Priapism

Priapism is a prolonged pathologic and painful erection caused by engorgement and thrombosis of the pelvic veins. It is seen in patients with metastatic malignant diseases such as pancreatic cancer and leukemia, pelvic trauma, sickle cell disease, or spinal trauma. Pathology of the corpora and local neurovascular abnormality can also cause priapism. Prompt therapy should be instituted to control pain and prevent subsequent impotence from fibrosis of the corpora cavernosa. The cause of priapism may be important in defining the treatment. Sickle cell priapism is treated with hydration, alkalinization, and blood transfusion to increase hemoglobin to more than 10 mg/dL. The priapism associated with leukemia responds to radiation therapy. Intracorporeal injection of phenylephrine is recommended for selected cases of priapism. Stepwise institution of pain medications from NSAIDs to opiates is recommended. Severe pain will warrant parenteral administration of morphine or hydromorphone.

Peyronie's disease is a sexually crippling condition that causes severe penile pain during sexual intercourse because of curvature. The treatment of choice is surgery and NSAIDs for pain.