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821.e2 Priapism

Priapism
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occlusive pelvic or perineal mass (tumor,
BASIC INFORMATION
abscess) impairing glans penis venous • An enlarged (or ruptured) urinary bladder
is possible with urethral obstruction.
Definition drainage; secondary to systemic disease
Persistent penile erection, an uncommon (e.g., hemoglobinopathy) Etiology and Pathophysiology
disorder of dogs and cats • Alteration of penile blood flow, causing
HISTORY, CHIEF COMPLAINT vascular stasis in the corpus cavernosum
Synonym Observation of persistent erection or inability and spongiosum
Persistent erection to withdraw erect penis into prepuce • Sluggish, damaged erythrocytes occlude
venous outflow.
Epidemiology PHYSICAL EXAM FINDINGS • Erythrocyte stagnation triggers carbon
SPECIES, AGE, SEX • Persistent and usually painful erection lasting dioxide release and trabecular edema.
Male dog or cat; in one case series of cats, 6/7 > 1 hour
cases were Siamese. • Bulbus glandis may be within or outside the DIAGNOSIS
prepuce
RISK FACTORS • Penile mucosa may be dry, inflamed, or Diagnostic Overview
• Reproductive status: intact males are more excoriated and is often purple (blood stasis). The diagnosis is made entirely on physical exam.
likely than neutered males to develop Eventually, the penis becomes necrotic. Diagnostic tests aim to identify the cause; test
priapism secondary to trauma. The male frequently licks the penis, and selection is based on other features of the history
• Neurologic disorder (e.g., spinal cord injury, self-mutilation may occur. and general physical exam.
distemper encephalomyelitis)
• Circulatory disturbance (e.g.,
hemoglobinopathy)
• Penile neoplasia or perineal abscess
• Achalasia
Clinical Presentation
DISEASE FORMS/SUBTYPES
• Traumatic: during mating or castration
• Nontraumatic: from disturbances in the
normal mechanisms of penile flaccidity (not
sexual stimuli)
○ Neurologic: spinal cord injuries (lumbar
stenosis, trauma), inflammation
(genitourinary, spinal cord [distemper]),
mechanical compression (constipation),
or pharmacologic (acepromazine- or
trazodone-induced priapism [dogs, cats]),
leading to the stimulation of the erection PRIAPISM Priapism in a 7-year-old male boxer. At admission, the penis was persistently erect and had been
center or the pelvic nerve exposed for 7 days. Penile mucosal erosion and congestion and periscrotal edema were evident. (Used with
○ Circulatory: occlusive penile thrombo- permission from Martins-Bessa A, et al: Priapism secondary to perineal abscess in a dog: a case report. Reprod
embolism that decreases venous outflow; Domest Anim 45:558-563, 2010.)

A B
PRIAPISM Priapism in a 13-year-old Portuguese pointing dog. A, The partially exposed erect glans penis is seen with
distention of the bulbus glandis (arrowhead). B, Evaluation of the preputial cavity shows engorgement of the preputial
vessels (arrow) and erosion of the penile mucosa (arrowhead). (Reprinted with permission from Payan-Carreira R, et al:
Priapism associated with lumbar stenosis in a dog. Reprod Domest Anim 48:e58-e64, 2013.)
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