Our Summary

Priapism is a condition where the penis stays erect for more than 4 hours without any sexual stimulation. It can be of two types: ischemic or low flow, and nonischemic or high flow, each having different causes, symptoms and treatments. This research paper discusses a case of a 58-year-old man who experienced an ischemic priapism after undergoing a specific kind of back surgery (anterior lumbar interbody fusion or ALIF). The man’s penis returned to normal after he was given two doses of a drug called phenylephrine HCL. After looking at past research, it appears that the anesthesia used during the surgery might have caused the priapism. This case serves as a reminder for medical staff to always be alert and not ignore any unusual symptoms or findings, as they could potentially cause significant harm to the patient.

FAQs

  1. What is priapism and what are its two types?
  2. How was the case of priapism in the 58-year-old man treated post lumbar fusion surgery?
  3. What is the possible link between anesthesia used during lumbar fusion surgery and priapism?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lumbar fusion is to be aware of potential complications such as priapism, a rare but serious condition that can occur after surgery. Patients should promptly report any unusual symptoms, including persistent erections, to their healthcare provider for evaluation and treatment. Early recognition and intervention can help prevent complications and promote optimal recovery after lumbar fusion surgery.

Suitable For

Patients who are typically recommended for lumbar fusion surgery include those with:

  • Degenerative disc disease
  • Herniated disc
  • Spondylolisthesis
  • Spinal stenosis
  • Fractures or traumatic injuries to the spine
  • Failed previous spinal surgery

It is important for patients to discuss their specific condition and symptoms with their healthcare provider to determine if lumbar fusion surgery is the most appropriate treatment option for them.

Timeline

  • Before lumbar fusion: The patient likely experiences chronic pain in the lower back, legs, or hips due to conditions such as degenerative disc disease, herniated discs, or spinal stenosis. They may have tried conservative treatments such as physical therapy, medications, and injections without success.

  • Day of surgery: The patient undergoes anterior lumbar interbody fusion (ALIF) surgery to fuse two or more vertebrae in the lower back to stabilize the spine and relieve pain. The surgery involves making an incision in the abdomen to access the spine, removing damaged discs, inserting a bone graft, and stabilizing the area with rods and screws.

  • Post-surgery: The patient is monitored in the recovery room for any immediate complications such as bleeding, infection, or nerve damage. They may experience pain, swelling, and limited mobility in the surgical area. Physical therapy is initiated to help with mobility and strengthen the muscles surrounding the spine.

  • Days to weeks after surgery: The patient continues to recover at home, following post-operative instructions provided by their healthcare team. They may gradually increase their activity level and return to work or daily activities. Pain medications and physical therapy may be continued to aid in recovery.

  • Ischemic priapism: In the case discussed, the patient experiences an uncommon complication of ischemic priapism, characterized by prolonged and painful erection unrelated to sexual arousal. This occurs due to restricted blood flow in the penis, leading to tissue damage if not treated promptly.

  • Treatment: The patient is administered phenylephrine HCL, a vasoconstrictor medication that helps reduce blood flow to the penis and alleviate the priapism. After two doses, the patient’s erection resolves, and they are monitored for any further complications.

  • Follow-up: The patient is advised to follow up with their healthcare provider for ongoing monitoring and management of their recovery. The medical team reviews the case and considers potential causes, such as the anesthesia used during surgery, to prevent similar complications in future patients undergoing lumbar fusion.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion include:

  1. What are the potential risks and complications associated with lumbar fusion surgery?
  2. How long is the recovery period after lumbar fusion surgery, and what can I expect during that time?
  3. Will I need physical therapy or rehabilitation after the surgery, and if so, for how long?
  4. What kind of restrictions or limitations will I have after the surgery, and for how long?
  5. How successful is lumbar fusion surgery in relieving pain and improving mobility?
  6. Are there any alternative treatments or procedures that I should consider before opting for lumbar fusion surgery?
  7. What is the long-term prognosis for someone who undergoes lumbar fusion surgery?
  8. How often do complications like priapism occur after lumbar fusion surgery, and what steps will be taken to prevent them?
  9. What is the plan for managing pain after the surgery, and what pain medications will be prescribed?
  10. How frequently will follow-up appointments be needed after lumbar fusion surgery, and what signs or symptoms should I watch for that may indicate a complication?

Reference

Authors: Otten C, Dunn KS. Journal: Orthop Nurs. 2024 Jan-Feb 01;43(1):41-44. doi: 10.1097/NOR.0000000000001001. PMID: 38266263