In Reply to: Case 0298_05 -- Post traumatic priapism posted by Editor on February 03, 1998 at 11:59:45:
Interesting case. We saw a very similar case in 1994; the patient was a 34 year old male who had developed priapism (partial tumescence) following a long bicycle ride. An ultrasound exam showed what was described as "venous pooling"; on arteriography there was leakage from the left bulbar/cavernosal arteries which was seen even on a nonselective pelvic arteriogram. Although we discussed embolization as a therapeutic option, the decision was made to attempt pharmacologic therapy first and to consider embolization only if this didn't work. The patient was placed on ephedrine and, after a few weeks, the priapism resolved and the patient had return of normal erectile function (lending credence to the conservative approach). The patient continues to have normal erectile function (the referring urologist had just seen him). I still have them films--I'll get them photo'd and send them in as an addendum.
With regard to the question on the urgency of therapy, I guess it depends on how severe the priapism/tumescene is; if the patient is not ischemic, I would think that the need for treatment is not emergent. I'd be interested in hearing the comments of other participants.