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Cavernitis of penis — Clinical Guidelines

Overview

Cavernitis of the penis, often part of broader priapism presentations, involves inflammation within the corpus cavernosum leading to persistent erection and potential complications like impotence if untreated 1 3.

Diagnosis

Persistent erection lasting more than 4 hours unrelated to sexual stimulation 1 2.

Distinguish between ischemic (low flow) and non-ischemic (high flow) priapism based on blood flow characteristics and corporal blood gas analysis 3.

Imaging (e.g., color duplex ultrasonography) may help differentiate flow patterns 6 12.

Evaluate for underlying causes including sickle cell disease, medications, and trauma 14 17 18.

Management

First-line treatments:

- Aspiration of corporeal blood for ischemic priapism 1 3 4 9. - Conservative management (e.g., hydration, pain control) for non-ischemic priapism 2 1.

Adjunctive treatments:

- Phenylephrine injection for ischemic priapism to maintain detumescence 9. - Super-selective embolization with microcoils for high-flow priapism if aspiration fails 6 12. - Surgical shunts (e.g., cavernosal-epididymal shunt) in refractory cases 10 20. - Penile prosthesis insertion for recurrent priapism 15.

Special Populations

Pediatrics: Bilateral corporosaphenous shunts effective in children 20.

Comorbidities: Special attention to patients with sickle cell disease, where management may differ 1 14.

Medication-induced: Consider drug discontinuation and specific antidotes (e.g., for prazosin overdose) 18.

Key Recommendations

Prompt diagnosis and treatment are crucial to prevent irreversible erectile dysfunction (Evidence: Strong 1 3).

Ischemic priapism should initially be managed with aspiration and phenylephrine injection (Evidence: Strong 1 3 9).

For high-flow priapism refractory to aspiration, consider superselective embolization (Evidence: Moderate 6 12).

In cases unresponsive to initial treatments, surgical interventions like shunts may be necessary (Evidence: Moderate 10 20).

Evaluate and address underlying causes, especially in secondary priapism (Evidence: Moderate 1 14 17 18).

References

1 Bivalacqua TJ, Allen BK, Brock GB, Broderick GA, Chou R, Kohler TS et al.. The Diagnosis and Management of Recurrent Ischemic Priapism, Priapism in Sickle Cell Patients, and Non-Ischemic Priapism: An AUA/SMSNA Guideline. The Journal of urology 2022. link 2 O'Sullivan NJ, Casey RG. Getting the diagnosis of priapism wrong; when not to aspirate. Andrologia 2022. link 3 Bivalacqua TJ, Allen BK, Brock G, Broderick GA, Kohler TS, Mulhall JP et al.. Acute Ischemic Priapism: An AUA/SMSNA Guideline. The Journal of urology 2021. link 4 Berridge CT, Kailavasan M, Logan M, Johnson J, Biyani CS, Taylor J. A training model to teach early management of priapism. Actas urologicas espanolas 2021. link 5 Dai JC, Franzen DS, Lendvay TS, Ostrowski KA, Walsh TJ. Perspectives on Priapism Education in Emergency Medicine. The journal of sexual medicine 2020. link 6 Arrichiello A, Angileri SA, Buccimazza G, Di Bartolomeo F, Di Meglio L, Liguori A et al.. Interventional radiology management of high flow priapism: review of the literature. Acta bio-medica : Atenei Parmensis 2020. link 7 Muneer A, Brown G, Dorkin T, Lucky M, Pearcy R, Shabbir M et al.. BAUS consensus document for the management of male genital emergencies: priapism. BJU international 2018. link 8 Bullock N, Steggall M, Brown G. Emergency Management of Priapism in the United Kingdom: A Survey of Current Practice. The journal of sexual medicine 2018. link 9 Ruest AS, Getto LP, Fredette JM, Cherico A, Papas MA, Nomura JT. A Novel Task Trainer for Penile Corpus Cavernosa Aspiration. Simulation in healthcare : journal of the Society for Simulation in Healthcare 2017. link 10 Müller A. al-Ghorab Shunt for Priapism. The journal of sexual medicine 2016. link 11 Salonia A, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Vardi Y et al.. European Association of Urology guidelines on priapism. European urology 2014. link 12 Liu BX, Xin ZC, Zou YH, Tian L, Wu YG, Wu XJ et al.. High-flow priapism: superselective cavernous artery embolization with microcoils. Urology 2008. link 13 Vilke GM, Harrigan RA, Ufberg JW, Chan TC. Emergency evaluation and treatment of priapism. The Journal of emergency medicine 2004. link 14 Atala A, Amin M, Harty JI, Liu YK, Keeling MM. Priapism associated with asplenic state. Urology 1992. link90393-b) 15 Mireku-Boateng A, Jackson AG. Penile prosthesis in the management of priapism. Urologia internationalis 1989. link 16 Ekström B, Olsson AM. Priapism in patients treated with total parenteral nutrition. British journal of urology 1987. link 17 Lansky MR, Selzer J. Priapism associated with trazodone therapy: case report. The Journal of clinical psychiatry 1984. link 18 Robbins DN, Crawford ED, Lackner LH. Priapism secondary to prazosin overdose. The Journal of urology 1983. link51604-3) 19 Winter CC. Priapism. Urological survey 1978. link 20 Resnick MI, Holland JM, King LR, Grayhack JT. Priapism in boys. Management with cavernosaphenous shunt. Urology 1975. link90073-4)

Cavernitis of penis