Why priapism in spinal cord injury

If excess movement at the level of an unstable fracture or dislocation is not prevented, there can be secondary damage to the spinal cord, which could lead to the patient with no initial SCI developing an incomplete or complete SCI that was potentially preventable or a patient with an incomplete SCI becoming complete.

Some men with acute SCI never develop priapism. If, however, on first assessment there was no penile erection and priapism was subsequently identified then, on a balance of probabilities, the complete SCI was not a consequence of the primary injury, but occurred subsequently.

Priapism occurs in a proportion of men with acute traumatic SCI. The proportion of men with acute SCI that develop priapism is not known. Priapism can be associated with injury to any part of the spinal cord from the foramen magnum to the conus. A turgid semi-erect or erect priapism is always associated with a complete American Spinal Injury Association A motor and sensory paraplegia. Priapism probably occurs at the moment of, or very shortly after, complete SCI.

This is high-flow arterial priapism. It, only, rarely requires medical treatment. There are medicolegal implications: if priapism was not present in the pre-hospital or initial hospital phases of management but priapism and complete motor and sensory paraplegia were subsequently identified, the complete SCI may have been a consequence of failure to immobilise the spine during the pre-hospital or early hospital care.

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Objectives: The objective of this study is to review the pathophysiology of priapism in acute traumatic spinal cord injury SCI ; to determine the incidence of priapism in traumatic SCI, whether or not priapism is associated with incomplete or only complete SCI and whether and what treatment might be required.

Methods: This is a review article based upon the available literature in this area. Results and conclusions: Priapism that follows acute traumatic SCI is high-flow non-ischaemic priapism, that is, the blood within the corpus is arterial in nature.

Priapism does not occur in all patients with acute SCI. Long-term outcomes were obtained by telephone from all 6 patients. Of the 6 patients, 5 had maintained spontaneous erections to date range 3 to 10 years. Conclusions: The results of our study have shown that priapism related to acute spinal cord injury is nonischemic and may be managed conservatively because of the high likelihood of resolution.

Corporal blood gas measurement is important because the results can guide further management decisions. Our results suggests that conservative management of priapism related to spinal cord injury has a low rate of causing long-term erectile dysfunction.