Priapism In Children

WHAT YOU SHOULD KNOW:

  • Priapism is a condition where your child's penis becomes, and remains, erect (rigid) for long periods of time. This happens when there is a problem with the flow of blood into and out of your child's penis. Arteries (blood vessels) bring blood with oxygen into the penis. Veins are blood vessels that return blood without oxygen to the heart. With priapism, there is too much blood in your child's penis. Having too much blood in the penis causes it to become engorged (very full) and rigid (firm). Engorgement lasting for a long time may put pressure on the tissue in your child's penis, causing pain and tissue damage.

  • There are different types of priapism called low-flow, high-flow, and stuttering priapism. Low-flow priapism is an emergency and must be treated quickly. Low-flow occurs when there is a blockage in the blood vessels and unoxygenated blood cannot leave the penis. High-flow occurs when too much blood is entering and collecting in the penis. Stuttering priapism is a repeating erection that occurs for no known reason and lasts from minutes up to three hours. Your child's risk for priapism increases if he has sickle cell disease, leukemia, or a spinal cord injury. Your child is also at risk if he has an injury to his penis and surrounding area.

  • Your child may need blood and urine tests and an ultrasound to learn the reason for his priapism. High-flow priapism may go away on its own without treatment. Treatments include medicines, aspiration, and surgery. Treatment may help decrease the amount of blood in your child's penis so it softens again. Treatment may help decrease your child's pain and prevent tissue damage. Receiving treatment quickly may decrease your child's risk for future problems, including erectile dysfunction (trouble having an erection).

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

  • Some medicines used to treat priapism may cause your child to have headaches or high blood pressure. Your child may feel weak, tired, dizzy, and he may have diarrhea (watery bowel movements). Your child's heartbeat may become too fast or irregular, and he may have palpitations (fast, forceful heartbeats). Medicines may also damage your child's liver. Sometimes, caregivers may unable to remove the trapped blood from your child's penis. Your child may need many treatments to resolve his priapism. After treatment, your child may get a hematoma (blood pooling under the skin) or an infection in his penis. His penis may be swollen and bruised. A fistula (abnormal connection) may form between his penis and urethra (tube through which urine passes out of the body). Even with treatment, your child's may get priapism again.

  • Without treatment, your child's priapism may not resolve. Your child may have permanent tissue damage in his penis. Tissue damage may cause your child to have erectile dysfunction (cannot get an erection). Your child may need a penile prosthesis (man-made device) to have an erection. Talk with your child's caregiver if you have questions or concerns about your child's priapism, treatment, or care.

WHILE YOU ARE HERE:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

  • An IV is a small tube placed in your child's vein that is used to give him medicine or liquids.

Medicines:

Medicines may be used to treat low-flow, high-flow, and stuttering priapism. Your child may be given any of the following:

  • Hormone therapy: Your child may be given hormones (body chemicals) to help resolve his priapism. Hormones are normally only given to teenagers after they have gone through puberty. Ask your child's caregiver for more information about hormone therapy.

  • Pain medicine: Your child may need medicine to take away or decrease pain. Know how often your child should get the medicine and how much. Watch for signs of pain in your child. Tell caregivers if his pain continues or gets worse. To prevent falls, stay with your child to help him get out of bed.

Monitoring:

  • Heart monitor: This is also called an ECG, or electrocardiogram. Sticky pads are placed on the chest or other parts of your child's body. Each pad has a wire that is hooked to a TV-type screen. This allows caregivers to see a tracing (picture) of your child's heartbeat. Your child may need a heart monitor if he is having a procedure to treat his priapism. The heart monitor helps caregivers make sure your child is handling the procedure well.

  • Vital signs: Caregivers will check your child's blood pressure, heart rate, breathing rate, and temperature. They will also ask you or your child about his pain. These vital signs give caregivers information about your child's current health.

Tests:

Your child may need the following tests to help caregivers plan his treatment:

  • Blood tests: Your child may need blood taken for tests. Blood may be taken from a vessel in your child's hand, the bend in his elbow, or his penis. The blood is tested to see how your child's body is doing. It can give your child's caregivers more information about his health condition. Your child may need to have blood drawn more than once.

  • Ultrasound: During an ultrasound, sound waves are used to show pictures of your child's penis on a TV-like screen. This test shows how blood is flowing in your child's penis and where blood vessels may be blocked.

  • Urine tests: A sample of your child's urine may be sent to a lab for testing.

Treatment options:

Treatment depends on which type of priapism your child has. If another condition is causing the priapism, your child may need treatment for that condition also. Ask your child's caregiver for more information about the following:

  • Treatment for low-flow priapism:

    • Aspiration: During aspiration, caregivers use needles to remove blood from your child's penis. Caregivers may also flush the penis with fluids to clear out the blood. Medicine may also be mixed with the fluid to help clear out the blood.

    • Alpha adrenergic agonists: Your child may be given alpha adrenergic agonist medicine to decrease the blood in his penis. This medicine will be given as a shot in the penis and may be needed more than once.

    • Surgery: If other treatments fail, a shunt (passage) may need to be placed in your child's penis. A shunt will allow blood to flow from one area of your child's penis to another.

  • Treatment for high-flow priapism: With high-flow priapism, your child's penis may become soft on its own without treatment. Caregivers may watch your child closely for a period of time. Ice or cold packs may be put on your child's penis for short periods of time. Ice may help slow the blood flow to your child's penis. Your child may also need the following treatments:

    • Embolization: Embolization is a procedure to block the blood flow within a blood vessel in your penis. Caregivers do this by placing a small plug in the blood vessel. This may help keep the blood flow normal.

    • Surgical ligation: During surgical ligation, a blood vessel in your child's penis is tied off to block blood flow. Surgical ligation may only be needed if other treatments do not work to treat your child's priapism.

  • Treatment for children with priapism and sickle cell disease: If your child has sickle cell disease, he may also need the following treatments:

    • Anti-sickling medicines: If your child has sickle cell disease, he may be given anti-sickling medicines. These medicines may help decrease the blood that has collected in his penis.

    • Hydration: Your child may be given extra fluids to drink to help control his symptoms.

    • Oxygen: Your child may need oxygen if his blood oxygen level is lower than it should be. Oxygen will help your child breathe easier. Your child may get oxygen through small tubes placed in his nostrils, or through a mask. He may instead be placed in an oxygen tent. Never take off your child's oxygen tubes or mask or remove him from the tent without asking his caregiver first.

    • Blood transfusion: During a blood transfusion, your child will get whole blood, or parts of blood through an IV. You may be worried that your child will get AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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