Penile priapism

　　According to statistics, 30% to 40% of penile priapism is primary, with the majority of etiologies unknown. Secondary causes include thromboembolic diseases (sickle cell anemia, fat embolism, etc.), neurological diseases (spinal cord injury and lesions, spinal stenosis, etc.), tumors (prostate cancer, renal cancer and other metastatic cancers, leukemia, melanoma, etc.), trauma (perineal or genital injury, etc.), infection or poisoning (dysentery, rabies, etc.), medications (antidepressants, α-adrenergic blockers, anticoagulants, etc.), total parenteral nutrition, intracavernosal injection of vasoactive agents, etc.

　　1. Sickle cell anemia

　　8% of American blacks suffer from sickle cell anemia. In a literature review of 321 pediatric patients, 6.4% experienced abnormal erections. Due to mild acidosis caused by mild acidosis during sleep, mild trauma during masturbation or sexual intercourse, sickle red cells accumulate in the corpora cavernosa. When the venous channel of the erect penis is maximally compressed during sleep, the accumulated red blood cells block the subintima microvessels, causing widespread venous obstruction. In a study of a group of adult patients with pure sickle cell disease, 42% of the patients had intermittent persistent erections for 2 to 6 hours during sleep. Although almost all cases are low-flow abnormal erections, there have been recent reports of 2 high-flow abnormal erections.

　　2. Intracavernosal injection

　　Intracavernosal injection of vasoactive drugs is a common method for diagnosing and treating erectile dysfunction (ED), which is achieved by relaxing smooth muscle. Smooth muscle relaxation is temporary, and smooth muscle regains contractile ability after the drug's effect. In patients with drug overdose or hypersensitivity to drugs, smooth muscle cannot regain contractile ability, leading to abnormal erections.

　　3. Neurological disorder-induced abnormal erections

　　It can be seen in patients with spinal stenosis, spinal cord injury, and intervertebral disc herniation. The mechanism may be the increased release of erectogenic neurotransmitters induced by parasympathetic nerves, or interference with the inhibitory effect of sympathetic nerves. Under spinal or general anesthesia, disinfection stimulation of the genitals can cause abnormal erections and may affect transurethral surgery. This exaggerated reflexive erection may be the result of blockage of central inhibitory impulses by anesthesia, which usually resolves after anesthesia.

　　4. Malignant tumors

　　Although the infiltration of tumor cells itself does not cause abnormal erections, venous return obstruction or invasion of the cavernous sinus can cause stasis and thrombosis. Tumors reported to have been transferred to the penis and causing abnormal erections include leukemia, prostate cancer, renal cancer, and melanoma.

　　5. Drugs

　　Antihypertensive drugs such as hydralazine (hydralazine), guanethidine, phenothiazine-type psychotropic drugs, especially chlorpromazine, antidepressants such as trazodone, are related to abnormal erections. In animal experiments, injecting trazodone and chlorpromazine into the corpora cavernosa of dogs can increase arterial blood flow and increase venous resistance, causing an erection. Injecting a metabolite of trazodone, m-chlorophenylpiperazine, into rats increases corpora cavernosa nerve discharge. The mechanism by which these drugs cause abnormal erections may be related to α-adrenergic blocking or stimulation of serotoninergic 1C or 1D receptors. However, only a small proportion of patients who take these drugs experience abnormal erections, and it is not dose-specific, suggesting that autonomous nervous system dysfunction may be the main cause.

　　6、全胃肠外营养

　　Parenteral nutrition can cause abnormal penile erection, especially when using 20% fat emulsion intravenously. This type of abnormal penile erection is of low flow type, similar to patients with sickle cell disease.

　　7. Trauma

　　The most serious delayed complication of abnormal penile erection is fibrosis and ED. The incidence is directly related to the duration of abnormal penile erection and the积极性 of treatment. Although literature reports that the total ED incidence in low-flow abnormal penile erection can reach 50%, most patients can recover their previous sexual function if medication is given within 12-24 hours to resolve the abnormal penile erection.

