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Priapism 821.e3

Differential Diagnosis doses (e.g., prednisone 1 mg/kg PO q 12h × Technician Tips
• Normal erection 5 days), antibiotics, and diuretics; generally Priapism is an emergency condition requir-
VetBooks.ir • Penile paralysis • Manual reduction of the penis into the detumescence. Diseases and Disorders
ing aggressive acute treatment to induce
• Paraphimosis without priapism
unsuccessful
prepuce (with or without incisional prepu-
Client Education
Initial Database
tioplasty) is unrewarding or impossible.
• Exam and palpation can confirm whether • Benzotropine mesylate 0.015 mg/kg IV, an Breeders should confirm that detumescence
the penis is firm (persistently erect) or flaccid anticholinergic and antihistaminergic drug, occurs after each breeding and contact the
(as in the case of paraphimosis without has been used successfully in horses but must veterinarian if an erection persists for more
priapism). be administered within 6 hours after the than 1 hour.
• Observation of urination or urethral cath- onset of priapism.
eterization to confirm that the urethra is not • Increasing venous outflow by drainage and SUGGESTED READING
obstructed flushing of the erectile tissues to remove Kutzler MA: Priapism. In Monnet E, editor: Small
• Neurologic exam (p. 1136) to determine the clotted blood with heparinized saline animal soft tissue surgery, Hoboken, NJ, 2013,
whether other neurologic deficits are present (0.9% NaCl) solution in combination with Wiley-Blackwell, pp 691-695.
• CBC if hemoglobinopathy is suspected infusion of phenylephrine, norepinephrine,
or epinephrine (successful in humans and ADDITIONAL SUGGESTED
Advanced or Confirmatory Testing horses; must be applied soon after onset) READINGS
• Serum chemistry panel and urinalysis if • Surgery: tunica albuginea incision (includes Burrow RD, et al: Penile amputation and scrotal
patency of the urethra and integrity of the incision of the bulbus glandis and pars long urethrostomy in 18 dogs. Vet Rec 169(25):657,
bladder are questioned glandis) is usually successful without perma- 2011.
• Ultrasonography with color-flow Doppler nent damage; must be performed within 12 Goericke-Pesch S, et al: Functional anatomy and
imaging can be used for identifying hours of onset ultrasound examination of the canine penis.
thromboemboli or masses and the extent Theriogenology 80(1):24-33, 2013.
of venous outflow impairment, and it is Chronic Treatment Guilford WG, et al: Fecal incontinence, urinary
less invasive than penile cavernography and If the penis is irreparably damaged or urethral incontinence, and priapism associated with
multifocal distemper encephalomyelitis in a dog.
cavernosography. patency cannot be maintained, penile amputa- J Am Vet Med Assoc 197:90-92, 1990.
• A penile cavernogram can be used for tion with a prescrotal (dog) or perineal (cat) Gunn-Moore DA, et al: Priapism in seven cats. J
identifying thromboemboli or masses and urethrostomy (and castration if still intact) is Small Anim Pract 36(6):262-266, 1995.
the extent of venous outflow impairment. necessary. Johnston SD, et al: Disorders of the canine penis
○ Dynamic cavernosography consists of and prepuce. In Canine and feline theriogenology,
infusing heparinized saline at increasing Behavior/Exercise Philadelphia, 2001, Saunders, pp 356-367.
rates (3-25 mL/min) until the intracavern- Keep away from estrous females. Lavely JA: Priapism in dogs. Top Companion Anim
ous pressure plateaus at full erection pres- Med 24(2):49-54, 2009.
sure, followed by infusing 60% Hypaque Recommended Monitoring Martins-Bessa A, et al: Priapism secondary to perineal
abscess in a dog—a case report. Reprod Domest
Meglumine contrast medium to opacify • Urination should be closely monitored and Anim 45(3):558-563, 2010.
abnormally draining veins. a catheter placed if stranguria develops. Murphy LA, et al: Effects of acepromazine and
○ Butterfly needles (21 gauge) can be • If severe penile necrosis develops, the penis trazodone on anesthetic induction dose of propofol
inserted into the corpora cavernosa and should be amputated. and cardiovascular variables in dogs undergoing
connected to a pressure transducer. general anesthesia for orthopedic surgery. J Am
• Angiography can also be used for identifying PROGNOSIS & OUTCOME Vet Med Assoc 250(4):408-416, 2017.
abnormal circulatory patterns. Orima H, et al: Surgical treatment of priapism
If priapism is treated aggressively, the prognosis observed in a dog and a cat. Jpn J Vet Sci 51:1227-
1229, 1989.
TREATMENT is guarded, but aggressive acute treatment may Payan-Carreira R, et al: Priapism associated with
prevent the necessity for penile amputation. lumbar stenosis in a dog. Reprod Domest Anim
Treatment Overview For dogs undergoing penile amputation, long- 48(4):e58-e64, 2013.
The goal of priapism therapy is to achieve term outcome is good with non-neoplastic Rochat MC: Paraphimosis and priapism. In Silver-
detumescence and restore normal circulation disease. stein DC, et al, editors: Small animal critical care
in the penile erectile tissues. Treatment aims medicine, St. Louis, 2009, Saunders, pp 615-618.
to preserve the penis from severe exposure PEARLS & CONSIDERATIONS Rochat MC: Priapism: a review. Theriogenology
and constrictive injury and to prevent ure- 56(5):713-722, 2001.
thral obstruction. A prompt diagnosis of the Comments Rogers L, et al: Priapism secondary to penile
metastasis in a dog. Can Vet J 43:547-549, 2002.
underlying cause allows optimal treatment, but Priapism is an emergency condition requir- Swalec KM, et al: Priapism after castration in a cat.
unfortunately, the cause may not be identifiable ing aggressive acute treatment to induce J Am Vet Med Assoc 195:963-964, 1989.
in many cases. detumescence.
AUTHOR & EDITOR: Michelle A. Kutzler, DVM, PhD,
Acute General Treatment Prevention DACT
• Conservative treatment: cool hypertonic com- Care should be taken during surgical castration
presses several times daily; topical lubrication; to avoid the stimulating pelvic nerves, which
systemic glucocorticoids at antiinflammatory could result in priapism.

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