell anemia;
leukemia, other blood diseases;
diseases of the male genital organs, which are accompanied by tumors and inflammation.

In addition, the cause of priapism can be various intoxications, due, for example, to chronic renal failure or using excessive amounts of alcohol or cocaine. Contribute to the development of diseases and injuries of the pelvic organs, injuries to the genitals or perineum. Other contributing factors are poisoning from venoms, particularly black widow or scorpion, metabolic diseases such as diabetes, and blood clots. Priapism can also be caused by the use of a number of medications. These are, in particular, drugs used to treat erectile dysfunction (Viagra and Levitra), drugs that are injected directly into the genital organ to treat impotence, psychotropic drugs (olanzapine and risperidone), antidepressants (buporpion and Prozac), indirect anticoagulants(heparin and warfarin), anti-anxiety medications such as Valium.

Symptoms of priapism in men

The first manifestations of true priapism usually occur suddenly and during sleep. In this case, the penis is tensed to the maximum, but urination is most often not impaired, since only the cavernous bodies are filled with blood, and the head of the penis, urethra and prostate do not take part in the erection. The erection itself is accompanied by pain in the perineum and at the root of the penis. A few hours after the onset of the attack, swelling of the penis, especially the foreskin, appears. For priapism, sexual arousal is completely uncharacteristic and sexual intercourse does not bring relief, due to the fact that it does not end with ejaculation and does not lead to a weakening of the erection, which only increases the pain.

They are distinguished by intermittent nocturnal priapism, which is characterized by short-term painful erections of the penis during sleep. In the initial stage, erections and awakenings occur no more than once a week, however, then they become more frequent up to several times a night and become more and more painful to bear. From true priapism similar condition characterized by weakening of erection after waking up, emptying the rectum or bladder, walking, active movements, or using sedatives or hypnotics.

Treatment of priapism

Treatment of priapism is more effective the earlier it is started. At the beginning of treatment, a puncture of the corpora cavernosa of the penis is performed using a special needle; this occurs under local anesthesia. Next, excess blood is sucked out and vascular injections are made. medicines. These drugs can penetrate into other vessels and lead to a sharp decrease in blood pressure and loss of consciousness, so treatment is carried out only in medical hospital, constantly monitoring arterial pressure. In case of failure drug therapy priapism, urgent surgical treatment is necessarily prescribed, which consists of creating a drainage vessel connecting the veins of the penis with other veins in order to accelerate the outflow of blood. After treatment, temporary impotence may occur, which soon disappears and sexual function returns to normal.

Non-ischemic priapism often goes away on its own without treatment and, due to the fact that there is no danger of tissue damage, the doctor usually takes a wait-and-see approach. It is recommended to apply cold to the base of the penis and perineum, this can help return the penis to its normal state.

MOST INTERESTING NEWS

The disease priapism received its name from the ancient god of fertility, debauchery and voluptuousness, Priapus, who is represented in all images and sculptures with an erect phallus.

Unfortunately, this disease is not “divine pleasure.” He is serious pathology with a prolonged, painful erection that is not associated with sexual arousal and does not end after ejaculation. The erectile state can last for several hours.

What is priapism is known from personal experience by a small number of men - 0.11-0.4% of the number of sufferers various kinds urological ailments. However, this disease deserves attention due to the fact that its consequences can be very serious.

The development of priapism can occur in any age period, but most often it occurs in boys before puberty and in men during active sexual activity

The main cause of involuntary painful erection is disruption of blood flow in the cavernous (cavernous) bodies of the penis. If a significant influx of arterial blood leads to overflow of the corpora cavernosa, usually due to trauma, non-ischemic priapism occurs. In cases where the venous outflow from the penis worsens, the blood stagnates and its properties change, veno-occlusive or ischemic priapism occurs.

The etiology of ischemic priapism is varied.

