An homage to my urologist husband:
[spacer height=”20px”]A 30 yo male arrives to your trauma bay intubated after a high speed MVC. He has signs of head trauma, bruises and abrasions diffusely and…an erect penis. This should signal two initial thoughts in your mind:
[spacer height=”20px”]1. First and foremost, spinal cord trauma. Priapism due to spinal cord trauma is associated with complete loss of motor and sensory function below the lesion. This lesion can occur at any point along the spinal cord, although most commonly reported in the cervical spine. The physiologic reasoning: a loss of sympathetic input results in increased parasympathetic input to the pelvic vasculature which allows for uncontrolled arterial blood flow into the penis.
[spacer height=”20px”]2. Direct trauma to the penis/groin. Trauma to the cavernosa may lead to arterial-cavernosal shunting which again results in increased arterial flow to the penis. Thus, with your patient in whom you can achieve a decent neurological exam with no focal findings or negative imaging, this is the more likely answer.
[spacer height=”20px”]Either way, this form of priapism is high flow and does NOT cause ischemia. Therefore, most cases are managed conservatively or via embolectomy, aka don’t stick a needle in it. Urology will be consulted for further management but there is far less urgency than with a low flow priapism.
[spacer height=”20px”]Sources:
Image taken from hawklegs.deviantart.com
http://www.nature.com/sc/journal/v49/n10/full/sc201157a.html
http://emergencymedic.blogspot.com/2013/06/priapism-in-acute-spinal-cord-injur.html
http://sfghed.ucsf.edu/Education/Lectures/Syllabus/MaleGUEmergencies.pdf