Abstract
Study design:
Prospective literature review; search via Oldmedline (1958–1965), Medline (1966–2005) and Pubmed.
Objectives:
The objective of this study is to review the pathophysiology of priapism in acute traumatic spinal cord injury (SCI); to determine the incidence of priapism in traumatic SCI, whether or not priapism is associated with incomplete or only complete SCI and whether and what treatment might be required.
Methods:
This is a review article based upon the available literature in this area.
Results and conclusions:
Priapism that follows acute traumatic SCI is high-flow (non-ischaemic) priapism, that is, the blood within the corpus is arterial in nature. Priapism does not occur in all patients with acute SCI. The literature does not allow us to determine in what proportion of patients priapism occurs. Priapism has been reported following a wide variety of spinal cord pathologies including acute SCI, transverse myelitis and postoperative extradural haematoma. In all patients, priapism is associated with complete motor and sensory (American Spinal Injury Association A) paraplegia. Priapism has been reported following spinal shock. Following traumatic SCI, priapism usually settles rapidly without specific treatment being required. Priapism occurs at the moment of complete motor and sensory paraplegia, it does not occur following a delay. There are medicolegal implications: the presence/absence of priapism assists in determining when the complete spinal cord lesion occurred.
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References
Sadeghi-Nejad H, Seftel AD . The etiology, diagnosis and treatment of priapism: review of the American Foundation for Urologic Disease Consensus Panel Report. Curr Urol Rep 2002; 3: 492–498.
Monllor J, Taño F, Arteaga PR, Galbis F . Priapism of the clitoris. Eur Urol 1996; 30: 521–522.
Gordon SA, Stage KH, Tansey KE, Lotan Y . Conservative management of priapism in acute spinal cord injury. Urology 2005; 65: 1195–1197.
Rodi Z, Strtaus I, Denic K, Deletis V, Vodusek DB . Transient paraplegia revealed by intraoperative neuropsyiological monitoring: was it caused by the epidural anaesthetic or an epidural haematoma? Anesth Analg 2003; 96: 1785–1788.
Dawodu ST . Spinal cord injury - definition, epidemiology, pathophysiology. http://emedicine.medscape.com/article/322480-overview.
Laha RK, Dujovny M, Huang PS . Intermittent erection in spinal canal stenosis. J Urol 1979; 21: 123–124.
Greschner M, Krautschick A, Alken P . High-flow priapism leading to the diagnosis of lung cancer. Urol Int 1998; 60: 126–127.
Haddad FS . Penile metastases secondary to bladder cancer. Review of the literature. Urol Int 1984; 39: 125–142.
Hammond ER, Kerr DA . Priapism in infantile transverse myelitis. Arch Neurol 2009; 66: 894–897.
Cuenca PJ, Tulley EB, Devita D, Stone A . Delayed traumatic spinal epidural haematoma with spontaneous resolution of symptoms. J Emerg Med 2004; 27: 37–41.
van Arsdalen KN, Chen JW, Smith MJ . Penile erections complicating transurethral surgery. J Urol 1983; 129: 374–376.
Thomas A, Woodard C, Rovner ES, Wein AJ . Urologic complications of nonurologic medications. Urol Clin North Am 2003; 30: 123–131.
Gallagher JP . A lesson in neurology from the hangman. J S C Med Assoc 1995; 91: 38.
Guy WA, Ferrier D . Principles of Forensic Medicine. Ballantyne Press: Edinburgh & London, 1861; pp, 2: 252–260.
Steinhardt GF, Steinhardt E . Priapism in Children with leukemia. Urology 1981; 18: 604–606.
Fowler Jr JE, Koshy M, Strub M, Chinn SK . Priapism associated with the sickle cell hemoglobinopathies: prevalence, natural history and sequelae. J Urol 1991; 145: 65–68.
Takamura S, Suzuki Y, Hiei T et al. A case of priapism caused by disseminated intravascular coagulopathy [in Japanese]. Hinyokika Kiyo 1987; 33: 453–457.
Keoghane SR, Sullivan ME, Miller MA . The aetiology, pathogenesis and management of priapism. BJU Int 2002; 90: 149–154.
Sneed RC, Stover SL . Undiagnosed spinal cord injuries in brain-injured children. Am J Dis Child 1988; 142: 965–967.
Hellier C, Connolly R . Cause of death in judicial hanging: a review and case study. Med Sci Law 2009; 49: 18–26.
Wood-Jones F . The ideal lesion produced by judicial hanging. Lancet 1319; 1: 53.
Vermooten V . A study of the fracture of the epistropheus due to hanging with a note on the possible causes of death. Anat Rec 1921; 20: 305–311.
Shkrum MJ, Green RN, Nowak ES . Upper cervical trauma in motor vehicle collisions. J Forensic Sci 1989; 34: 381–390.
James R, Nasmyth-Jones R . The occurrence of cervical fractures in victims of judicial hanging. Forensic Sci Int 1992; 54: 81–91.
Spitz WD . Medicolegal Investigations of Death: Guidelines for the Application of Pathology to Crime Investigation. Springfield: Illinois, USA, 1993.
Subramanyam BV (ed). Modi's Medical Jurisprudence and Toxicology. Butterworths: New Delhi, India, 1992.
Reay DT, Cohen W, Ames S . Injuries produced by judicial hanging. A case report. Am J Forensic Med Pathol 1994; 15: 183–186.
Wallace SK, Cohen WA, Stern EJ, Reay DT . Judicial hanging: postmortem radiographic, CT, and MR imaging features with autopsy confirmation. Radiology 1994; 193: 263–267.
Numan F, Cakirer S, Işlak C, Oǧüt G, Kadioǧlu A, Cayan S et al. Posttraumatic high-flow priapism treated by N-butyl-cyanoacrylate embolisation. Cardiovasc Intervent Radiol 1996; 19: 278–280.
D’Aleo G, Rifici C, Kofler M, Saltuari L, Bramanti P . Favorable response to intrathecal, but not oral, baclofen of priapism in a patient with spinal cord injury. Spine 2009; 34: E127–E129.
Marshall LF, Knowlton S, Garfin SR, Klauber MR, Eisenberg HM, Kopaniky D et al. Deterioration following spinal cord injury. A multicenter study. J Neurosurg 1987; 66: 400–404.
Tator CH, Fehlings MG . Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991; 75: 15–26.
Frankel HI, Hancock DO, Hyslop G, Melzar J, Michaels IS, Ungar GH et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 1969; 7: 179–192.
Spinal cord injury. In: Stover E et al. (eds) Clinical outcomes from the model systems 1995 p 173.
De Le Torre J . Spinal cord injury. Review of basic and applied research. Spine 1981; 6: 315–335.
Toscano J . Prevention of neurological deterioration before admission to a spinal cord injury unit. Paraplegia 1988; 26: 143–159.
Poonnoose PM, Ravichandran G, McClelland MR . Missed and mismanaged injuries of the spinal cord. Trauma 2002; 53: 314–320.
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Todd, N. Priapism in acute spinal cord injury. Spinal Cord 49, 1033–1035 (2011). https://doi.org/10.1038/sc.2011.57
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DOI: https://doi.org/10.1038/sc.2011.57
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