|Year : 2002 | Volume
| Issue : 2 | Page : 146-147
Role of cold saline enema in management of priapism
Pankaj Khurana, AR Bansal, Hemant Kamal, Vinod Malik
Department of Surgery, Pt. B.D. Sharma PGIMS, Rohtak, India
H-65, DDA Flats, Phase - 1., Ashok Vihar. Delhi - 110 052
Source of Support: None, Conflict of Interest: None
| 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
| Introduction|| |
Priapism is a prolonged painful erection of penis unaccompanied by sexual desire.  The disorder is idiopathic in 60% of the cases.  Priapism is best treated conservatively rather than by shunting or surgical procedures.  Sedation followed by cold saline enema has been advocated as the initial therapy which may cause subsidence of erection.  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|| |
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|| |
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|| |
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|| |
Priapism, ironically named after the Greek god of male generative power, can cause impotence in up to 50% of the cases.  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,  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.,,
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.  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. 
| Comments|| |
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|| |
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