1-15 MAY 2017 • MALAYSIA FOCUS • 16
Safely improve erection, reduce risk of priapism
DR. JOSLYN NGU
To counter the rising incidence of improper
penis ring utilization that leads to priapism,
the public needs to be taught how to choose
and use the appropriate methods to manage
erectile disorders, says an expert.
Common treatment modalities for erectile
disorders include oral phosphodiesterase-5
inhibitors such as sildenafil, vardenafil and
tadalafil; injection of intracavernosal prostaglandin
and vacuum pump devices. Unfortunately,
instead of approaching a doctor, most men prefer
to seek help through the internet—where the
information available may not be credible. They
would experiment with different types of therapy
without medical advice or supervision. In
the case of vacuum pump erection device, they
may make mistakes such as putting on rings
that are too tight or rings made of metal and are
unaware of the risk of complications such as
priapism, said Professor Christopher Ho Chee
Kong, a professor of surgery, and consultant
urologist and sexual medicine physician at the
Universiti Kebangsaan Malaysia Medical Centre
in an interview with MIMS Doctor.
Among the procedures that men experiment
with to enhance their sexual prowess include
injecting silicone, paraffin or oil into the penis to
make it bulky; and inserting ball bearings into
the penis, he continued. Complications arise
when these procedures are not conducted under
proper medical settings. For example, Ho
said he has seen patients with ball bearings accidentally
inserted into the urethra. Moreover,
some men had injections done in a non-sterile
environment and technique, causing infection
and gangrene in their genitals. In some instances,
granulomatous reaction also occurs, causing
the penis to thicken and go out of shape.
When gangrene occurs, removal of necrotic tissue
is necessary. In some cases, it entails the
removal of the whole penis. Penile reconstruction
can be done but the patient will still end
up with erectile dysfunction, said Ho. This is
unfortunate as most of them had normal erection
but due to dissatisfaction and experimentation,
they ended up losing their penis or getting
erectile dysfunction.
When faced with a patient with priapism, it
is important to first differentiate ischaemic from
non-ischaemic priapism, advised Ho. If it is
painful, the most probable diagnosis is ischaemic
priapism. Conservative measures that
can be tried by GPs include putting ice packs to
the penis and perineum, and asking the patient
to do exercises such as walking up the staircase.
The latter is believed to help via steal phenomenon,
where blood is shunted to the limbs
instead of the penis, he elaborated. Oral terbutaline
5 mg can also be considered. Analgesics
as well as penile block with local anaesthetics
can relieve the pain. Aspirating blood from the
corpus cavernosum is also an option to treat
priapism. However, do not delay referral to the
hospital as time is of essence, he stressed. Prolonged
priapism will cause fibrosis and may be
irreversible. In the hospital, phenylephrine will
be injected into the corpus cavernosum and if
this fails, shunting procedures will be done.
If the patient does not feel any pain, the most
probable diagnosis is non-ischaemic priapism,
said Ho. This condition is not an emergency
and the GP does not have to do anything except
to refer the patient to a hospital for probable
angioembolization.
