Priapism in children is a prolonged, often painful erection that occurs without sexual arousal and lasts for an extended period, typically four hours or more. This condition is considered a medical emergency requiring immediate attention. Recognizing and addressing pediatric priapism promptly helps prevent long-term complications.
Understanding Pediatric Priapism
The condition results from an imbalance in blood flow within the penis, where blood either becomes trapped or flows excessively into the erectile tissues. There are two primary types of priapism.
Ischemic, or low-flow, priapism occurs when blood becomes trapped in the penis, preventing normal outflow. This type is often painful and can lead to tissue damage if not treated quickly. In contrast, non-ischemic, or high-flow, priapism results from an uncontrolled increase in blood flow into the penis, often due to an injury. While it also causes a prolonged erection, high-flow priapism is less painful and poses less immediate risk of tissue damage compared to the low-flow type.
Common Causes in Children
Sickle cell disease is a frequently identified cause of priapism in children. In this genetic blood disorder, abnormally shaped red blood cells can block blood vessels, leading to impaired blood flow out of the penis. Trauma to the perineum or penis, such as from a fall or injury, can also cause priapism, particularly the non-ischemic type, by creating an abnormal connection that increases blood flow into the erectile tissue.
Certain medications, including those used for attention deficit hyperactivity disorder (ADHD) or some antidepressants, have been linked to priapism as a side effect. Leukemia, a type of cancer affecting blood and bone marrow, can similarly contribute to priapism due to the infiltration of cancerous cells into the penis. In some instances, no clear cause is identified, and these cases are referred to as idiopathic.
Recognizing the Signs and Urgency
For younger children or infants who cannot communicate verbally, signs might include irritability, persistent crying, or difficulty with diaper changes due to the erection. Older children may express pain or discomfort in the penile area.
The penis often feels rigid and may appear pale or grayish, particularly with ischemic priapism. Due to the potential for irreversible tissue damage, especially with low-flow priapism, immediate medical attention is important. Prompt intervention can help preserve penile function and prevent long-term complications.
Treatment Approaches
Treatment for pediatric priapism varies depending on the type and underlying cause. For ischemic priapism, immediate interventions often involve aspirating blood from the penis using a needle to relieve pressure and restore blood flow. Medications like phenylephrine may be injected into the penis to help constrict blood vessels and reduce the erection. In severe or unresponsive cases, surgical shunts might be created to redirect blood flow out of the penis.
Non-ischemic priapism is often managed with less invasive approaches. Initial steps may include observation, applying ice packs to the area, or using compression to help reduce swelling and blood flow. In some instances, if the condition persists, a procedure called embolization might be performed to block the abnormal blood vessels causing the increased flow.