Painful Erection
Article Outline
A 32-year-old man presented, complaining of a painful erection for the last 18 hours. His medical history was significant for insomnia and depression, for which he was taking quetiapine, bupropion, and prazosin. Examination revealed a mildly tender, fully erect penis and a soft glans. He was given 0.25 mg of subcutaneous terbutaline, with no improvement of symptoms. A color Doppler ultrasonograph in the transverse plane was taken before (Figure 1) and after (Figure 2) definitive treatment by urology.
Figure 1.
Color Doppler ultrasound of penis pretreatment.
Figure 2.
Color Doppler ultrasound of penis posttreatment. Used with permission of Eric B. Tomich, DO, Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA.
Diagnosis
Low-flow (ischemic) priapism. Priapism is classified as low-flow/ischemic, a urologic emergency, or high-flow/nonischemic, a condition that warrants only observation and outpatient follow-up.1 Prompt differentiation between the 2 is important for the emergency physician and has classically been accomplished through corporal blood gas analysis, a potentially painful procedure with risk of iatrogenic injury to the cavernosal artery.2 It may also overestimate the actual flow state in ischemic priapism.3 The use of color Doppler ultrasonography in priapism is well documented in the urology literature, with many studies showing it to be an equivalent or preferred modality.1, 3, 4 While a high-frequency linear transducer is used, the penis is scanned on the ventral aspect in both transverse and longitudinal planes. The presence or lack of flow from the cavernosal arteries can be rapidly determined.1 Emergency medicine treatment algorithms recommend early consultation with urology when the diagnosis is suspected.5
References
- Priapism. Radiol Clin North Am. 2004;42:427–443
- Cocaine associated priapism. J Urol. 1999;161:1817–1818
- . Erectile dysfunction and priapism. Nat Clin Pract Urol. 2004;1:49–53
- The prediction of papaverine induced priapism by color Doppler sonography. J Urol. 2001;165:416–418
- . Low-flow priapism needs recognition and early correct treatment. Emerg Med J. 2007;24:209–210
For the diagnosis and teaching points, see page 210.
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The opinions or assertions contained herein are the private views of the authors and not to be construed as official or reflecting the views of the Department of the Army, the Department of Defense, or the US Government.
PII: S0196-0644(07)01797-0
doi:10.1016/j.annemergmed.2007.11.029
© 2008 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
