Urology Flashcards
Priapism
- Definition
-Causes
prolonged erection of the penis or clitoris that is not associated with sexual stimulation or desire and not relieved by ejaculation. Classified into ischemic (low flow veno-occulsive) or non-ischemic (high flow, arterial) . common in sickle cell anaemia
Idiopathic
Intracavernosal vasoactive injections for erectile dysfunction - prostaglandin E, phentolamine
Oral meds-alpha-1 adrenergic antagonists, antidepressants (SSRI), anticoagulants, CCBs, alpha antagnoists, Sodium valproate and stimulant, sildenafil (viagra) medications
Recreational drugs (cocaine)
Trauma - urological surgery, cycling (saddle injury)
Congenital abnormality - avernous arterial fistulas, pseudoaneurysm,
Leukaemia/ Thalassemmia
High spinal lesion
Malaria/ rabies
Black widow spider, CO
Blood gas of pH <7.25, CO2 >60 O2 <40 for ischaemic
Doppler U/S
Priapism Management
Micturition
Ice
Exercise
Oral pseudoephedrine
intracavernosum injection - metaraminol/ phenylephrine 0.2mg - can repeat 20mins x3 max doses
Aspiration and irrigation (vasoactive medication 500mL N/S with 0.5mg Adrenaline) of corpus cavernosum under LA (either dorsal penile block or LA simple wheal) - only one side needs to be aspirated - 2 or 10 oclock. slow aspirate up to 300mls - to irrigate 10-20mL of vasoactive solution until detumescence. Wrap penis to discourage re-engourgment
