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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Priapism, trauma, infection with mycoplasma pneumoniae, cauda equina compression syndrome

Answered by
Dr. Sunil.N

General & Family Physician

Practicing since :2010

Answered : 157 Questions

Posted on Sat, 19 May 2012 in Men's Health
Question: I have a reoccurring priapism which occurs for 10-12 hrs. 5 days a week which I have been living with regularly for 2 1/2 yrs. I have been to the doctor numerous times including the ER, urologist, chiropractor, and acupuncturist. They don't know what is wrong with me. I have had MRI's and nothing was found. While in the ER I have had my penis drained with a syringe which took about an hour to get all the blood out. This was one of the most successful acts to happen because it bruised my penis so severely that I was unable to get an erection for a month. Next they started shooting epinephrine directly into my penis which worked but the erection managed to come back within a day or two. The chiropractor had never heard of such things and the acupuncturist hadn't either but prescribed urinary tract helper. The first time this occurred was in 2004 after a car accident in which I didn't see a doctor. But I have been in many car accidents even hit by a car while I rode my bike and even hit by a semi that decided to take a wide turn off the road and into my back but I had been to the doctor for most of the incidents and they all agreed that I was okay. The problem occurs either when I am sitting down which will go away as soon as I move around a bit but at it's worst will occur after I have gone to bed and then wake up with it. The ways in which I have found to help the situation is to lay flat on the floor or better to sleep flat on the floor. Or, I will ride my bicycle from 1-2 hrs and sometimes the pain and/or the erection will go away. Sex and masturbation do alleviate the pain for 30 min. to an hour then the pain will come back thrice fold. Have also found applying pressure to my shaft with my hands to push the blood out of my penis helps greatly but once the pressure isn't kept up the pain awakens. For every 10 min. of pressure I can handle myself for about 45 min. before I have to retreat and push the blood out again. The longer I ignore the pain the longer I have to apply pressure before I am able to look at someone with a normal facial expression. I have also found that drinking alcohol, particularly vodka and 2 four lokos, different servings not mixed, have helped to a very little extent to keeping my disability from controlling my life. My lower back seems to be getting worse making it uncomfortable to stand long periods of time but I would like to go back to school and get my master's but it is unbearable to sit in a seat for an hour before I have to escape to the bathroom and apply pressure. I am an ex wrestler with a father in the marine corps so I try to handle the pain as well as the strongest people but I have jobs to keep and a children to raise. my mother, I was told had to wear a back brace as a child and my father has been in a many accidents himself and had pinched nerves which caused him to kill muscle in his arm. Is there any back brace available for me? I have tried to cutoff circulation to my penis but didn't work and caused pain. My lower back hurts and seems to worse. It feels like what I would think passing a kidney stone after my penis decides to go down. December '08 is when this all started to happen.
Please Help me
Answered by Dr. Sunil.N 5 hours later

Thanks for your query.

Though the Most of the times Priapism is Idiopathic(cause not known),yet the cause has to be found so that treating the cause relieve the Priapism .

Some of the causes which are relevant in this scenario are :
1)Cauda equina compression syndrome.

2)Trauma (pelvic, genital, or perineal).

3)Infection with Mycoplasma pneumoniae.

Since you have not mentioned about the Penile arterial Doppler i assume it ts not done in your case which is essential to know the arterial conditions of the penis.
Color flow penile Doppler imaging is currently the study of choice.

Other relevant tests that should be done are:
1.Complete blood count(CBC)
2.An ABG of the cavernous is useful in differentiating between high and low flow disease. Values similar to venous blood suggest a low-flow etiology. Values similar to arterial blood suggest high-flow priapism.
3.Coagulation profile
4.Platelet count

Treatment depends on the report of the Doppler which helps in differentiation of Low-flow (vaso-occlusive) Priapism and High-flow (arterial) Priapism.

Oral pseudoephedrine therapy , Aspiration ,Direct epinephrine injections are all tried in the initial stages.

IF condition doesn't resolve or get worsened other options like
Selective angiography with subsequent embolization of the offending vessel can be done.
Surgical ligation of the fistula is required if the fistula found in the Doppler study.

Rarely in the Refractory Priapism the placement of a corpus cavernosum-spongiosum shunt is considered.

So i suggests you to discuss this possible treatment option as few are known to cause impotence , a careful and proper treatment should be considered.

