Fransen van de Putte E E, Ananias H J K, Gi N P Tjon Pian, de Boer H D
Department of Urology, Martini Hospital, Groningen, The Netherlands.
Acta Anaesthesiol Scand. 2014 Aug;58(7):903-5. doi: 10.1111/aas.12314. Epub 2014 Mar 28.
Priapism is a rare complication of epidural anaesthesia, and the pathophysiology is poorly understood. In general, 95% of all priapism episodes are ischemic because of decreased penile blood flow, and therefore requires immediate treatment. A case is reported of a 45-year-old male patient in which a clear relation is demonstrated between continuous thoracic epidural analgesia and priapism after transabdominal nephrectomy. The level of epidural anaesthesia supports the theory that the erection is a consequence of increased penile blood flow, thus a relatively harmless condition. However, confirmation by serial cavernous blood gas analysis or colour duplex ultrasonography is mandatory. Until this hypothesis is confirmed, termination of epidural infusion is advised as a primary treatment.