　　Abnormal penile erection is common in children aged 5-10 and adults aged 20-50, generally involving only the corpora cavernosa of the penis, and most cases occur during nocturnal penile congestion. Low-flow type abnormal penile erection may cause pain due to tissue ischemia if it lasts for several hours, with a firm erection. High-flow type abnormal penile erection rarely causes pain, and the penis cannot reach complete erection hardness. This type usually has a history of perineal or penile trauma. Most cases of this type can recover complete erection after arterial embolism or surgical ligation of the blood vessels, but generally requires several weeks to several months.

　　1. Sudden onset without sexual stimulation, often occurring at night, with erection lasting for several hours or days, accompanied by pain in the penis, waist, and pelvic area.

　　2. The corpora cavernosa of the penis are congested and firm, while the urethral cavernosa and glans are soft.

　　3. There is a history of intracavernosal injection of vasoactive drugs.

　　4. Physical examination may show that the corpora cavernosa of the penis are firm, congested, and painful, while the glans penis and urethral cavernosa are soft, with normal urination. Sometimes, there may be difficulties in urination and defecation.

　　If a man's penis becomes erect without sexual stimulation and remains firm, it is considered abnormal. Such an erection may make the man embarrassed, form embarrassing thoughts, and be detrimental to the man, with a significant impact. Therefore, prevention is important. So, what are the methods to prevent abnormal penile erection?

　　Avoid excessive and frequent masturbation.

　　Avoid excessive indulgence in sexual desires and frequent masturbation to prevent kidney essence deficiency and liver yang excess, which may lead to abnormal penile erection.

　　Maintain a moderate diet and do not drink excessively.

　　Do not indulge in alcohol, and do not overindulge in rich and heavy foods in diet to avoid dampness accumulating into phlegm, leading to the mutual binding of phlegm and fire, and triggering abnormal penile erection.

　　Maintain an optimistic attitude and moderate work and rest.

　　It is important to participate in physical activities regularly, maintain an optimistic attitude, and keep the mind and spirit comfortable. Pay attention to the combination of work and rest, and consciously participate in some cultural and sports activities to delight the body and mind.

　　4. Avoid various sexual stimuli

　　Avoid sexual stimulation and control the frequency of sexual life to prevent the penis from staying in an over-erect state for a long time.

　　Experts remind: Once male friends encounter the embarrassment of abnormal penile erection in important situations, they can transfer their attention to make the penis normal, but they must go to the hospital for a check-up and treatment as soon as possible after the event.

　　To confirm abnormal penile erection, it is necessary to exclude other diseases, such as blood analysis to exclude sickle cell anemia and leukemia, urine analysis and urine culture to exclude urinary tract infection. Cavernosal blood gas analysis is very useful for determining the type of abnormal penile erection, that is, blood gas values similar to venous blood indicate low-flow abnormal penile erection, and similar to arterial blood indicate high-flow abnormal penile erection. All abnormal penile erections are high-flow at the onset, and blood gas value measurement cannot distinguish them. 99mTc scanning can be used as a means to distinguish between the two types, with a high intake in arterial-type abnormal penile erection and a low intake in venous occlusion-type abnormal penile erection. Cavernosal angiography shows venous occlusion type with venous blood pooling and rapid reflux in the cavernosa as arterial type.

　　The diagnosis and differential diagnosis of abnormal penile erection generally start with blood gas analysis, and if there are doubts, cavernosal artery and cavernosal color Doppler ultrasound scanning can be performed. In low-flow abnormal penile erection, the smallest artery blood flow and expanded cavernosa can be seen, while in traumatic high-flow abnormal penile erection, there is no regulated pooling of blood in the area of artery rupture.

