Priapism

Question 1

What history to elicit for priapism?

Answer 1

medical, sexual, surgical

baseline erection function, how long priapism, what he did, what he does to try to have it go away, pain, any recreational drugs, any history of trauma, sickle cell hx, any GU malignancy

Question 2

What are possible lab tests in addition to corporal blood gas?

Answer 2

CBC, hemoglobin electrophoresis, urine drug screen

Question 3

What must you monitor in patients that you give intracavernosal phenylephrine?

Answer 3

Blood pressure (hypertension) and HR (reflex bradycardia), esp with patient with hx of cardiovascular dx or on MAOI

Question 4

What are potential injuries in distal shunt?

Answer 4

urethral injury, corporoglanular fistula persistence, infection, penile skin necrosis

Question 5

What added risk with tunneling?

Answer 5

worsening ED, and gangrene

Question 6

What should be in back of mind for someone you are putting in an IPP that underwent distal shunt?

Answer 6

Distal perf / erosion

Question 7

What are some options for recurrent ischemic priapism?

Answer 7

baclofen, dutasteride, PDE5i, ketoconazole with pred (has sig liver toxicity though, and will effect fertility by impact on HPG axis), sudafed, aspirin

Question 8

What should you never use in SCD patients?

Answer 8

Ice packs - can worsen

Question 9

How long is surveillance period in patient with NIP?

Answer 9

4 weeks, see if the fistula closes

Question 10

What study do you do next?

Answer 10

PDUS if it doesnt close

Question 11

What is treatment for NIP?

Answer 11

embolization (risks include ED, recurrence, and failure to treat)

Embolization again is preferred, then to do surgical ligation