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Priapism in Children

GENERAL INFORMATION:

What is priapism in children?

  • 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. Engorgement lasting for a long time may put pressure on the tissue in your child's penis, causing pain and damage.

  • There are different types of priapism that may last for minutes, hours, or days. 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).

What are the common types of priapism in children?

  • Low-flow: Low-flow priapism occurs when veins in your child's penis become blocked and blood cannot flow out. Low-flow priapism is also called ischemic priapism. When blood flow leaving the penis is blocked, the blood with oxygen in it cannot enter the penis. This means your child's penis may not get enough oxygen, and his penis may be permanently damaged. Low-flow priapism is an emergency and must be treated quickly.

  • High-flow: High-flow priapism occurs when too much blood flows into your child's penis. High-flow priapism is also called nonischemic priapism. When too much blood flows into the penis, the blood may become trapped because it cannot drain out as quickly. High-flow priapism often occurs after an injury to an artery near or in your child's penis.

  • Stuttering: Stuttering priapism is an unwanted erection that occurs from a few minutes up to three hours. The erection continues to repeat for no known reason. The repeat erections may occur for days, months, or years. Stuttering priapism occurs more often in teenagers.

What increases my child's risk of getting priapism? The cause of your child's priapism may not be known. Ask your child's caregiver for more information about these and other risk factors for priapism in children:

  • Medical conditions: Certain blood diseases, such as sickle cell disease and leukemia (blood cancer) can increase your child's priapism risk. With sickle cell disease, abnormal shaped blood cells can get trapped and block the blood flow in the penis. If your child has a spinal cord injury, his risk may also increase. Children who need total parenteral nutrition (liquid nutrition) are also more likely to get priapism.

  • Trauma: An accident, such as a bike seat injury, can damage the blood vessels that bring blood to your child's penis. The damaged blood vessel may cause too much blood to flow into your child's penis. Sexually active teens are also at risk if the penis is injured during sex.

  • Medicines: Medicines used to treat high blood pressure, depression, and other mood disorders may increase your child's risk for priapism.

  • Newborn conditions: Newborn babies are at risk for priapism if they were injured during birth. An injury may occur if tools, such as a forceps, were needed to help deliver your baby. Babies who are born with trouble breathing or babies born with a syphilis infection are also at increased risk. Syphilis is a sexually transmitted disease passed from an infected mother to baby. If your baby needed a catheter (thin tube) in his umbilical cord blood vessel after birth, his priapism risk increases.

  • Street drugs or alcohol: Certain street drugs, such as marijuana and cocaine, can increase your child's risk of getting priapism. If your child drinks alcohol, his risk also increases. Alcohol is found in beer, wine, whiskey, and other adult drinks.

What are the signs and symptoms of priapism in children? With priapism, your child's penis stays erect for at least four hours. If your child has stuttering priapism, he may have repeat erections that last from minutes up to three hours. Your child's penis may look darker in color than usual, and he may have mild to very bad pain.

How is priapism in children diagnosed? Your child's caregiver will ask when your child's erection began and if he has other symptoms, such as pain. Tell your child's caregiver what happened just before the erection started and if it has happened before. If your child has had priapism before, tell your child's caregiver what was done to treat it. Tell your child's caregiver if your child has any medical problems or if he is taking any medicines. Your child's caregiver may do a physical exam and check your child's abdomen (stomach), penis, and rectum. Your child may also need the following:

  • 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. Your child's urine may be tested for certain medicines or street drugs that can cause priapism.

How is priapism in children treated? Treatment will depend on which type of priapism your child has. If another condition is causing your child's priapism, caregivers may also treat the condition. 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 child's 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.

  • Medicines:

    • 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.

What are the risks of treating priapism in children?

  • 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 be 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 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). Talk with your child's caregiver if you have questions or concerns about your child's priapism, treatment, or care.

How can I help my child decrease his risk for priapism? It may not always be possible to prevent priapism, but the following may help decrease your child's risk:

  • Make sure your child sees his caregiver for regular checkups. If your child has a medical condition, such as sickle cell disease, make sure he follows his caregiver's treatment advice.

  • Talk with your child about avoiding alcohol and illegal street drugs. Talk with your child's caregiver if your child drinks alcohol or takes drugs and needs help to stop.

When should I call my child's caregiver? Call your child's caregiver if:

  • Your child has an unwanted, painless erection for four or more hours.

  • Your child has sickle cell disease and symptoms of an infection, such as a fever (high body temperature).

  • Your child has an unwanted erection that comes and goes, lasting from minutes to hours.

When should I seek immediate help for my child? Seek care immediately or call 911 if:

  • Your child has an unwanted, painful erection for four or more hours.

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. 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.

© 2013 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.


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