I'm afraid to ask but: How do they treat an erection that lasts for more than 4 hours?

[HeyHomie]

@carnut

Of course, if they guy is only age 14, four hours might be normal.

Kidding aside, is a four-hour erection in an adolescent to be expected and thus not cause for concern?

Any pediatric urologists in the house? Is pediatric urology even a specialty?

[WhyNot]

@HeyHomie

Kidding aside, is a four-hour erection in an adolescent to be expected and thus not cause for concern?

Not, it is not expected and is still a cause for concern. The most common causes of priaprism in adolescents (and children) are sickle cell and perineal trauma.

Adolescents may get more *frequent *erections than adults (although I’m not entirely sure about that, that’s based on water cooler talk rather than research), but they still shouldn’t be unremitting.

[RoniaBorkason]

@HeyHomie

Any pediatric urologists in the house? Is pediatric urology even a specialty?

Yup, and just like regular ones, you don’t want to have to meet them. My baby son had posterior urethral valves, we have his 6 month follow up visit with, no joke, Dr. Huang, next week.

[Leaffan]

@WhyNot

I think you mean the corpus cavernosum, the spongy erectile tissue that fills with blood to produce an erection. That is a treatment, about in the middle of the list of things they’re likely to try.

First of all, there are two kinds of priaprism - ones where the blood can’t get out (vaso-occlusive or “low flow”) and ones where the blood won’t stop coming in (arterial, or “high flow”) Obviously, they’re treated differently, if the docs can figure out which yours is.

High flow are often just observed to see what happens. This kind of priaprism isn’t so likely to cause lasting injury, and often time is all that’s needed to reduce the erection. Compression therapy (which is just about what it sounds like) can often resolve high flow priaprism, especially in little boys (yes, it happens). Sometimes, there’s a fistula (opening) where it shouldn’t be that’s causing the blood to keep coming into the penis, and a simple procedure is needed to close the fistula, either with angiography or surgical incision.

Low flow priaprism is more common, more dangerous, and the one the ED drugs may cause. With low flow priaprism, the least invasive interventions are ice to the groin and perineum, pressure on the perineum and having the man walk up some stairs. These can all be tried at home before the 4 hours are up, by the way.

If four hours pass, an ER visit really is called for. Low flow priaprism can cause pretty hellacious long term effects on your penis. If ice, pressure and stairs don’t do it, they’ll probably give you one or more drugs which may make the erection go away - terbutaline taken orally resolves about one third of the cases. Some docs will use oral pseudoephedrine, but I’m not sure how widely that’s accepted yet. If that doesn’t work within 30 minutes, an injection of an alpha-adrenergic blocker will be attempted. Third line of intervention is the aforementioned aspiration of the blood in the corpus carvernosum with a needle. If this doesn’t work they’ll also inject alpha-adrenegeric blockers or methyline blue into the cavernosum itself

I love it when you talk nerdy to us.

I’ll be in my bunk.

[WhyNot]

@Leaffan

I love it when you talk nerdy to us.

I’ll be in my bunk.

lol

Ok, see you in 3 hours and 59 minutes, or we’re sending a urologist in there with a needle!
(Sorry if my nerdiness is too much. I actually use this site (and a couple of others) to practice my 'splaining skills. Someday I may actually need to nerd out at a patient or his wife in real life, and having some things rehearsed in layspeak like “blood can’t get out” will, I hope, make me a better nurse!)

[cwthree]

@WhyNot

High flow are often just observed to see what happens. This kind of priaprism isn’t so likely to cause lasting injury, and often time is all that’s needed to reduce the erection. Compression therapy (which is just about what it sounds like) can often resolve high flow priaprism, especially in little boys (yes, it happens). Sometimes, there’s a fistula (opening) where it shouldn’t be that’s causing the blood to keep coming into the penis, and a simple procedure is needed to close the fistula, either with angiography or surgical incision.

This may also be treated with drugs that cause the blood vessels of the penis to constrict, thereby reducing the amount of blood that can flow into the penis. Said drugs may be administered intravenously or by injection directly into the penis.

If the urologist suspects that ischemic (low flow) priapism is caused by a blood clot, anti-clotting drugs may be used.

[WhyNot]

@cwthree

If the urologist suspects that ischemic (low flow) priapism is caused by a blood clot, anti-clotting drugs may be used.

Do they use thrombolytics to actually break up the clot, or things like heparin to prevent more? Or both? Do you have any more information on clots and priapism? We didn’t cover that cause in class, except tangentially r/t sickle cell.

[Diogenes_the_Cynic]

They show you naked pictures of Dick Cheney.

[Kevbo]

<Mae West> Like a god!</MW>

[Morgenstern]

@Khadaji

So I’m watching NFL and I see lots of adverts for Viagra - and one thing that is always stated is that you should see an doctor if your erection lasts more than 4 hours.

I’m sure I don’t want to know but - so what *do *they do?

Obligatory TSA witty comment here.

The last “Untold Stories of the ER” had just such a patient, as well as the dudes wife rushing to the ER only to discover her hubby holding hands with his mistress waiting the Urologist exam.
They took him to surgery and attacked his warrior with a needle.

[purplehorseshoe]

@RoniaBorkason

Yup, and just like regular ones, you don’t want to have to meet them. My baby son had posterior urethral valves, we have his 6 month follow up visit with, no joke, Dr. Huang, next week.

I’m 30 going on 12. This made my morning, after I sat for a moment sounding it out. (Hope your son’s okay, of course. But still, thanks for the lol.)

[cwthree]

@WhyNot

Do they use thrombolytics to actually break up the clot, or things like heparin to prevent more? Or both? Do you have any more information on clots and priapism? We didn’t cover that cause in class, except tangentially r/t sickle cell.

Looks like both approaches have been tried - I found references to the use of streptokinase, heparin, and warfarin.

This seems to associated with sickle-cell disorder more than anything else. Sickling can make the blood more liable to clot anywhere in the body. The penis, or the blood vessels associated with it, are no exception.

I believe our **Qadgop **has treated a couple of men with priapism related to sickle cell disease.

[limegreen]

You could watch that episode of True Blood where the brother drinks all the vamp blood… It describes the needle thing pretty squickishly.

[KlondikeGeoff]

I am soooo relieved that the answer is not, “amputation.”

[Washoe]

That’s reserved as an option of last resort for intractable cases of “robot arm grasping a man’s penis.”

[ShibbOleth]

A sharp “thwack” with a ruler usually does the trick.

[Clothahump]

I think one of these is involved.

[fumster]

@Washoe

That’s reserved as an option of last resort for intractable cases of “robot arm grasping a man’s penis.”

What a turn-off.

[Rysdad]

@Diogenes_the_Cynic

They show you naked pictures of Dick Cheney.

Bea Arthur.

[jayjay]

@sh1bu1

What a turn-off.

You’re gonna hurt Robot Arm’s feelings…