Dr. M.J. Bazos, MD. Patient Handout


About Your Diagnosis
Priapism is persistent erection of the penis. This disorder is most common among patients with sickle cell disease, infants or adults. The specific cause is unknown. There is speculation that once the erection is present, the abnormal red blood cells of sickle cell anemia perpetuate the episode. It is also known that once these cells are trapped inside the penis, the amount of oxygen on the blood also decreases. Acute attacks often begin during sleep, and a full bladder usually is an associated factor. Some episodes begin after sexual activity. However, there is frequently no identifiable event or cause.

Living With Your Diagnosis
There are three basic types of priapism, as follows:
1. Stuttering priapism is characterized by repeated erections that are usually reversible but painful. They come and go, do not last long, and cause no problem with sexual function once resolved. This is very common and occurs among 40% of patients.
2. Acute, prolonged priapism can last for several hours, but typically lasts for several days or weeks. The erection is painful, and induration may develop after the episode. This may cause impotence and necessitate a doctor’s intervention.
3. Persistent priapism can last for weeks to years and usually develops after an acute attack as described in number 2. Persistent priapism is usually painless. It is characterized by enlargement or induration of the penis. It may also lead to partial or complete impotence.

1. Stuttering priapism is often managed at home. The patient is encouraged to drink plenty of fluids and to empty his bladder frequently once the attack begins. Warm baths and exercise also are recommended. If the episode does not resolve in 3 hours, the patient should seek medical attention.
2. Acute, prolonged priapism necessitates hospitalization. Intravenous fluids and narcotics usually are prescribed to decrease the pain. The doctor may start blood transfusions immediately or opt to do a more complicated procedure called exchange transfusion. In this procedure a machine is connected to the patient that exchanges fresh blood with the patient’s old blood. This may take one or two days to work; if it does not work, a surgical procedure may be indicated. The operation usually is performed with local anesthesia. The blood in the penis is drained through a small needle; the needle is removed, but the blood continues to drain until the patient experiences some relief. Transfusion and surgical treatment may decrease the incidence of loss of erection from 80% to 25% to 50%.
3. There is no standard treatment for persistent priapism. Patients usually are not in pain, but erection is impaired. Use of inflatable or fixed prostheses may have complications, but some patients have had good results. Some patients adjust to altered sexual function with the support of a partner, because ejaculation, orgasm, and fertility remain intact.

The DOs

• Empty your bladder as frequently as possible.
The DON’Ts
• Avoid prolonged dehydration and avoid extended sexual activity.

MedWebHematology: http://www.gen.emory.edu/medweb.hematology.html
MedMark Hematology: http://medmark.bit.co.kr/hematol.html
National Heart, Lung, and Blood Institute Information Center
Joint Center for Sickle Cell and Thalassemic Disorders: http://cancer.mgh.harvard.edu/medOnc/sickle.htm