　　In addition to general treatment, patients with abnormal penile erection can also alleviate the condition through dietary methods (for reference only, please consult a doctor for specific needs):

　　1. Fried chicken liver with Chinese wolfberry and chrysanthemum

　　200 grams of chicken liver, 20 grams of Chinese wolfberry, 10 grams of white chrysanthemum, egg whites, salted bread crumbs, yellow wine, salt, lard, flour, monosodium glutamate, and cornstarch as needed. Clean the chicken liver, cut it into slices, and mix with salt, yellow wine, and monosodium glutamate to flavor. Boil Chinese wolfberry and chrysanthemum in water to extract a concentrated juice, take the medicine juice, cornstarch, flour, and egg whites, mix them in a bowl to make a paste, wrap both sides of the chicken liver slices with a layer of paste, and one side with bread crumbs. Place a wok over medium heat, add lard and heat to 160°C, and fry the chicken liver slices one by one until they are fully cooked and remove them. It is suitable for eating with meals. It has the effects of nourishing the liver and kidney, nourishing the blood and improving eyesight. It is suitable for abnormal penile erection caused by yin deficiency and yang hyperactivity.

　　2. Boil two ingredients with di bone

　　10 grams of di bone skin, 10 grams of dried tangerine peel, 10 grams of shenqu, 250 grams of tender lamb meat, 250 grams of sheep liver, scallion slices, fermented black bean paste, cornstarch, salt, sugar, and a moderate amount of yellow wine. Add di bone skin, dried tangerine peel, and shenqu to an appropriate amount of water, decoct for 40 minutes, and filter the juice to remove the dregs. Heat the filtered juice and concentrate it into a thick liquid. Wash the lamb meat and slice it; remove the tendons and membranes from the sheep liver, wash and slice it; mix the lamb and liver slices with a sauce of cornstarch. Place a wok over high heat, add vegetable oil, and when it is hot, add the lamb and liver slices, stir-fry, add the medicine juice, scallion slices, fermented black bean paste, salt, sugar, and yellow wine, and then remove the juice and dish it out. It is suitable for eating with meals. It has the effects of nourishing the liver and blood, nourishing yin and reducing fever. It is suitable for abnormal penile erection, etc.

　　3. Raw rehmannia and goji berry shreds

　　Goji berries, young bamboo shoots, lard each 100 grams, lean pork 500 grams, raw rehmannia slices 30 grams, sugar, soy sauce, salt, monosodium glutamate, sesame oil, and cooking wine in appropriate amounts. Wash the lean pork clean, cut into long strips; cut the bamboo shoots into thin strips; cut the raw rehmannia into strips; clean the goji berries. Heat the wok with lard, add the strips and bamboo shoots at the same time, pour in cooking wine, add sugar, soy sauce, salt, and monosodium glutamate, stir well, add goji berries, stir-fry a few times, pour in sesame oil, and cook until done. It is suitable for consumption with meals. It has the effect of nourishing Yin and kidney, and improving eyesight and health. It is applicable to penile erection caused by liver Yin deficiency.

　　4. Stir-fried silver fish slices

　　Silver ear 30 grams, crucian carp meat 300 grams, bamboo shoots, green vegetables, egg white, water chestnut starch, salt, monosodium glutamate, cooking wine, scallion, ginger, lard, and fresh soup in appropriate amounts. Wash the crucian carp clean, cut into 5 cm long and 1.3 cm wide slices, put them in the egg, mix with egg white, water chestnut starch, and salt, and marinate. Wash the green vegetables clean, cut them into 4 pieces from the root. Wash the silver ear clean, soak it in warm water, and remove the root. Heat the pot, pour in lard, and heat it to 150°C. Pour in the fish slices, stir-fry until cooked, and remove the oil. Sauté the scallion and ginger slices in the oil pot, add the green vegetables, silver ear, and bamboo shoots, and stir-fry. Add fresh soup, salt, cooking wine, monosodium glutamate, and fish slices, stir-fry a few times, thicken with water chestnut starch, pour in lard, and serve. It is suitable for tonifying the liver Yin and is applicable to penile erection caused by Yin deficiency and Yang hyperactivity.

