Chapter 70 Priapism

Question 1

: What are the three types of priapism?

Answer 1

A: Ischemic, Nonischemic (high-flow), and Stuttering
Pearl: All painful priapism is ischemic until proven otherwise

Question 2

Which priapism type is an emergency?

Answer 2

A: Ischemic
Pearl: Treat within 4–6 hrs to prevent irreversible ED

Question 3

What is stuttering priapism?

Answer 3

A: Recurrent, self-limited ischemic episodes
Pearl: Seen in SCD; prevention is key

Question 4

Most common cause of ischemic priapism in adults?

Answer 4

ED pharmacotherapy (ICI or PDE5i)

Question 5

Most common cause in children?

Answer 5

SCD

Question 6

MEchanism in SCD-related priapism

Answer 6

A: Hemolysis → ↓ NO → ↓ PDE5 → ↑ cGMP
Pearl: “NO singer lost, cGMP band plays on”

Question 7

: Most common cause of high-flow priapism?

Answer 7

: Trauma → arteriolar-sinusoidal fistula

Question 8

: First step in undifferentiated priapism?

Answer 8

Corporal blood gas

Question 9

ISchemic Blood Gas Profile

Answer 9

PO2 <30, PCO2 >60, pH <7.25

Question 10

Non ischemic BG profile

Answer 10

PO2 >90, pH 7.35-7.45

Question 11

Most useful imaging

Answer 11

CDU Color duplex Ultrasound

Question 12

CDU finding in ischemic priapism

Answer 12

Absent cavernosal artery flow

Question 13

CDU finding in high flow priapism

Answer 13

Normal or increase arterial flow, possible blush

Question 14

Role of penile arteriography

Answer 14

For embolization planning

Question 15

Penile MRI used

Answer 15

refractory cases to assess fibrosis or thrombosis

Question 16

First Line Treatment

Answer 16

Aspiration + phenylephrine

Question 17

Max safe phenylephrine dose?

Answer 17

1 mg/hr

Question 18

AFter ICI aspiration next step?

Answer 18

Percutaneous distal shunt

Question 19

Open distal Shunt examples

Answer 19

AL Ghorab, T-shunt

Question 20

Burnett snake?

Answer 20

Maneuver using Hegar dialtor after T shunt for proximal decompression

Question 21

Proximal Shunt Examples

Answer 21

Quackels (unilateral), Sacher (bilateral)

Question 22

Critical ischemia time for ED risk

Answer 22

> 48 hours , 48 Erectile Fate

Question 23

Definitive Tx for >48 ischemia with necrosis

Answer 23

Penlie prosthesis

Question 24

is high flow priapism painful, 1st line mgt

Answer 24

No, Observation +/- compression

Question 25

High flow priapism definitive tx if persistent

Answer 25

SAE

Question 26

Best embolic agent to preserve function

Answer 26

Autologous clot or gelfoam

Question 27

Prevention for stuttering priapism

Answer 27

A-agonists(selective) PDE5i, hormonal supression

Question 28

PDE5i paradox in SCD

Answer 28

restores PDE5 baseline in preventing future attacks

Question 29

CAn GnRH agonists be used in children

Answer 29

With caution, avoid in preburtal boys

Question 30

Most common long-term complication of ischemic priapism?

Answer 30

A: Erectile dysfunction

Question 31

Histologic change in prolonged priapism?

Answer 31

A: Smooth muscle necrosis → fibrosis

Question 32

Mnemonic for distal shunt escalation?

Answer 32

Al-Ghorab's WET SNAKE is Burning" percutaneous distal shunt W- Winter - Needle E-Ebbehoj - blade 11 T-Shunt

Question 33

Mnemonic for stuttering prevention?

Answer 33

STUTTER": Sympathomimetic, Testosterone suppression, Understand age, Tadalafil, Timing, Education, Rescue plan

Question 34

: What is the role of exchange transfusion in pediatric SCD priapism?

Answer 34

A: Not first-line — reserved for persistent or severe cases Pearl: Risk of ASPEN syndrome (neurologic complication)

Question 35

: Long-term preventive options for stuttering priapism in children?

Answer 35

o Nightly oral pseudoephedrine o Low-dose PDE5 inhibitors o GnRH analogs or antiandrogens (in selected postpubertal patients) Pearl: Use hormonal agents cautiously in prepubertal boys