Direct injection of vasoactive drugs into the cavernous tissue during treatment. The risk of an attack is especially high when using papaverine.
Hematological diseases. At increased viscosity blood, adhesion of blood elements and thrombus formation occurs. In 23% of men and 63% of children, ischemic priapism occurs against the background of sickle cell anemia. In 1% of all cases, the cause is leukemia.
Cancers (prostate, bladder, kidney, colon, genitourinary system) and accompanying metastatic processes into the cavernous tissue or venous collectors of the pelvis block venous outflow from the penis.
Taking psychotropic, narcotic, antihypertensive drugs, alcohol, antidepressants.
In 12%, perineal trauma leads to ischemic priapism. When tissue swells at the base of the penis, thrombosis occurs.
Diseases and injuries of the central nervous system, such as tumors, multiple sclerosis, brain injuries (brain and spinal cord).
Psychoneurological factors.

If the cause of involuntary erection is not clear, and this happens in 30-60% of patients, priapism is given the name idiopathic.

Etiology of non-ischemic arterial priapism

Blunt trauma to the penis or perineum is almost always the cause of arterial priapism - rupture of the cavernous artery or its branches. After vascular surgery to restore erectile dysfunction, this condition is less common. There are cases that arterial priapism manifests itself several days after injury. This is explained by the fact that a blood clot formed in the damaged artery resolves after some time.

It is believed that an arterial form of the disease may exist long time without consequences for the cavernous bodies. In medical practice, there have been cases when this form of priapism was observed in patients for several years while maintaining potency.

Intermittent nocturnal priapism is the episodic occurrence of ischemic priapism, usually during sleep. In this case, each episode either goes away on its own or is successfully treated with aspiration of the cavernous bodies or intracavernosal injections of adrenergic agonists. Nocturnal priapism is characterized by maximally tense penis. Erections are short-term, but painful. After waking up, defecating, and active movements, the erection weakens.

Nocturnal priapism can occur at any age. At first, awakenings in the middle of the night due to an erection occur occasionally (once a week or 10 days); over time, they occur every night and more than once.

The etiology of intermittent priapism is poorly understood, but it is believed that it arises from a defect in smooth muscle with an increased tendency to relax.

Treatment of this condition involves systemic preventive treatment, preventing future attacks of priapism episodes, including self-administration of an intracavernosal injection of adrenergic agonists, antiandrogen therapy, acupuncture and, as a final treatment option, penile prosthesis.
Also, when a diagnosis of “nocturnal priapism” is made, long-term therapy with antidepressants and tranquilizers is prescribed, and it is recommended to consult a psychotherapist.

Common Causes of Priapism

Priapism may occur due to the following medications:

drugs that enhance erectile function - Viagra, Levitra, etc.;
antidepressants and sedatives - Buporpion, Prozac, Valium, Diazepam;
indirect anticoagulants - Heparin, Warfarin;
psychotropic drugs - Zyprexa, Risperidone;
drugs injected into the penis to treat impotence.

In addition, prolonged involuntary erection of the penis is a consequence of certain diseases:

anemia, leukemia;
brain tumors;
spinal cord injuries;
diseases of the genitourinary system (tumors, injuries, etc.);
metabolic disorders (diabetes mellitus);
intoxication (alcohol, drugs).

Symptoms

As a rule, the urinary process is not disturbed, since in this case the overflow of blood occurs in the cavernous bodies, and the head, prostate and urethra do not participate in the erection. The head of the penis is flabby and small, the surface of the penis is smooth without any bulges caused by the erection of the corpus spongiosum located around the urethra.

With ischemic priapism, there are severe pain in the penis and perineum several hours after the attack. Swelling of the penis and foreskin may occur. There is no relief during intercourse, and sometimes pain syndrome is only getting stronger. With arterial ischemic priapism, the patient usually does not experience pain, since the venous outflow is normal.

The absence or presence of pain makes it possible to distinguish the ischemic form from the non-ischemic one.

The type of priapism is determined using a blood gas test. A thin needle is used to draw blood from the penis. If the blood is dark, it is most likely a case of ischemic priapism; if it is light red, it is most likely non-ischemic. More accurate results analyzes are obtained through laboratory tests.

In most cases, an ischemic type of priapism is observed, when the level of oxygen in the blood entering the cavernous bodies decreases, pain appears and damage to the smooth cavernous muscles develops. If left untreated, there is a risk of developing cavernous fibrosis, which can lead to loss of normal erection.

If an erection lasts more than 4 hours, a man should seek help from a urologist. But, unfortunately, the patient, due to false shame, turns to the doctor a day later or later.

