A panel of experts will discuss the treatment of penile priapism, testicular torsion and penile fracture during a panel discussion Sunday morning titled Update on Urologic Emergencies. The 30-minute presentation begins at 9:20 am during the Next Frontier plenary session in Hall E at Moscone North.
“All three of these are common urologic emergencies that are well within the purview of a trained urologist, but the demographics of each condition are very different,” said Gregory Broderick, MD, professor of Urology at Mayo Clinic. “Torsion occurs in young patients, fracture occurs in men during their active sexual life and priapism occurs in men with sickle cell disease or in patients who have overdosed on medication for erectile dysfunction.”
Dr. Broderick will present updated information on penile priapism.
“Penile priapism is defined as prolonged erection lasting more than four hours,” he said. “This occurs in the absence of sexual stimulation and persists despite a natural orgasm.”
According to Dr. Broderick, the three types of priapism are priapism associated with penile trauma, priapism associated with disease and priapism induced by the use of medications.
Penile priapism most commonly occurs in men who present to the emergency department after administering an injection for erectile dysfunction. These men typically have ischemic priapism where blood is not able to leave the penis.
“This becomes an emergency because, if the erection persists there can be permanent damage to the erectile tissue,” Dr. Broderick said.
Priapism is most often reversible. An aspiration needle is inserted into the penis to remove the old blood, allowing new oxygenated blood to enter the penis. Reversal agents are then injected.
However, it’s important to determine the precise time of erection onset. If it has been more than four hours, it becomes increasingly difficult to reverse and to guarantee that the man can have normal sexual function.
“Very rarely do we have to revert to surgery to bring an erection down,” Dr. Broderick said. “Men who have failed multiple attempts of pharmacologic reversal or who have gone 12 to 24 hours before presenting to the emergency department may have to undergo shunting procedures.”
Anthony Caldamone, MD, Director of Pediatric Urology at Hasbro Children’s Hospital and professor of Surgery and Pediatrics at the Warren Alpert School of Medicine at Brown University, will discuss testicular torsion and how urologists can improve outcomes.
Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that supplies blood to the testicle. If uncorrected, torsion will result in loss of the testicle. Testicular torsion is relatively common, occurring either during the newborn period, shortly before or immediately after birth, or in older prepubertal and post- pubertal boys.
“Typically, a boy would present to the emergency department with severe scrotal pain, usually on one side, and undergoes an ultrasound that demonstrates a lack of blood flow to the testicle,” Dr. Caldamone said. “As a result, the child will go to the operating room to attempt to salvage the testicle.”
Dr. Caldamone will discuss measures that could improve access to care for testicular torsion, as well as the misdiagnosis of torsion.
“I will also discuss whether there are changes in health care systems that could streamline the amount of time it takes to get a boy who comes to the emergency department to the operating room in a focused way by following a certain set of criteria,” Dr. Caldamone said.
He will discuss steps urologists can take to reduce the consequences of ischemia in boys who have testicular torsion.
“There are relatively straightforward ways that we have available today in order to reduce the amount of time that a testicle is ischemic,” he said. “In addition, by paying attention to certain signs on ultrasound that may not be classic signs that we are accustomed to seeing, such as lack of flow to the testis, we may be able to prevent delay in the diagnosis of boys who have intermittent torsion — a difficult diagnosis to make with confidence — which could prevent recurrence with potential loss of the testis.”
The third panelist, William Brant, MD, FACS, FECSM, a urologist at Veterans Affairs Medical Center, will provide an update on penile fracture.
“Penile fracture requires immediate assessment to decide whether or not it needs to be repaired immediately or iced down and repaired in the morning,” said Dr. Broderick, noting that there’s some controversy about timing of the surgical intervention following a penile fracture.