Priapism

Disease Description (Causes and Symptoms)

• Definition: A condition in which an appendage within the scrotum (e.g., the testicular appendix, appendix epididymis, etc.) twists (torsion), blocking blood flow and causing acute pain and localized inflammation.
• Causes·Pathophysiology: Torsion occurs when there is a congenitally short appendage with a false stalk (an anatomically abnormal stalk susceptible to twisting) or due to sudden exercise or trauma. The blood flow to the appendage is blocked by the torsion, leading to ischemia → inflammation.
• Main symptoms: Sudden unilateral scrotal pain (usually localized), scrotal swelling and redness; the testis itself is usually in its normal position, with relatively preserved blood flow. There is localized tenderness above the testis (in the upper part), and rarely a blue spot visible through the skin (blue dot sign) may be observed. Fever and urinary symptoms are usually absent.

Treatment Methods

• Initial treatment (mostly conservative treatment):
  • Pain control: NSAIDs (e.g., ibuprofen) and analgesics if necessary.
  • Local measures: Scrotal support (underwear·pad), rest, and application of an ice pack (for a short time).
  • Observation: Monitor the course of symptoms (several hours to several days). It is important to confirm by ultrasound that blood flow to the testis is maintained.
• Surgical treatment:
  • If severe pain persists, symptoms do not improve, or the diagnosis is uncertain, a scrotal incision (exploration) and excision of the twisted appendage are performed. In addition, if testicular torsion is suspected based on examination or clinical findings, emergency surgery is required.
• Antibiotics: Generally not necessary unless there are clear signs of infection or epididymitis.
• Precautions (self-care):
  • Visit the emergency room immediately if there is severe pain, sudden worsening of pain, fever, vomiting, or rapid worsening of scrotal swelling.
  • Limit activities and exercise until the symptoms have resolved.
• Prognosis: Most cases improve within several days with conservative treatment, and the prognosis is good. Rarely, chronic pain or residual calcification may occur.

Checklist Before an Outpatient Visit (Including Example Questions)

Items/records to prepare:

• Time symptoms began (exact time), nature of the pain (sudden/gradual, constant/intermittent), and location of the pain (left/right, above the testis, etc.)
• Pain intensity (0–10), and factors that trigger or relieve the pain (when moving, when pressing, etc.)
• Associated symptoms: fever, chills, vomiting, urinary abnormalities (painful urination, feeling of incomplete emptying), and whether there has been any trauma
• Previous scrotal problems (past testicular torsion, epididymitis, surgical history, undescended testis·congenital abnormalities)
• Medications currently being taken (especially anticoagulants and antiplatelet drugs)
• Results of tests already performed (bring ultrasound·color Doppler images or reports if available)
• Recent activities (sports·trauma), and information related to sexual activity (if necessary) Example questions (items the patient may find helpful to prepare):
• "When and under what circumstances did the symptoms first begin?"
• "Which area hurts more? Does the pain get worse when you move or press on it?"

General Example Questions to Ask the Doctor

• "Is torsion of an appendage within the scrotum the most likely cause of this pain? How likely is testicular torsion?"
• "Are there cases in which surgery is necessary even when the ultrasound (color Doppler) results are normal?"
• "What are the side effects of the medication currently prescribed? Are there any precautions I should take when taking it?"
• "When can I expect to return to daily activities·sports after treatment?"
• "Can this condition affect fertility (sperm·hormones)?"

Examples of Condition-Specific Questions

• "If blood flow to the testis is normal on ultrasound but the pain is severe, would you recommend surgery immediately? What criteria do you use to decide whether surgery is needed?"
• "Do specific findings seen at the time of diagnosis (e.g., blue dot sign, location of localized tenderness) suggest this condition? Are there any additional tests that should be performed?"

(Note: Because the treating medical team makes diagnostic and treatment decisions by considering the clinical and ultrasound findings together, specific discussion with the treating doctor based on the questions above is necessary.)