Prolonged priapism dramatically increases the incidence of erectile dysfunction. Taking into account the peculiarities of the course of the disease, treatment of priapism should be fast, effective and step-by-step, aimed at maintaining potency.

Ischemic priapism treatment:

If the patient consults a doctor within 6 hours of the onset of the attack, he is prescribed the use of a cold compress, intravenous or intramuscular injections Relanium, drugs that improve blood properties.

In case of an attack lasting more than 6 hours, the following is carried out:

aspiration of blood and irrigation of the cavernous bodies (efficiency 30%);
intracavernous administration of adrenergic drugs (efficacy 58%)
sequential aspiration/irrigation with intracavernous injections.

The use of any sympathomimetic agent can stop an attack of priapism, however, when using adrenaline, tachycardia and arrhythmia occur, and when using metaraminol there is a risk of developing a severe form of hypertension. Minimal amount side effects gives the use of phenylephrine, mezatone.

Treatment of priapism (ischemic), which lasts more than 24 hours, with adrenergic agonists should be carried out with great caution, as this can lead to increased ischemia of the cavernous tissue.

If the attack lasts more than 48 hours, there is a need for shunt surgery or endophalloprosthetics, since during this period the functionality of the smooth muscles is impaired. The effectiveness of adrenergic drugs is practically absent.

Shunt operations are aimed at improving venous outflow from the cavernous bodies.

Priapism that occurs against the background of a hematological factor has some features. The patient is injected intravenously with alkaline solutions, a reduction in the level of pathological hemoglobin S in the blood is carried out using hypertransfusion, rehydration, plasmapheresis, etc. are carried out. After this, treatment of priapism occurs according to standard methods (aspiration/irrigation of the cavernous bodies, intracavernous injections of adrenomimetic drugs).

In case of irreversible changes, when the outcome is cavernous fibrosis, penile prosthesis is the only method of restoring normal physiological potency.

Endofalloprosthetics is excluded in the following cases:

In the arterial form.
For symptomatic (non-idiopathic) nocturnal priapism, when it is necessary to vigorously eliminate the cause of the disease.

Priapism is a prolonged, usually painful erection that is not associated with sexual arousal. The term comes from the name greek god Priapus, a penis that was constantly in an erect state. Priapus, always ready for sexual intercourse, Greek mythology was assigned the role of a fertility deity.

Types of priapism

There are two types of priapism - with a weak blood supply (ischemic) and with a good blood supply (non-ischemic). Ischemic priapism can develop as a result of sickle cell anemia, leukemia, the use of anticoagulants (drugs that reduce blood clotting), spinal cord damage, fat embolism, malignant inflammation of the penis, autonomic neuropathy, and the effects of certain medications. Often the causes of ischemic priapism remain unknown.

Priapism with good blood supply most often develops as a result of injuries to the perineum and penis. In this case, a communication occurs between the artery and the cavernous bodies of the penis. As a result, the penis fills with blood under high pressure. This blood does not have time to evacuate back, and an erection occurs.

How does priapism manifest?

The main manifestation of priapism is an involuntary erection not associated with sexual desire. Priapism is often accompanied by pain in the penile area. With priapism, in contrast to a true erection, the corpora cavernosa become hard, while the glans penis remains soft.

Is priapism dangerous? What to do

The main danger of priapism is a violation of the blood supply to the tissues of the penis, necrosis, which can become a reason for amputation of the penis. With ischemic priapism (with poor blood supply), after some time due to damage, fibrosis occurs - proliferation connective tissue. With fibrosis, impotence occurs.

If priapism is detected, you should CONSULT A DOCTOR IMMEDIATELY! In cases of priapism with good blood supply, the situation is acute. It requires immediate surgical intervention. As the duration of priapism increases, the incidence of subsequent erectile dysfunction increases sharply.

Treatment

Treatment of priapism begins with an examination, clarification of complaints, as well as some features. Once a diagnosis is made, treatment can begin. In case of priapism with poor blood supply (ischemic), it is necessary to establish the true causes of its occurrence and, if possible, influence them. Treatment of priapism itself in this case begins with non-surgical methods. So, a needle is inserted into one of the corpora cavernosa, a small amount of blood is taken and sent for testing. Saline solution is injected into the corpora cavernosa. Repeat the manipulation until the blood turns scarlet. After this, a special drug (Phenylephrine) is administered, which relieves the symptoms of priapism.

