PRIAPISM

From Big Medical Encyclopedia

PRIAPISM (Latin. priapismus painful excitement at men) — the resistant pathological erection which is not connected with sexual excitement and not stopping after the sexual intercourse.

Occurs seldom, preferential at men. Isolated cases of P. of a clitoris are described, but genesis it is not studied.

The etiology

is observed by P. at various damages and diseases: spinal fractures with damage of a spinal cord, an injury and some tumors of a penis (epitelio ma, sarcoma), inf. diseases, back to tabes, multiple sclerosis, tumors of a head and spinal cord, exogenous poisonings, etc. Especially often P. develops at leukoses (according to some urologists, to 20 — 30% of all cases of P.). Patol, changes in cavernous bodies penis (see) at their fibrinferment, a cavernitis also promote P. Vozmozhno's emergence P.'s development owing to suddenly interrupted sexual intercourse, sexual excesses. Quite often it is not possible to reveal P.'s reason (idiopathic P.).

Many doctors recognize the neuroreflex mechanism of development of the Item. Increase in viscosity of blood and fibrinferments of cavernous bodies arise later owing to stagnation of blood at a long erection. It is considered to be that at P.'s leukoses it is caused by development of the extramedullary centers of a hemopoiesis in cavernous bodies though there is an opinion that thrombosis of pelvic veins is P.'s reason. Morphologically at P. in the beginning cavernous bodies are filled with thick dark blood, and then clots are formed. The necrobiosis of tissue of cavernous bodies, the centers of punctulate infiltration are microscopically noted. Further in cavernous bodies the sclerosis and fatty infiltration develops.

The symptomatology

P.'s Symptomatology is characteristic. Unlike fiziol. erections (see) at P. only cavernous bodies of a penis are strained, the spongy body of an urethra and a balanus do not participate in an erection. The penis is dugoobrazno bent, adjoins a dorsum to a stomach. Pain in a penis and a crotch on intensity is various (from insignificant to sharp pains), has constant character. Moderate puffiness and a hyperemia of a prepuce and skin of a penis is noted. The urination is usually not broken.

On P.'s current can be acute and chronic. Acute P. begins suddenly, is followed by the sharp tension of a penis, severe pain. Proceeds from several hours to several weeks. Hron. The item is shown periodically, patol. the erection is usually less expressed and can be observed within several years. The sexual intercourses at P. are not followed orgasm (see) and ejaculation (see), the erection after them does not pass.

The diagnosis

P.'s Diagnosis in connection with characteristic a wedge. a picture does not cause difficulties. The item should distinguish from a satiriazis (sharp increase in sexual desire at men, at Krom the sexual intercourse is followed by an ejaculation and an orgasm).

Treatment

Treatment can be conservative and operational. Conservative actions: locally cold, inside high doses of bromides, phenobarbital, subcutaneously solutions of Omnoponum, morphine, an enema with Chlorali hydras. Apply short-term etherization. In certain cases novocainic blockade gives good effect (presakralny, lumbar, perinephric, bilateral vnutriarterialnan, made through femoral arteries). Topical administration of bloodsuckers, and also perfusion of cavernous bodies is shown by solution of heparin. At P. connected with a leukosis apply a roentgenotherapy, it is not necessary to resort to operational treatment. At severe pains and inefficiency of conservative actions make a section of a white at a root of a penis and squeeze out clots. Such cuts should be carried out with care since hems after operation can deform a penis. A puncture of cavernous bodies thick needles and washing by solution of heparin are rather safe and not less effective. Most pathogenetic a reasonable operative measure is imposing of a bilateral safenokavernozny anastomosis in early terms of emergence of P. Proizvodyat a section on a hip, bare, tie up and cross a big saphena, carry out it via the hypodermic tunnel to a root of a penis. Sideways at a root of a penis cut a white and impose an anastomosis of a saphena with a cavernous body. Sometimes apply a spongiokavernozny anastomosis. At the same time the slit is done closer to a root, between cavernous and spongy bodies of a penis, baring a white. In a white of a cavernous body cut a semi-oval opening of 0,5 X 0,6 cm in size. From a cavernous body squeeze out blood. The opposite cavernous body is punktirut and wash out 0,25% solution of novocaine from 20 000 PIECES of heparin. Patol. the erection at the same time disappears. According to an opening in a cavernous body do an opening in a spongy body of an urethra, then these openings connect catgut seams.

Forecast

Forecast for life favorable. Gradually pains decrease, the penis becomes softer, and the erection completely passes. However concerning an absolute recovery the forecast is more often unsatisfactory. After P.'s elimination there can be organic changes in a penis, and after long P. in most cases comes impotence (see).



Bibliography: Vasyutkov V. Ya. Successful treatment of persistently proceeding priapism by means of a safeno-cavernous anastomosis, Surgery, No. 12, page 98, 1974; Gasparyan A. M. and Vasilyev V. V. Priapizm, Urol. and nefrol., No. 1, page 65, 1970; Novikov I. F. Operational methods of treatment of a priapism, in the same place, No. 5, page 39, 1980; Smirnov V. N. and Lushnikoval. A. Priapizm as complication of a chronic leukosis, Kazansk. medical zhurn., No. 4, page 20, 1962; Tyurin A. I., Kudryavtsev S. S. and Plotkinr. BB. Successful treatment of a priapism partial perfusion of cavernous bodies, Urol. and nefrol., No. 2, page 60, 1973; Yunda I. F. and Karpenko E. I. The alternating priapism, in the same place, No. 5, page 41, 1980; In about 1 1 ig e of G. Priapismus, Z. Urol., Bd 5, S. 551, 1961; Moncada J. Potenzsto-rungen nach Corpus Cavernaosum-Vena Sap-hena Anastomose beim Priapismus, Urologe A, Bd 18, S. 199, 1979.

V. V. Mazin.

Яндекс.Метрика