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Priapismus

Aktuelle Diagnostik und Therapie

Priapism

Current diagnostics and therapy

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An Erratum to this article was published on 20 December 2015

Zusammenfassung

Der Priapismus ist gekennzeichnet durch eine unerwünscht andauernde Erektion, infolge oder unabhängig von einer sexuellen Stimulation. Die diagnostische Abklärung (inkl. Dopplersonographie, ggf. Blutgasanalyse) entscheidet über die zugrunde liegende Pathophysiologie und somit das therapeutische Prozedere. Arterielle Blutgaswerte erlauben ein konservatives Vorgehen, sauerstoffarme Blutgaswerte führen zum Funktionsverlust durch Fibrose. Der „Low-flow“-Priapismus (LFP) kann bereits nach 4 h zu irreversiblen Erektionsstörungen führen und stellt einen andrologischen Notfall dar. Die Behandlung besteht aus Blutaspiration und evtl. intrakavernöser (i.c.) Sympathomimetikainjektion. Bei Therapieversagen ist ein distaler, selten ein proximaler Shunt notwendig. Zur Prophylaxe des rezidivierenden Priapismus („stuttering“) werden erektionshemmende und erektionsfördernde Substanzen in der Dauerbehandlung eingesetzt, welche noch der Validierung bedürfen. Der „High-flow“-Priapismus (HFP) benötigt keine Sofortmaßnahmen, ein konservatives Vorgehen oder selektive Embolisation bei nachgewiesenem Shunt ist möglich.

Abstract

Priapism is characterized by involuntary persistent penile erection after or independent of sexual stimulation. The diagnostic clarification, including patient history, physical findings, duplex ultrasonography and analysis of blood gases is decisive for the underlying pathophysiology and the appropriate therapeutic procedure. Non-hypoxic and non-acidotic blood gas parameters enable a conservative approach, hypoxic, hypercarbic and acidotic parameters may lead to fibrosis of the corpora cavernosa and, in turn, to a loss of penile function. Low-flow or ischemic (veno-occlusive) priapism is an emergency situation and can lead to irreversible erectile dysfunction within 4 h. Treatment consists of blood aspiration and possibly intracavernosal injection of sympathomimetic drugs. A distal shunt is necessary in the case of treatment failure (in rare cases a proximal shunt). Management of recurrent priapism (stuttering) includes self-injection of sympathomimetic drugs and preventive long-term administration of erection inhibitory and erection promoting substances. This concept still needs to be validated. High-flow or non-ischemic priapism does not necessitate immediate treatment measures and should be kept under observation. In cases of a detectable fistula selective artery embolization is often a successful option.

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Notes

  1. Warnung der FDA vom 17.12.2013: Bei Methylphenidat ist der Mechanismus unklar. Es besitzt α-adrenerge Wirkung, sodass der Priapismus paradox erscheint. Dosismodifikation und Auftreten nach abruptem Absetzen sind mögliche Auslöser; Auftreten auch bei Atomoxetin.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Bschleipfer, B. Schwindl und T. Klotz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Urologie, Andrologie und Kinderurologie, Klinikum Weiden/Kliniken Nordoberpfalz AG, Söllnerstr. 16, 92637, Weiden, Deutschland

    T. Bschleipfer F.E.B.U,  B. Schwindl & T. Klotz

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  1. T. Bschleipfer F.E.B.U
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  3. T. Klotz
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Correspondence to T. Bschleipfer F.E.B.U or B. Schwindl.

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Bschleipfer, T., Schwindl, B. & Klotz, T. Priapismus. Urologe 54, 1631–1641 (2015). https://doi.org/10.1007/s00120-015-3987-9

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  • DOI: https://doi.org/10.1007/s00120-015-3987-9

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