Urological Emergencies in Clinical Practice стр.100

If we find an appendix testis or appendix epididymis at the time of scrotal exploration, whether there is a testicular torsion or not, we remove it (with diathermy or by ligating it with a small suture), so that it cannot twist in the future, which would necessitate repeat scrotal exploration.

If we find that the testis is not twisted, then we assume that the testis had undergone torsion, but had untwisted once the patient had been anaesthetised, or that the diagnosis could be epididymo-orchitis. If there was free fluid surrounding the testis,

132 J. REYNARD AND H. HASHIM

we take a swab and send it for culture. We fix the testis and the contralateral testis as a prophylactic measure.

PRIAPISM

Definition

Persistent erection of the penis for more than 4 hours that is not related or accompanied by sexual desire. There are two main types: ischaemic (veno-occlusive, low flow), and nonischaemic (arterial, high flow). It can affect any age, but the two main age groups affected are 5- to 10-year-old boys and 20- to 50-year-old men. There is a third type of priapism called stuttering priapism, which is an intermittent recurrent form of ischaemic priapism.

History

Ask the patient about these four main points:

■ Duration of erection >4 hours?

■ Is it painful or not? Pain implies ischaemia due to low flow; absence of pain implies high flow priapism with no ischaemia.

■ Previous history and treatment of priapism?

■ Identify any predisposing factors

Causes

Idiopathic drugs: Antihypertensives

Anticoagulants, e.g., heparin, warfarin Antidepressants, e.g., paroxetine, fluoxetine Alcohol

Recreational drugs, e.g., Marijuana, cocaine Intracavernous injections of vasoactive drugs, e.g., alprostadil, papaverine Trauma: Pelvic Genital

Perineal, e.g., straddle injury Neurological: Seizure

Cerebrovascular accident Lumbar disc disease Spinal cord injury Haematological disease: Sickle cell disease Thalassaemia Thrombophilia Leukaemia Myeloma

б. SCROTAL AND GENITAL EMERGENCIES I33


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