Priapism: Etiology and Pathophysiology

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Priapism has been associated with several pharmaceuticals; however, the antihypertensives, antipsychotics – conventional and atypical, and antidepressants are best quoted.
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Antihypertensives such as guanethidine, prazosin, and hydralazine have been implicated in causing priapism. Centrally acting agents such as trazodone, thioridazine, chlorpromazine, clozapine, quetiapine, haloperidol, and risperidone may cause priapism. It is thought that the mechanism is via adrenergic antagonism.

Cocaine-induced priapism has been seen with topical and oral use. Alcohol has been implicated in priapism.

There are also recent reports of the association of priapism and tamsulosin and alfuzosin. Tacrolimus (FK506) is said to be a risk factor for priapism. Exogenous androgens may also be etiological. Priapism has also been associated with scorpion toxin.

Neurological Disorders

Priapism has been seen in patients with lumbar disc disease, herniated disc, or cauda equina syndrome. Decompression can potentially relieve symptoms. It may also be seen in patients with cerebrovascular disease, seizure disorders, syphilis, brain or spinal cord tumors, and brain and spinal cord trauma. Cialis in Australia

Regional and general anesthesia may also cause priapism.

Trauma

Blunt penile or perineal trauma may lead to an arterial-lacunar fistula, which bypasses the control of the helicine arteries. This typically leads to high-flow priapism. The venous system is unaffected and the condition is typically painless. This may also be seen in cases of traumatic needle insertion during intracavernosal therapy.

Sold Organ Malignancies

Penile, urethral, bladder, prostate, and testicular tumors may lead to priapism by malignant infiltration of the corpora cavernosa and venous obstruction. Metastatic rectosigmoid and renal carcinoma may also predispose to priapism.

Idiopathic

Priapism for which there is no discernible cause may be seen in as much as 50% of presentations. This can be quite frustrating.

Pathophysiology

There has been a dramatic shift in the theory of the pathophysiology of priapism moving from a solely vascular abnormality to the critical role of molecular dysfunction.

Significant contributions to the understanding of priapism must be credited to Frank Hinman Sr. He classified priapism as mechanical or nervous. The former, he thought, was due to “thrombosis of the veins of the corpora.” Pelvic abscesses, penile tumors, perineal or genital injuries, and hematological dyscrasias were examples of this type. This type of priapism was said to account for 80% of cases. The nervous type could be seen in conditions such as syphilis, brain tumors, epilepsy, intoxication, and brain and spinal cord injury.

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