Priapism
Introduction
Introduction to abnormal penile erection An abnormal erection of the penis refers to a state of continuous erection of the penis that has nothing to do with sexual desire. The penis continues to erect for more than 6 hours and is already an abnormal erection. Traditionally, abnormal penile erections are classified into primary (specific) and secondary. According to hemodynamics, it is divided into low blood flow type (ischemic) and high blood flow type (non-ischemic). Penile abnormal erection is also divided into acute, intermittent (recurrent or intermittent, such as sickle cell anemia) and chronic (usually high blood flow type), the initial penile erection is a physiological penile erection, and later developed into a high blood flow type. basic knowledge The proportion of illness: 1% Susceptible people: male Mode of infection: non-infectious Complications: abnormal penile erection erectile dysfunction
Cause
Cause of abnormal penile erection
Neurological disorders (15%):
Abnormal erection can be seen in patients with spinal stenosis, spinal cord injury and herniated disc, the mechanism may be parasympathetic-induced erectile neurotransmitter release, or interfere with sympathetic inhibition, spinal cord or general anesthesia, disinfection stimulation of genitalia may occur Abnormal erection, and may affect transurethral surgery, this exaggerated reflex erection may be the result of anesthesia to central inhibition of impulsive block, most of which can disappear after anesthesia.
Trauma (20%):
Perineal or genital trauma caused by severe thrombus or penile root hemorrhage, tissue edema, obstruction of penile venous return, causing abnormal erection (low flow type), trauma or intracavernous injection caused rupture of cavernous artery, resulting in unregulated cavernous sinus blood Siltation, causing abnormal erections (high flow patterns), typical post-traumatic high-flow abnormal erections generally occur during sleep erections, vasodilatation ruptures damaged arteries, resulting in unregulated high-speed blood flow into the corpus cavernosum, but due to veins Partial recharge of the reflux, the hardness of the erection is low, no ischemia or pain.
Malignant tumors (10%):
Although tumor cell infiltration itself does not cause abnormal erection, venous return obstruction or invasion of cavernous sinus can cause stasis and thrombosis. Tumors that have been reported to metastasize to the penis and cause abnormal erection include leukemia, prostate cancer, kidney cancer and melanoma. .
Drug factor (8%):
Antihypertensive drugs such as hydralazine (pyridazine), guanethidine, phenothiazines, especially chlorpromazine, and antidepressants such as trazodone, are associated with abnormal erections.
In animal experiments, injection of trazodone and chlorpromazine into the dog's cavernous body can increase arterial blood flow, increase venous resistance, cause erection, and inject a trazodone metabolite m-chloropiperazin into the rat. The cavernous nerve discharge increases.
The mechanism by which these drugs cause abnormal erection may be related to alpha adrenergic blockade or stimulation of serotonin 1C or 1D receptors. However, only a small number of patients with abnormal erections taking these drugs are non-dose-specific and suggest autonomous System dysfunction can be the main cause.
Total parenteral nutrition (7%):
Total parenteral nutrition can cause abnormal erections, especially when intravenously applying 20% fat emulsion. This type of abnormal erection is a low-flow type. Similar to patients with sickle cell disease, the mechanism may be:
1 blood coagulation power increased;
2 adverse reactions to blood cell components;
3 fat embolism, it is recommended to use 10% fat emulsion, slow infusion and mixed with amino acid-dextrose solution to extend the infusion rate to prevent abnormal erection.
Causes
According to statistics, 30% to 40% of abnormal penile erections are primary, most of the causes are unknown, secondary causes are: thromboembolic diseases (sickle cell anemia, fat embolism, etc.), neurological diseases (spinal cord injury and lesions) , spinal stenosis, etc., tumor (prostate cancer, metastasis of kidney cancer, leukemia, melanoma, etc.), trauma (perineal or genital injury, etc.), infection or poisoning (dysentery, rabies, etc.), drugs (antidepressants, alpha - adrenergic blockers, anticoagulants, etc.), total parenteral nutrition, intracavernosal injection of vasoactive agents, etc. 1. Sickle cell anemia 8% of African Americans with sickle cell anemia, in the right In the literature review of 321 infants, 6.4% of patients with abnormal erection, due to abnormal endothelial adhesion, relative acidity during erection, mild acidosis caused by hypopnea during sleep, mild trauma during masturbation or sexual intercourse, Caustic red blood cell sponge deposits, when the sleep penis erectile venous channel is under maximum pressure, the deposited red blood cells block the subcapsular venules, causing extensive venous obstruction, in the composition of human homozygous sputum red Study of disease in 42% of patients continued to have intermittent sleep 2 ~ 6h of priapism, although almost all of the cases are low-flow type priapism, but recently there are two cases of high-flow type of priapism were reported.
2. Intracavernous injection of intracavernous vasoactive drug injection is a common method for diagnosing and treating erectile dysfunction (ED). It is achieved by smooth muscle relaxation. The smooth muscle relaxation is temporary, and the smooth muscle regains its contraction ability after drug action. In patients who are overdose or overly sensitive to drugs, smooth muscle does not restore contractility, resulting in an abnormal erection.
Literature review Cavernous injection of papaverine for the diagnosis and treatment of erectile dysfunction (ED), the incidence of abnormal erection in the first diagnostic test was 5.3%, family therapy was 0.4%, most abnormal erection occurred in patients with neurological or psychological ED .