　　5. Steamed sea bream

　　Ophiopogon japonicus fresh sea bream 1 piece (250-400 grams), Ophiopogon japonicus 20 grams. Remove the head and gills of the sea bream, remove the internal organs, wash clean, cut into small pieces, and steam first. After the sea bream is cooked, take the oil on the top and mix it with Ophiopogon japonicus, add an appropriate amount of water, and steam for another 20-30 minutes. Take the juice for consumption. It has the effect of tonifying the liver and kidney, and nourishing Yin and blood. It is suitable for abnormal penile erection caused by deficiency of Yin and blood in the liver and kidney.

　　The purpose of treating abnormal penile erection in Western medicine is to ensure smooth blood circulation in the erect penis, soften the penis, and strive to restore normal sexual function. It is generally believed that any persistent penile erection for more than 6 hours should be actively treated. If it exceeds 24 hours, most patients will have varying degrees of sexual dysfunction. Therefore, it should be handled as an emergency as soon as possible and correctly.

　　1. Non-surgical treatment for abnormal penile erection

　　(1) Low-flow type abnormal penile erection

　　If the etiology is confirmed, the treatment should target the primary cause of the abnormal penile erection to prevent the persistent injury to the corpus cavernosum caused by the primary disease, and alleviate pain. With the extension of time, fibrosis and the risk of erectile dysfunction (ED) increase. If the abnormal penile erection subsides within 24 hours, the incidence of ED will significantly decrease. The purpose of drug treatment is to reduce arterial inflow and increase venous outflow. The preferred treatments include corpus cavernosum aspiration and intracavernosal injection of α-adrenergic agents. Epinephrine, norepinephrine, and phenylephrine have similar effects. First, a thick needle is used to puncture the corpus cavernosum of the penis to aspirate 20-60ml of blood, followed by the injection of phenylephrine, once every 5 minutes until the abnormal penile erection subsides.

　　① Sickle Cell Disease: About 28% have priapism, although patients with sickle cell disease can have high-flow priapism, the vast majority are still low-flow. Treatment should be timely because the priapism of these patients often recurs. After diagnosis, active hydration, oxygenation, and metabolic alkalinization to reduce red blood cell sickling, blood transfusion and red blood cells are second-line treatment, and penile lavage and injection therapy should be done as much as possible.

　　② Recurrent Priapism: Intermittent or recurrent priapism usually exists in patients with sickle cell disease and sickle cell disease precursor, the mechanism is unclear, and changes in adrenergic receptors or cavernous venous injury may be part of the cause. Priapism related to sexual activity, patients can inject α-adrenergic agents such as phenylephrine every 5 minutes until the priapism subsides. If it is not related to sexual activity, using antiandrogens or gonadotropin-releasing hormone, inhibiting penile erection during sleep, can effectively prevent recurrence.

　　(2) High-Flow Priapism

　　Early ice application can cause vasoconstriction and spontaneous thrombosis of the ruptured artery. Most delayed cavernous artery rupture cases cannot regress spontaneously, and internal pudendal artery embolism usually requires arteriography. There are reports of injecting methylene blue to counteract NO release or performing internal pudendal artery embolism to treat high-flow priapism.

　　2. Surgical Treatment for Priapism

　　The purpose of surgical treatment is to shunt blood within the cavernous sinus, increase the pressure gradient between the cavernous artery and cavernous sinus, restore normal blood perfusion of the cavernous artery, and prevent further ischemic damage to the cavernous tissue. Common shunting surgeries include cavernous body of the penis to urethral cavernous body shunting, great saphenous vein cavernous body shunting, glans penis to corporal body shunting, cavernous body of the penis to deep or superficial penile dorsal veins shunting, and so on.