The same tactics are followed for priapism with good blood supply. If measures are ineffective, surgical treatment is required. In this case, a communication is created between the cavernous bodies and the glans penis or the saphenous vein system. In such cases, blood is removed from the corpora cavernosa through an additional pathway. According to materials.

Lasting more than three hours without connection with sexual arousal.

Name

The term "Priapism" comes from Greek mythology, according to which, the god of fertility Priapus (Πρίαπος, Priapus), had a constant erection at any time of the day.

Symptoms

Types of priapism

Ischemic (accompanied by a sharp decrease in blood flow in the arteries of the cavernous bodies of the penis);
Non-ischemic, in which there is no disturbance in blood flow;
Drug-induced - caused by the effect of drugs on the arteries of the cavernous bodies, for example, with injection therapy.

There is also a condition called “pseudopriapism”.

Causes

Apart from the causes of drug-induced priapism, other factors causing this condition have not been thoroughly studied.

Non-ischemic priapism can accompany injury to the penis, due to a violation of the insulation between the cavernous bodies and their circulatory system.
Ischemic priapism can be caused by: inflammatory processes, consumption narcotic drugs(the ability to cause priapism is attributed to cocaine), blood diseases such as sickle cell anemia; oncological diseases, spinal cord injuries and side effect medicines.
Pseudopriapism is a strong nocturnal erection, which is not pathological condition and does not require treatment.

Prevention of drug-induced priapism

Each patient undergoing a test at the clinic must receive a clinic business card with a telephone number for emergency communications. It is necessary to explain to the patient that in case of an erection lasting more than 4 hours, he must contact the duty officer, regardless of the time of day.
In some countries (Israel, USA), 2 tablets of sinufed (a drug for the common cold containing pseudoephidrine) are used as prophylaxis. This therapy suggested if you have an erection lasting more than two hours.

Treatment

Conservative treatment

immediate cessation of sexual activity until the erection completely disappears;

If the patient is generally healthy, a cold shower is helpful;
If cold water unacceptable from the patient's point of view - it is necessary to apply ice to the in a plastic bag to the base of the penis. The procedure lasts about half an hour.
Physical activity such as climbing stairs, squats, or riding an exercise bike.

Pressing hard on pubic bone thumb for 30 – 60 seconds;

If the erection begins to weaken, it is highly recommended that the patient go to sleep. By morning, as a rule, the penis will be completely relaxed. Sometimes there may be a slight swelling of the corpora cavernosa. This passes in a period from 6 hours to two days;

If symptoms continue or pain occurs, the patient should report to the clinic for drainage.

Drainage

For drainage you need: kidney-shaped basins, a 20 ml syringe, a 19 G butterfly needle, an elastic bandage, a solution of neosynephrine or its analogues. At Es Class Clinic, it is customary to drain, in contrast to world practice, not by puncturing the head of the penis, but from the lateral side of the penis, a few centimeters from its base.
The penis is disinfected with alcohol and anesthesia is performed with chlorethyl (optional).
Carefully but immediately insert the butterfly needle into the corpus cavernosum until blood begins to flow through the tube into the reniform pelvis.
It is necessary to let the first portion drain. Sometimes this is enough, but in most cases active evacuation of blood from the cavernous bodies is required. Using a syringe, 10-15 ml of blood is evacuated and drained into a basin. Instead, the same amount of neosynephrine solution is injected (diluted 1 to 500), washed with it, followed by evacuation. The procedure is repeated until the pulsating softening of the penis begins. In this case, it is necessary to stop the drainage and wait without removing the needle from the corpus cavernosum. If the erection does not return, it is necessary to remove the needle and bandage the penis with an elastic bandage for 2 hours. The maximum allowable amount of blood during drainage on an outpatient basis is 500 ml. In case of complicated priapism, when after drainage of 500 ml and lavage there is no effect, it is necessary to send the patient to the hospital. After drainage and dressing, the patient is recommended to rest for half an hour and have sweet coffee. Continuation