Pathogenesis
Traditionally, abnormal erections are classified into primary, secondary or secondary, and in hemodynamics, they can be divided into two different types: low flow (ischemia) and high flow (non-ischemic). Since the low-flow state is due to venous obstruction and the high-flow state is due to an increase in arterial blood flow, Witt et al. (1990) performed a new classification: venous obstructive and arterial, and abnormal erections can be acute, intermittent or chronic. Physiologically, the blood gas level of the penis is similar to that of the systemic venous blood. When the erection reaches the arterial level, it must be remembered that every abnormal erection begins with a normal physiological erection, the venous blood oxygen level is normal, and the high flow type The blood oxygen level of the cavernous body is normal, but after 6 hours of low-flow type, blood gas shows signs of ischemia and acidosis. When in doubt, blood gas analysis and duplex ultrasound examination are helpful for differential diagnosis.
The study found that low-flow abnormal erectile corpus cavernosum venous return delay to 15min, angiography only the dorsal artery and ball artery development, high-flow abnormal erectile corpus cavernosum and angiography showed that venous return accelerated, ruptured cavernous artery Sponge blood deposits.
It is generally believed that this disease is caused by obstruction of penile venous return due to various reasons. However, it has been suggested that the pathogenesis of this disease is not caused by venous return, but mainly due to excessive arterial blood flow. It is unclear that after the penis continues to erect more than normal time, the corpus cavernosum microcirculatory disorder, local hypoxia and deposition of metabolites, increased permeability of the blood vessel wall, tissue edema, continuous swelling and pain of the penis, increased tension Large, further aggravating microcirculatory disorders, such as still unable to remove the cause in time, improve the blood circulation of the penis, and finally lead to embolization of the vascular lumen, in the late cavernous tissue fibrosis, will eventually lose erectile capacity.
Prevention
Penile abnormal erection prevention
1. Maintain an optimistic and open-minded mood and be good at regulating bad emotions.
2. Moderate sexual intercourse to avoid strong sexual stimulation.
3. Eat less fat and sweet, drink less, eat more whole grains, radish, greens.
4. Do not abuse all kinds of tonics that nourish the kidneys and impotence.
Complication
Penile abnormal erection complications Complications, abnormal penile erection, erectile dysfunction
The most serious delayed complications of abnormal erection are fibrosis and ED, and the incidence is directly related to the duration of abnormal erection and the enthusiasm of treatment, although the literature reports that the incidence of total ED in low-flow abnormal erection is as high as 50%, but if at 12 Administration of medication within ~24h caused abnormal erection to resolve, and most patients recovered their previous sexual function.
Symptom
Penile abnormal erection symptoms common symptoms penile abnormal congestion and defecation difficulties
Abnormal erection of the penis is common 5 to 10 years old and 20 to 50 years old, generally involving only the corpus cavernosum. In most cases, the penis is congested at night.
Low blood flow type penile abnormal erection if it lasts for several hours, it is painful due to tissue ischemia, penile erection is hard, high blood flow type is penic less pain, penis can not reach full erection hardness, usually history of perineal or penile trauma, this type In most cases, the penis still recovers completely after an arterial embolization or surgical ligation of the blood vessels, but it usually takes weeks to months.
1. Sudden onset in the absence of sexual stimulation, often at night, erections last for hours or days, accompanied by pain in the penis, waist and pelvis.
2. The corpus cavernosum is solid and the urethral sponge and glans are soft.
3. There is a history of intrathecal injection of vasoactive drugs.
4. Physical examination, the corpus cavernosum is hard, congested, tender, and the penis head and urethral sponge are soft, normal urination, sometimes accompanied by urination and difficulty in defecation.
Examine
Examination of abnormal penile erection
1. Blood routine: Leukemia, sickle cell anemia has obvious peripheral blood changes.
2. Analysis of local blood gas in cavernous sinus: It can distinguish between high blood flow type and low blood flow type. The former blood gas analysis value is the same as arterial blood, the latter is the same as venous blood. It is worth noting that early penile abnormal erection is high blood flow. Type, there are two kinds of performance: one is partial blood pH acid, the oxygen partial pressure is obviously reduced, the carbon dioxide partial pressure is obviously increased; the other is partial blood pH, alkali partial change, oxygen partial pressure change is not obvious, carbon dioxide partial pressure is not high .
3. Cavernous angiography: two types can also be identified. When the vein is blocked, the blood flow is stagnant; the arterial type has rapid blood flow to the cavernous body, color Doppler examination, low blood flow type shows little arterial blood flow, and the cavernous body expands; Blood flow patterns can show arterial rupture and abnormal blood pools in vascular injury areas.
Some people advocate the use of 99m scan as a means of distinguishing between two types of abnormal erection, high intake is high blood flow type, while low is low blood flow type, and corpus cavernosum can also be used for identification: venous stasis is low blood Flow pattern; if the vein is rapidly refluxing, it is a high blood flow type (Table 1). Color Doppler examination is very helpful in identifying low blood flow type and high blood flow penis abnormal erection. Secil is predicted by color Doppler examination. The abnormal penile erection occurred after the injection of papaverine sponge, the specificity was 100%, the accuracy rate was 97%, and the predicted positive rate was 96.9%.
Diagnosis
Diagnosis and diagnosis of abnormal penile erection
According to the medical history, clinical manifestations are easier to diagnose.
Clinically, the abnormal penile erection is distinguished from the physiological erection. Under normal conditions, the male penis can naturally erect when it is sexually active. Generally, the natural penis becomes soft after ejaculation. This condition is a physiological erection, even if it is partially Human libido is strong, and soon after ejaculation, it can erect and even sexual intercourse, but from ejaculation to repeated erection, there should be a short "unknown period", and there is no penis pain, abnormal erection of the penis, no matter ejaculation after sexual intercourse. Whether or not the penis is still not weak, and many pathological changes and features can be seen, so the two are not difficult to identify.
