From a clinical point in time of view , priapism is fix as a prolonged and irritating erection , unrelated to sexual desire .
There exists an unbalanced vestibular sense between arterial inflow and penile venous drainage . The state of hard-on is specify to the cavernous bodies , without affecting the spongy body or the glans as it happens in the physiological erection .
Since the insertion of intracavernous injections of vasoactive drug into aesculapian pattern , the incidence of priapism has increased enormously , becoming a relatively frequent entity . It has been draw in all groups and age .
Venous - occlusive priapism is an emergency , so it is important to experience its pathophysiology , diagnosing and treatment of this entity that if not decently identified can determine the appearance of a definite impotency for the patient .
essentially , two responsible physiopathological mechanisms have been describe . As we will see , each of them offer a different etiological mechanism , prospect and treatment .
Will Priapism Go Away On It’s Own?
Priapism is a medical hand brake and , therefore , the patient must be treated immediately . However , priapism can adjudicate spontaneously , which occurs more often in the tyke , so sometimes it does not need treatment . It is advisable to establish a reasonable waiting flow ( 3 to 4 hour ) , after which it will be necessary to begin treatment .
High Flow, Pulsatile or Non-Ischemic Priapism
The sustentation of the erection is not due to an active brawniness rest of the erectile organic structure , but to a permanently increased arterial flow , being the venous drain normal , but deficient to cause detumescence ( appendage of decreased erection after orgasm and ejaculation ) . The absence of blood stasis , which intend decelerate or pooling of lineage , explicate its good permissiveness . It is usually due to arterial or penile psychic trauma with laceration of the erectile arterial blood vessel or one of its arm .
In this type of priapism , the cavernous lesions are less serious and require much more clip to be set up than those with small period . Therefore , the evolution is favorable for the subsequent criminal maintenance of sexual part .
Low Flow, Stasis or Ischemic Priapism
The affected role goes agitated to the hand brake room , with a sore hard-on lasting several hours . Except in cases associated with intracavernous injection , the patient role usually find for the first fourth dimension the prolonged erection on waking , in the center of the night , or after own sexual intercourse . This temporal relationship with nocturnal or sexual erection suggests that in many cases the elementary change that extend to priapism is the intervention with the physiologic mechanisms that regularize the detumescence of the erecting . The phallus usually presents a complete erection and is painful to the touch modality .
Arterial Priapism
The patient always refers to a history of trauma that , when it is a perineal contusion or phallus , may have take place from a few hours to a few day before the appearance of priapism . When it comes to a penetrating hurt , unremarkably by needle , priapism is usually established like a shot . Although some affected role manifest sealed irritation associated with erection , this form of priapism is usually painless and , of row , does not present the stark ischemic pain that qualify veno - occlusive priapism . The penis is normally found in an uncomplete state of erection ( 60 - 75 % ) , is not painful to the touch , and has an elastic consistency to inspection .
Regardless of the etiology , the forecast depends on the metre of evolution and this is also the result of the different therapeutic actions .
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