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Management of priapism with a trial of exercise in the emergency department

  • Jonathan Gravel (a1), Constance LeBlanc (a2) and Catherine Varner (a1)

Abstract

Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature. Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed. Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism. If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.

Le priapisme se caractérise par une érection persistante du pénis devant l’absence d’excitation ou de désir sexuels, ne cédant pas à l’orgasme. Bien que le trouble soit relativement peu fréquent, il s’agit d’une urgence génito-urinaire qui nécessite une exploration rapide et une prise en charge appropriée du fait qu’il existe une relation temporelle entre la durée totale de l’érection et le risque accru de dysfonctionnement érectile permanent. Un élément crucial d’une prise en charge appropriée est la reconnaissance du type de priapisme et, dans la majorité des cas examinés au service des urgences, le trouble est de nature ischémique. On trouve, çà et là dans la documentation médicale, des interventions de prise en charge conservatrice de ce type de priapisme, qui comprennent généralement l’application de glace sur la région touchée, des douches froides et la masturbation, mais rarement des exercices. Ces mesures reposent sur des données probantes insuffisantes, mais les risques qu’elles comportent sont minimes dans la mesure où elles ne retardent pas l’application du traitement indiqué. Les exercices des membres inférieurs comme traitement de première intention justifient une étude approfondie chez les patients traités pour priapisme, toutes causes confondues, au service des urgences. Il sera question, dans l’exposé, des avantages possibles d’un essai d’exercices des membres inférieurs de courte durée, plus précisément de la montée et de la descente d’escaliers, comme traitement du priapisme d’origine médicamenteuse. Si la mesure se montrait efficace, il s’agirait là d’une simple intervention de prise en charge non effractive qui permettrait de réduire le temps écoulé avant la mise en œuvre d’un traitement efficace, qui exige très peu de ressources et qui éviterait, en fin de compte, la nécessité de traitements effractifs.

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Copyright

Corresponding author

Correspondence to: Dr. Jonathan Gravel, Schwartz/Reisman Emergency Medicine Institute, University of Toronto, 600 University Avenue, Toronto, ON M5G HK5, Canada. Email: gravel.jon@gmail.com

References

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Management of priapism with a trial of exercise in the emergency department

  • Jonathan Gravel (a1), Constance LeBlanc (a2) and Catherine Varner (a1)

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