MIMS Doctor May 2017

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.