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PRIAPISM

Satish Ranka*, Chetan Kantharia**,Shabbir Hussain***, Girish Bakshi***, R D Bapat****
*Medical Officer; **Associate Professor; ***Resident; ****HOD, Department of Surgery, KEM Hospital and Seth GS Medical College, Parel, Mumbai 400 012.
Priapism is a prolonged penile erection not associated with sexual arousal. It is a rare complication of haematological disease. Among Leukaemia, it is most frequently seen in patients with chronic myeloid leukaemia, due to high leucocyte count that these patients achieve. We report a 32 year old male, a known case of chronic myeloid leukaemia in remission phase presenting with priapism. He responded well to aspiration.

INTRODUCTION

Priapism is a rare acute urological emergency. It is a pathological erection which do not involve glans and corpora spongiosa. Although initially conservatively managed, surgical intervention is frequently needed to conserve potency.

CASE REPORT

AJ, a 32 year old male, married with 2 kids, known case of chronic myeloid leukaemia, presented with penis remaining erect after the sexual intercourse. He had mild pain and swelling in the organ. Pain, erection and swelling increased during the next 5-6 hours when he presented to us.

On examination, the patient was moderately built and nourished. He was anaemic but was not jaundiced and had no lymphadenopathy or sternal tenderness. Pulse was 84/min, Blood Pressure : 120/84 mm Hg. He had Grade III splenic enlargement. Other systems revealed no abnormality on clinical examination. Local examination revealed an erect, swollen, engorged and tender penis (Fig. 1).

In view of urgency of the situation, we aspirated it, and thus relieved his condition. At present he is symptom free and in haematological remission.

Fig.1
Fig.1 Engorged,Oedematous, Erect penis.

DISCUSSION

Priapism is prolonged penile erection, usually painful without sexual desire. Two types are encountered 1) Veno-occlusive due to intracavernosal injection of vasoactive drugs for treatment of erectile dysfunction. 2) High-flow following perineal trauma or direct penile trauma.[1] It can also be classified according to the cause a) Primary : cause unknown b) Secondary due to overdose of intracavernous vasodilators, tumours of bladder, prostate, rectum.[2] Haematological disorders account for 20% of its causes and 1% of all male cases of priapism are due to haematological malignancies.[3] Amongst all Leukaemia’s it is most frequently seen in patients with chronic myeloid leukaemia.[4] Our patient was a known case of chronic myeloid leukaemia on treatment in remission phase. Proposed mechanism for priapism in chronic myeloid leukaemia are 1) Venous congestion of corpora cavernosa due to splenomegaly resulting in mechanical obstruction of abdominal veins. 2) Sludging of leukaemic cells in veins of penis. 3) Leukaemic infiltration of sacral nerves. 4) Direct stimulation of central nerve.[3] In our patient there was Hackeet’s grade III splenic enlargement[5] and we suspect sludging of leukaemic cells and infiltration of sacral nerves to be the cause for his painful priapism.

It is usually a clinical diagnosis based on history and physical examination. However if in doubt it can be compounded with cavernous blood gas determination, colour flow doppler ultrasound and lastly angiography.[6]

Treatment should start within six hours after its development as later ischaemic irreversible fibrotic damage develop leading to permanent erectile dysfunction.[2] Our patient presented 10 hours after the onset with painful priapism, we aspirated to relieve his condition.[7] Other methods recommended for treatment are intracavernous injection of etilefrin, superselective transcatheter embolisation, Unilateral cavernoglandular fistula and lastly penile implant.

Early diagnosis and rapid relief is the key for maintenance of sexual potency. It is believed that 6-12 hours duration has 100% chance of preventing impotence while the picture is bleak after 3 days.[8] In our patient, although treatment offered was after 10 hours, at the time of follow up 2 months later, patient reported satisfactory intercourse with approximately 75% of penile rigidity.

ACKNOWLEDGEMENT

We would like to thank Dean, Seth GS Medical College and KEM Hospital for granting us permission to publish this case report.

REFERENCES

  1. Colombo F, Lovaria A, Saccheri S, et al. Arterial embolisation in the treatment of posttraumatic priapism. Annales d Urologie 1999; 33 (3) : 201-8.
  2. Hora M, Ouda Z. Priapism. Casopis Lekaru Ceskych 1999; 138 (5) : 131-5.
  3. Ghalaut PS, Kalra GS, Gupta S Priapism. A rare presentation in chronic myeloid leukaemia. Journal of Association of Physicians of India 1996; 44 (5) : 354-5.
  4. Rojas B, Labrera ME, Kliwadenko W, et al. Priapism in a patient with chronic myeloid leukaemia. Revista Medica de Chile 1998; 126 (8) : 978-80.
  5. Colin Ogilvie, Christopher C, Evan Butterworth. Chamberlain’s Symptoms and Signs in Clinical Medicine. 11th edition. USA. 1992.
  6. Goto T, Yagi S, Matsushita S, et al. Diagnosis and treatment of priapism : experience with 5 cases. Urology 1999; 53 (5) : 1019-23.
  7. Bondil P, Descottes JL, Salti A, et al. Medical treatment of venous priapism apropos of 46 cases : puncture, pharmacologic detumescence or penile cooling. Progres en Urologie 1997; 7 (3) : 433-41.
  8. Nelson JH, Winter CC. Priapism : Evaluation of management in 48 patients in a 22 years series. Journal of Urology 1977; 117 : 455-58.
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