Page 110 - Remedial Andrology

9.1.2 Diagnostic evaluation

Figure 12: Differential diagnosis of priapism

Prolonged erec on
For > 4 hours

Ischaemic Non-ischaemic
priapism priapism

Penile Penile Penile Penile
History blood gas History blood gas
analysis Doppler US analysis Doppler US

Normal arterial
Perineal or
Dark blood; Sluggish or penile trauma; Bright red flow and
Painful, rigid hypoxia, blood; may show
painless,
erec on hypercapnia non-existent fluctua ng arterial blood turbulent flow
blood flow
and acidosis gas values at the site of
erec on
a fistula
9.1.2.1 History
Taking a comprehensive history is critical in priapism diagnosis and treatment [1243, 1268]. The medical history
must specifically enquire about SCD or any other haematological abnormality [1269, 1270] and a history of
pelvic, genital or perineal trauma. The sexual history must include the duration of the erection, the presence
and degree of pain, prior drug treatment, history of priapism and erectile function prior to the last priapism
episode (Table 33). The history can help to determine the underlying priapism subtype (Table 34). Ischaemic
priapism is classically associated with progressive penile pain and the erection is rigid. However, non-
ischaemic priapism is often painless and the erections often fluctuate in rigidity.

Table 33: Key points in the history for a priapism patient (adapted from Broderick et al. [1243])

Duration of erection
Presence and severity of pain
Previous episodes of priapism and methods of treatment
Current erectile function, especially the use of any erectogenic therapies prescription or nutritional supplements
Medications and recreational drug use
Sickle cell disease, haemoglobinopathies, hypercoagulable states, vessel vasculitis
Trauma to the pelvis, perineum or penis

9.1.2.2 Physical examination
In ischaemic priapism, the corpora are fully rigid and tender, but the glans penis is soft. The patient complains
of severe pain. Pelvic examination may reveal an underlying pelvic or genitourinary malignancy [1265].

9.1.2.3 Laboratory testing
Laboratory testing should include a complete blood count, white blood cell count with blood cell differential,
platelet count and coagulation profile to assess anaemia and detect haematological abnormalities [1243, 1268].

A genome-wide association study on Brazilian patients identified four single nucleotide polymorphisms
in LINC02537 and NAALADL2 significantly associated with priapism, although testing is not routinely
recommended in clinical practice [1271].

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