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Pathology for Urologists

Priapism and Strangulation


Image A
(click on the image above)

Image B
(click on the image above)

Priapism

  • Prolonged erection unrelated to sexual desire.
  • Pain and tenderness usually result after 6-8 hours and are related to ensuing ischemia (image A).
  • Etiology: primary or secondary (trauma, thromboembolism, hemostasis, neurologic defects, cancer, drugs, other).
  • Histology.
    • Corpora are edematous, indurated, and ultimately sclerotic.
    • By 12 hours: edema.
    • By 24 hours: destruction of the sinusoidal endothelium and exposure of the basement membrane with adherence of platelets.
    • By 48 hours: vascular thrombi associated with ischemic necrosis of the smooth muscle.

Strangulation

  • Prolonged erection resulting from obstruction of the venous outflow (image B), due to the application of some constricting device.
  • Etiology: stupidity? curiosity? unusual practices?
  • Histologic feature: essentially the same as priapism.

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