Priapism: Fifty Persistent Erections

The image shows a case of priapism

This article is a rare case of priapism in a 48-year-old man. He presented in the emergency department with a complaint of more than fifty episodes of erections. Each erection lasted approximately five minutes and was painless. Moreover, persistent erections had an association with generalised body spasms, which lasted for a few seconds.

The patient had a medical history of a cerebral tumour. The treatment was successful, however, it reoccured. He underwent two years of chemotherapy that resolved it and was in remission since the last chemotherapy.

Moroever, he appeared well oriented during his general physical examination and showed signs of mild distress. His urology examination showed an erected penis. However, there was no sign of ischemia.

The doctors then performed further routine investigations on an urgent basis, which included, complete blood count, liver function tests, renal function tests, C-reactive protein and coagulation profile. All the reports had normal results.

Differential Diagnosis: High Flow Priapism

Treatment included a dose of oral pseudoephedrine and cavernosal aspiration. Cavernosal aspiration removed 380 ml of bright red blood, after which, the doctors could make a differential diagnosis of high flow priapism. However, despite the aspiration, the patient’s symptoms did not resolve. The d for blood gas analysis, however, it did not result in any definitive diagnosis.

The patient was transferred to the operation theatre and the doctors performed another cavernosal aspiration. Before the aspiration, the doctors gave the patient an intra-cavernosal injection of phenylephrine. It resolved the patient’s priapism, which concluded that surgery was unnecessary.

He was shifted to the ward and further investigations, which were, CT brain, abdomen and pelvis were done. None gave an evidence of recurrence or distant metastasis.

Soon after, the patient developed another episode of priapism while showering. But the episode resolved spontaneously without reuccurnce. Hence, he was discharged.

What is this condition?

Priapism is a prolonged erection of the penis. The full or partial erection continues for hours and is not due to sexual stimulation. The main types of priapism are ischemic and nonischemic. Ischemic priapism is a medical emergency.


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