Priapism - prolonged painful erection not associated with sexual arousal and does not stop after sexual intercourse. Erections when priapism persists for several hours or even days, accompanied by a bow-shaped curvature of the penis, pain and swelling of the penis, lack of sex drive. Sexual intercourse or masturbation if priapism does not lead to a weakening of erection, ejaculation and orgasm buy levitra online. Diagnosis of priapism is aimed at clarifying the etiology and the form definition violations through the analysis of the gas composition of the penile blood UZDG vessels of the penis, cavernosography, biopsy of the cavernous tissue. priapism treatment may be medical or surgical (aspiration of blood with irrigation corpus cavernosum, bypass surgery).
Priapism - pathologically persistent erection that occurs regardless of sex drive and does not disappear after intercourse. Priapism is a rare condition, occurring in approximately 0.2% of urological patients a wide age range (mainly 20-50 years). Priapism has been described for the first time in 1616 Petraens, as its name pathology received on behalf of the ancient deity of fertility and sensuality of Priapus, which was considered the main attribute of a giant erect phallus. In urology and andrology priapism refers to urgent conditions requiring emergency medical care.
Depending on the development mechanism allocate non-ischemic (arterial, High-flow type) and ischemic (venookklyuzivny, Low-flow type) priapism. At the heart of nonischemic priapism is excess inflow of arterial blood to the erectile tissues with intact venous outflow. In this case the penis ischemia tissues do not develop, and the erection itself painless. Ischemic priapism is caused by a defective venous outflow from the penis, caused by the increased viscosity of blood, thrombosis, venous stasis, and so on. This is the most unfortunate form of priapism, leading to ischemic damage to the tissues of the penis. According to the clinical course of priapism can be acute or chronic (intermittent, intermittent).
In total, more than 50 have been described etiological factors leading to the development of priapism. All of them, in accordance with the driving mechanism can be combined into a few large groups. Neurogenic priapism patients may suffer from diseases of the nervous system -. Multiple sclerosis, brain tumors and spinal cord, the effects of encephalitis, myelitis, traumatic brain injury and other psychogenic priapism occurs in patients with neuroses, epilepsy, schizophrenia. Priapism may occur against the background of acute stressful situations, when there is a sudden interruption of intercourse due to the strong fear that causes a sharp spasm of vessels of the penis. In some instances, priapism may be due to an infringement of the penis into the vagina of women with vaginismus.
Traumatic priapism is most often the result of trauma of the penis and perineum (the so-called "rider injury"). In this case, penile vein occlusion develop ischemic priapism and if damaged cavernous arteries (the formation of artery-cavernous fistula) - non-ischemic. The blockade of the venous outflow from the penis may be caused by changes in blood rheological characteristics (for sickle cell anemia, thalassemia, leukemia, vasculitis, hemodialysis) or metastatic (cancer of the prostate, bladder, kidney, colon, melanoma).
The causes of intoxication priapism may make use of alcohol, drugs; the impact of poisons spiders and other insects. Development of medical priapism usually is caused by medication, having this side effect (antidepressants, psychostimulants, antihypertensive agents, agents for the treatment of impotence) and intracavernous injections of vasoactive drugs. cases of priapism in patients with gout are also described, diabetes mellitus, amyloidosis, malaria and other diseases. In 30-60% of men the cause of abnormal erection remains unclear - in this case speak of idiopathic priapism.
Acute priapism develops suddenly, regardless of sexual desire. A typical isolation erection with priapism is that it only affects the cavernous bodies; spongy body is erect; due to insufficient blood supply to the glans penis is not increased and remains soft. Heavy penis is bent towards the abdomen, getting an arcuate shape. In ischemic priapism the form of a few hours after the occurrence of an erection develops pain in the base of the penis and perineum, congestive hyperemia and edema of the penis. The attack of priapism is not associated with sexual desire; sexual intercourse or masturbation is not accompanied by ejaculation and erectile weakening, but only increase the pain. Unlike normal erection, priapism when the free urination, however, due to the curvature of a sexual member of urine stream is directed upwards.
Painful erections with priapism persists from 3-4 hours to several days. Prolonged ischemia of the penis tissues can cause permanent damage, the development of a cavernous fibrosis, impotence, purulent kavernita, gangrene of the penis.
Erections lasting more than 4 hours and cause discomfort, should be grounds for immediate treatment to the urologist, andrologist or surgeon. The basis for diagnosis is the anamnesis and survey data, however more research is needed to determine the causes and forms of priapism. For the purpose of differential diagnosis of arterial and venookklyuzivnoy form priapism performed Doppler blood vessels of the penis, cavernosography, investigated the gas composition of blood aspirated from the corpora cavernosa. According to Doppler ultrasound of the penis when venookklyuzivnom priapism is defined by a significant reduction in penile blood flow velocity and gasometry reveals signs of hypoxia, hypercapnia, and acidosis. Also distinguish between ischemic priapism of blood allows the presence or absence of pain in the penis during erection pathological.
For information about the viability of the cavernous tissue can be obtained after a biopsy of the penis. According to the testimony of a patient with priapism appointed consulting neurologist, proctologist, a hematologist. Priapism must be distinguished from satiriazis (hypersexuality), characterized by the preservation of sexual desire, orgasm and ejaculation, erection farmakoindutsirovannoy and normal nocturnal erections.
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