Description priapism
Under this name hides a prolonged and persistent erection spontaneously accompanied by considerable pain. The word comes from the Greek, is derived from the Greek god Priapus, which was the god of love gardens and the plant and animal world. This disease is not so frequent, but deserves attention because of possible serious urologic complications. It is important to note that erectile priapism is not related to sexual excitement, nor libidózními ideas or feelings, often unrelated to the previous sexual activity. Erection is a long-term, it is not associated with orgastickými experiences nor terminated ejaculation. It is a pathological condition requiring medical attention.
Turn for a moment to the anatomy of the male reproductive tract, we understand why priapism must be addressed and what are the risks. The main structures of the penis erectile bodies that together contain three and elastin, blood vessels and smooth muscle. One of the pair and one unpaired. The unpaired body extends urethra, which is a man 3-4 times longer than in women. Erectile bodies are “attached” to the pubic bones, which are part of the pelvis. The surface of the erectile bodies are wrapped in a fibrous membrane (imagine membrane similar to that for beef, but is naturally thinner).Of this membrane withdraws into its own connective tissue elements and smooth muscles pervaded spicules, which divide the body into small cavities into which open arterial connections of the small blood vessels that supply the penis. Erection occurs to sexual stimuli, whether visual or tactile. It’s a fairly complex storyline, in which he is involved in many brain structures. The result is that in the erectile bodies begin to flow without limitation blood, erectile bodies are actually such a “mushroom”, takes in the inflowing blood in the meantime and its increasing volume utalčují small veins so that they can not divert blood to a sufficient degree. It then accumulates in the penis until until slack fibrous membrane which is on the surface of the erectile bodies. At that moment begin withdrawing small smooth muscles and up to ten times the normal blood pressure, increases blood pressure in the body. Penis parallels, urethra expand its lumen and is ready for the passage of sperm. Is a reflex of the brain stopped urinating. Erection state is maintained for a certain period nervous reflex circuit and waits until sexual arousal reaches such a degree that it can run plot ejaculation. Priapism has been reported in every age, from birth to 70 years, with a peak incidence between the fourth and fifth decade of life. In children and adolescents, most often occurs in combination with the blood disease – sickle cell enemie.
Priapism primary (idiopathic)
We do not know the underlying cause and you can not fathom it.
secondary priapism
The causes can be divided into several categories. The priapism occurs occasionally in identifying erectile dysfunction. To determine this diagnosis is applied by special substances which cause an erection directly into the penis and observing the response to their action. The procedure is not in itself a rather unpleasant and stressful for many men. With the correct recommended dose should not be allowed to priapism, if that happens, it is an advantage that is immediately close to the doctor and solve the problem.
Overall incidence after medication dosages was observed with antidepressants, anti-anxiety drugs, marijuana and substance abuse – with alcohol and cocaine users typically u. Another group of drugs in which priapism was observed, the drugs are designed to “thinning” the blood – heparin and warfarin, drugs to lower blood pressure and a separate chapter consists of male sex hormones testosterone and androstenedione. They tend to be abused by athletes and bodybuilders, of course, are also used therapeutically to treat various hormonal imbalances. The priapism occurs even after excessive local application of different aphrodisiac directly to the penis in the form of ointments or emulsions. Priapism has been observed in patients with various tumors of blood. The reason it is easier to stagnation altered tumor cells in a body or bodies infiltration of tumor blood cells in leukemia.
Priapism can also occur after trauma or pans directly to the penis. It is the result of established connection = fistula between artery erectile bodies and the female bodies. When injuries pelvis or pelvic floor tears open the artery and fistula resulting in voids body escapes disproportionate amount of blood.
In neurological diseases we encounter priapism as well. This is a narrowing of the spinal canal or meningitis.
The priapism occurs even within the local disability. Originates at stagnation of venous blood in the penis and then a blood clot which is formed in the veins of the erectile bodies. This phenomenon occurs in either primary or metastatic tumors of the penis, the urethra and the pelvic floor.
classification priapism
Arterial (high-flow, dynamic)
It is rare and is caused by sustained high blood flow. Usually little pain and is prognostically favorable for prolonged duration. Erection is more elastic than the stiff character rigid.
Veno-occlusive (either low, ischemic, static)
It is more common and is with him permanently closed the veins that drain blood from the erectile bodies. Erection is a solid, very painful, the longer it takes, the more difficult to treat and is accompanied by even worse treatment of early and late results.
Symptoms and diagnosis of priapism
Priapism affects always paired corpus cavernosum. Consequently, there is also the clinical findings.We find hard upper side of the penis and soft bottom. Head sign is completely soft acorn. The doctor performed an ultrasound examination and distinguish whether the problem is in the arteries or veins of the erectile bodies. When suspected fistula spraying aretrií contrast agent which shows exactly where the artery is damaged and which communicates with ferrules.
treatment of priapism
It is basically twofold. Either conservative, i.e. it does not resort to surgery or surgical procedures exist to deal with priapism. Conservative treatment includes cooling penis tiles with crushed ice ordraining excess blood from the penis syringe and application of adrenaline, a hormone that restores the correct voltage walls of small blood vessels, namely to encourage contraction of the vascular wall and prevents further inflow of blood. It is also possible to create a blood clot in a blood vessel in the supplying bodies, and once again reduce the volume of incoming blood. All these interventions are used when detecting vysokoprůtokového priapism.
Surgery is reserved for veno-occlusive priapism form. It is used when it preserved venous unpaired body, which is not affected by priapism. Between the venous system to establish temporary connections that later must be canceled in order to restore erections. It can be cut open and fibrous packing bodies to release overpressure and cuts later stitches. This is used by several anatomical approaches the body of the penis.
To accept a patient with priapism is as follows. The doctor receives the patient immediately and ask about what all of the patient’s current state before. Within 12 hours of the difficulties penis cooler, if that does not work, and within 24 hours is removed from the penis blood for laboratory tests (detects oxygen content) and the right to apply adrenalin dose and number of repetitions in dependence on the state of the cardiovascular system of the patient. If priapism lasts longer than 24 hours, and this is usually the case, then accesses sphincterectomy ligamentous container and emptying topořivého body puncture. If priapism resolves within 36 hours, the success of treatment is very high and there are no changes to the blood vessels of the erectile bodies. Over 36 hours after the beginning of the trouble is always a certain degree of change in blood vessel walls appear. In the treated arterial priapism are affected by erectile dysfunction, 20% of patients with veno-occlusive type Bozel half of patients.
complications priapism
Inability slump erection and long-term presence of blood in one location leads to a local reduction of oxygen. This occurs after 4-6 hours. Because oxygen is necessary for the proper functioning of all cells, its shortage is manifested gradual dying off of cells and subsequently tissues. Large amounts of blood has a mechanical oppression that leads to swelling of connective tissue spicules bodies, changing the properties of smooth muscle cells and kills the cells that line the small arteries in the hollows of erectile bodies. The tubes leads to the formation of small blood clots that gradually clog the vessel. Over time, the sealed vessel transforms its structure and lose its function to respond to the changing amount of blood during sexual arousal, so that ultimately there is apersistent failure to get an erection.
Complications can be divided into early and late. Early include high blood pressure, headache, bleeding and possible infection after puncture. Frequent are also bruises and contusions after sucking blood from the penis. Of late, they are the most vascular remodeling and subsequent erectile dysfunction.