Priapism in acute spinal cord injury

Prospective literature review; search via Oldmedline (1958-1965), Medline (1966-2005) and Pubmed.

The objective of this study is to review the pathophysiology of priapism in acute traumatic spinal cord injury (SCI); to determine the incidence of priapism in traumatic SCI, whether or not priapism is associated with incomplete or only complete SCI and whether and what treatment might be required.

This is a review article based upon the available literature in this area.

Priapism that follows acute traumatic SCI is high-flow (non-ischaemic) priapism, that is, the blood within the corpus is arterial in nature. Priapism does not occur in all patients with acute SCI. The literature does not allow us to determine in what proportion of patients priapism occurs. Priapism has been reported following a wide variety of spinal cord pathologies including acute SCI, transverse myelitis and postoperative extradural haematoma. In all patients, priapism is associated with complete motor and sensory (American Spinal Injury Association A) paraplegia. Priapism has been reported following spinal shock. Following traumatic SCI, priapism usually settles rapidly without specific treatment being required. Priapism occurs at the moment of complete motor and sensory paraplegia, it does not occur following a delay. There are medicolegal implications: the presence/absence of priapism assists in determining when the complete spinal cord lesion occurred.