Hope this helps you.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Sunil.N 16 hours later
Hola thank you most of the information very helpful but limited in helping me on a limited budget. I believe that the Doppler was taken by my urologist and the day the looked at my genitals I was having a priapism and they did not find anything abnormal. I am living in a erect hell. With the doppler they gave me like a XXXXXXX to drink and gave me instructions not to eat before coming in then put me against a machine similar to a MRI to check out the muscles in my penis and found nothing. That was the last time I saw the urologist he said I need to go to oschner in New Orleans but to costly for a guy that works for $8 an hour. I am saving money for more to be done but in the mean time is there anything you can help me with? I will not hold you liable for anything just want any kind of help available. Is there any exercises recommended, I am in very good shape having to ride my bike to make the pain subside. Can I assume it is some kind of back or spine problem, having to sleep on the floor? Should I try for disability and if so where because I was trying to be a public official like in the fire dept. or the police but I think I am very unreliable considering I don't know I my problem will stop me from preforming duties of that or any job. Is there anything I should make sure to avoid, medicine or food? When erect should I avoid bending the muscles in my penis because I have been and it sort of helps keeping pressure out of the area and pain away. What are the consequences? I have taken pain relievers like advil and such but only seems to make my body ignore the pain and when the medicine wears off just like sex comes back with viciousness. Does smoking ciggarettes hurt my condition. I was donating plasma before and during my problem is that a problem. Any particular food I should stick to to keep a good blood flow. I use to wrestle in High School and little in college and have kept to a pretty healthy diet. If I go to a specialist what kind should it be and for what? Is there hope, Is it my back could it be, if so what can I do? If not treated what is the worse case scenario? Thank you for all your help By the way have had blood work done maybe not a plasma count but don't have sickle-cell or any disease. Again thank you this has been more helpful than doctors I have spoken to. Forgot to mention that also when I drink if the erection has not already gone away it only adds to pain and longevity. Longest this has occurred is 32 hours. Ice and heat haven't stopped the spasm if that what it be. Urinating does give some relief but in the worse situation takes quite some concentration. Hope I have given you enough to help me I am grateful for any and all information in no rush just running out of options. I have to raise a child and hold down a job have my degree but don't know how to let my employer understand the condition they only want the work done. I also understand that I may and have lost most control of my penis and becoming aroused and that is fine with me as long as this goes away asap so I can better care for my child. Please Help Please Help
Thank You
Have not taken viagra but heard there are chance with my condition that it may have reverse effects I am a little afraid to have more pain then already exposed to thank you
Answered by Dr. Sunil.N 20 hours later
Hi again,

Thanks for following me up,

let me answer your queries in sequency :

1)Can I assume it is some kind of back or spine problem, having to sleep on the floor?
yes, I t can be.As i mentioned earlier the cauda equina compression syndrome could be a possibility which can give relief sometimes on mere lying down.This may be supported by the history of accidents you had.

2)Should I try for disability...
Well this depends on the cause of the condition, It hold good as an option in treatment if its spinal cord defects like cauda equine syndrome.

3) Is there anything I should make sure to avoid, medicine or food?
No , there are no such food related complications expected in this condition but yes, restricting fatty food may help by avoiding emboli which can cause emergencies.

4)When erect should I avoid bending the muscles in my penis because I have been and it sort of helps keeping pressure out of the area and pain away. What are the consequences?
There is no problem in doing that, you can proceed based on your comfort.It may on maximum chance shift the blood in between the sinusoids in the spongiosis muscle.

5)Is there hope, Is it my back could it be, if so what can I do? If not treated what is the worse case scenario?
As i mentioned in my previous post , the cause of the condition has to be made out first .Only after that the right treatment and the success in the same can be determined.Untreated cases may end up in complications which include ischemia, clotting of the blood retained in the penis (thrombosis), and damage to the blood vessels of the penis which may result in an impaired erectile function or impotence. In serious cases, the ischemia may result in gangrene, which could necessitate penis removal.I hope none of the above be a chance in you.

Ice packs and climbing up stairs when it pains the most are the best conservative measures.This condition is one amongst those which do need to be corrected surgically for a complete relief.Work on finding the cause this is the only way to combat it and rip it off from the root.

Mean while narcotic pain killers , local anesthetic blocks,injection of epinephrine, pseudoepidrine and aspiration are the only pain management modalities available.

Distal shunts, such as the Winter's,involve puncturing the glans (the distal part of the penis) into one of the cavernosa, where the old, stagnant blood is held. This causes the blood to leave the penis and return to the circulation. This procedure can be performed by a urologist at the bedside and can be repeated as and when required without complications.Ask for the same to the urologist.These procedures do not cost you much

Proximal shunts, such as the Quackel's are more involved and entail operative dissection in the perineum , this too is a low budget procedures newly established in the treatment of the condition.

Hope this helps and wish you good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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