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ORIGINAL ARTICLE
Year : 2002  |  Volume : 18  |  Issue : 2  |  Page : 146-147
 

Role of cold saline enema in management of priapism


Department of Surgery, Pt. B.D. Sharma PGIMS, Rohtak, India

Correspondence Address:
Pankaj Khurana
H-65, DDA Flats, Phase - 1., Ashok Vihar. Delhi - 110 052
India
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   Abstract 

Priapism, the prolonged erection of penis is a urologic emergency. Untreated, the patient can land up in impo­tence. Various methods have been described for its treat­ment but the initial management remains conservative. The authors present their experience with use of seda­tion followed by ice-cold saline enema in management of priapism.


Keywords: Priapism; Ice Cold Saline Enema


How to cite this article:
Khurana P, Bansal A R, Kamal H, Malik V. Role of cold saline enema in management of priapism. Indian J Urol 2002;18:146-7

How to cite this URL:
Khurana P, Bansal A R, Kamal H, Malik V. Role of cold saline enema in management of priapism. Indian J Urol [serial online] 2002 [cited 2019 Jun 26];18:146-7. Available from: http://www.indianjurol.com/text.asp?2002/18/2/146/37617



   Introduction Top


Priapism is a prolonged painful erection of penis un­accompanied by sexual desire. [1] The disorder is idi­opathic in 60% of the cases. [2] Priapism is best treated conservatively rather than by shunting or surgical pro­cedures. [3] Sedation followed by cold saline enema has been advocated as the initial therapy which may cause subsidence of erection. [2] The authors present their expe­rience with use of enemas of ice-cold saline solution in 10 cases of priapism over a period of 2 years.


   Patients and Methods Top


10 patients of priapism presented in the accident and emergency department of this institute over last two years. 9 of the patients were sexually active young adults (age ranging from 20 to 39 years with a mean of 28.1 years). One patient was a 13-year-old boy with sickle cell trait.

3 patients gave a definite history of some intracaver­nosal injection as treatment for impotence. Two of them were using these injections regularly and the third one had priapism after first injection. One patient each had chronic myeloid leukemia, sickle cell trait and trauma. Rest 4 cases had idiopathic priapism, 2 of them gave history of recurrent prolonged erections in past which subsided spontaneously.

7 patients had priapism of less than 24 hours duration, two of 24-36 hours and 1 patient came with more than 36 hours erection.


   Management Top


After a thorough history and physical examination the patients underwent a complete blood count and blood chem­istry analysis.

An an initial therapy all the patients received intravenous diazepam (10 mg) as bolus injection. This was followed by enemas of ice-cold normal saline solution (250 ml). The enema was repeated after 1 hour if required.


   Results Top


Idiopathic priapism - 50% of the patients (2 out of 4) had penile detumescence after a couple of ice-cold saline enemas. The other two patients were referred to urologist for further management.

Papaverine induced priapism - 2 of the 3 patients had subsidence of erection within 3 hours of initiating the therapy. 2 enemas were required in both the cases. The third patient responded to aspiration of sledged blood from cavernosa and irrigation.

Sickle cell trait - The young boy with sickle cell trait responded to above regimen combined with oxygenation, hydration and blood transfusion.

C.M.L. - Sedation, cold saline enema and chemotherapy produced detumescence of the penis.

Trauma - The patient failed to respond to the above therapy and was referred to a urological centre.

Overall 6 out of 10 patients responded to cold saline en­ema. They were observed overnight and discharged next day with a flaccid penis. 5 of these 6 patients had erection of less than 24 hours duration. Rest of the cases were referred to urologist for further management.


   Discussion Top


Priapism, ironically named after the Greek god of male generative power, can cause impotence in up to 50% of the cases. [4] Most commonly priapism follows excessive sexual activity, though some patients especially young may give history of frequent recurrent prolonged erections es­pecially on awakening from sleep, [3] as was the case in 2 of our patients.

Priapism must be considered a urologic emergency and treated promptly. It is the delay in management that re­sults in complications especially impotence.[2],[5],[6]

Patients usually report to a general surgeon initially and most of them try only the conservative methods, i.e., se­dation repeated aspiration and irrigation of cavernosa. De­finitive procedure like shunting usually come in the domain of urologists. Combined with sedation, cold saline enema has been proposed as an effective method of producing detumescence. [2] The results of sedation and ice-cold sa­line enema in our experience have been fairly encourag­ing. However, a thorough search of literature could not reveal any possible mechanism of ice-cold enema which caused detumescence. Appropriate management of any un­derlying cause should be instituted along with. [7]


   Comments Top


A noticeable feature in the present study was the dura­tion of priapism which responded to our treatment. Overall 5 out of 6 patients who responded to treatment had pria­pism of less than 24 hours duration.

Another point which needs to be highlighted is the per­sistence of priapism even after a couple of ice-cold saline enema - such patients should be referred early to a uro­logical centre.

Although ice-cold saline enemas appear to be useful initial therapy for management of priapism, the results further need to be evaluated because of the short number of cases in the present study.

 
   References Top

1.Lue TF. Hellstrom WIG, McAninch JW, Tanagho EA. Priapism : A refined approach to diagnosis and treatment. J Urol 1986: 136: 104­-108.  Back to cited text no. 1    
2.McAninch JW. Disorder of the penis and male urethra. In : Tanagho EA, McAninch JW, eds. Smith's General Urology. New York, McGraw-Hill. 2000; 668-669.  Back to cited text no. 2    
3.Winter CC. McDowell G. Experience with 105 patients with priapism : Update review of all aspects. J Urol 1988: 140: 980-983.  Back to cited text no. 3    
4.Winter CC. Priapism. Urol Surv 1978; 28: 163.  Back to cited text no. 4    
5.Hinman F. Priapism : Reasons for failure of therapy. J Urol 1960; 83: 420.  Back to cited text no. 5    
6.Pryor JP. Hehir M. The management of priapism. Br J Urol 1982; 54: 751-754.  Back to cited text no. 6    
7.Multall JP, Honig SC. Priapism : Etiology and management. Acta Emerg Med 1996; 3: 810.  Back to cited text no. 7    




 

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    Abstract
    Introduction
    Patients and Methods
    Management
    Results
    Discussion
    Comments
    References

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