hey guys welcome back to my channel I'm dr. Rena Malik I'm a urologist and
female pelvic surgeon and today I'm going to do something a little bit
different than my usual I'm gonna react to a Grey's Anatomy episode and this
episode is back from season two and I'm told there's a little bit of a urologic
story here so I'm gonna watch tell you how accurate is and give you some
details on the science behind all of it I hope you like what you see today make
sure if you do you give me a thumbs up and subscribe right there and make sure
you click on the bell so you don't miss any of my episodes I make new episodes every
Monday alright let's go there's a boy in my bed
guess where I am? Where? Burke's apartment he went to the
hospital he left me here alone are you oh there's no stuff to go through it
it's a freak show okay you can do surgery in here
oh he arranged his books using the Dewey Decimal System Mer I'm scared get
out get out of the house now are you talking to I so this is really funny I
think this happens all the time I mean girls call each other after any sort of
jarring event in their life particularly when they're dating new people or having
new milestones in their life like seeing their boyfriend's apartment for the
first time running guy you know Alex come home last night you I don't want to
talk about it actually I really do want to talk about it but he doesn't want to
talk about it because there were technical difficulties what you know he
didn't
you can't say anything George stop it I'd I mean at least think about making
fun of him next time I see him I said it never happened before
well that's what we all say and I mean they that's what they all say
I don't know maybe this relationship just isn't meant to be I mean I just
just need some sex George you know I just I need sex now you know what I mean
no matter how hard you beg this is not doing you so this actually happens very
often men have performance issues and this is totally normal and what drives
me nuts about this is that girls obsess over it beneath them but really you know
there's a lot of stress factors in having intercourse and having an
erection and particularly there are a lot of psychological factors that can
thing into your ability to have an erection and so really if it happens
once especially when someone really like you I wouldn't get too worried about it
and I definitely wouldn't tell his guy friend or guy colleague surgical
resident because that's not cool Meredith
you work here Oh what are you doing here Steve I'm having a little problem Steve
Jim I'm having a big problem what Steve hi Christina ever since you and I it
won't go away Christina it's right there looking at me so many things I could say
right now, champ. what he has what's called a priapism and so that is
technically defined as a persistent penile erection that can use for hours
after or unrelated to sexual intercourse and that's an emergency so he really
shouldn't be walking up to the hospital looking for people he should be in the
ER and presumably he had intercourse with her at some point when it was still
dark out and if it's been now morning time it's probably been about four hours
so he really needs to get attention right away we were just bringing him up
here because he's got this problem you see he's a friend
what did your friend take take which erectile dysfunction drug you took
absolutely not I swear it was all natural between us yeah your condition
is called priapism usually brought on by the overuse of EDS
I didn't take anything but we have to take your word for it because there's no
test to see if you're lying we'll have to look for other causes
there'll be lots of labs lots of procedures painful procedures procedures
which might make you wish you never had a penis you sure you don't want to
change your story I swear I'm clean all right great start
his workup get some blood get him some loperadine for his pain
as of now your friend is admitted so many things wrong that so number one he
should be in an emergency room and not being evaluated by a general surgeon
presumably this is typically managed when you have a prior PES and it
typically managed by going to the ER and a lot of the ER doctors can manage this
on their own but oftentimes they'll call a urologist number two that response was
completely inappropriate you cannot tell a guy who has a priapism
that and question them and interrogate them in that manner
assuming they took their medication because priapism is always caused by
taking medications for erectile dysfunction yes it can certainly be
caused by that and that's something that we warn patients about when we start
them on medications for erectile dysfunction that if you have an erection
lasting longer than four hours you need to come to the emergency room however
there are other causes some of these include sickle-cell disease, certain
kinds of cancers like leukemia can actually have a malignant infiltration
of the penis, sometimes having a nutrition through an IV like TPN can
cause this problem certain medications like trazadone can cause an erection as
well as cocaine use and then also sometimes very rare IV contrast can
cause a priapism there's a number of reasons often times we can't find a
cause it's important to treat these people with compassion and you know
they're scared and they're freaked out this is a very sensitive area you can't
just tell them I'm gonna be doing painful tests and procedures they're
gonna make you wish you didn't have a penis I mean that is just wrong I'm
going to take this opportunity to be someplace else
Steve's labs came back clean. So? so someone needs to induce vasoconstriction
oh nice try it with the fancy word he needs an enema and the answer is no I
can't do it oh I knew that a guy you pick up in a bar see you're naked and
you can't give him an enema totally uncalled for
well I'm keyed up and currently I would do it for you yes maybe no but that's
not the point okay here's how it goes I do this for you and you do every enema
I'm assigned to for an entire month deal you don't want to do this okay
treatment of priapism is absolutely not in enema so let me just kind of go over
the steps of priapism when a patient comes in the priapism the first and most
important thing is deciding what kind of priapism it is you have an ischemic or
low flow priapism and that is your presents with an erect very fully erect
penis that is painful or you can have a non ischemic priapism which is called a
high flow pipe ISM and that is where it's partially arrived with typically
not painful and that often follows some sort of trauma this guy appears to have
a d'emic priapism what happens pathophysiological II in these patients
if they get an erection from one of the causes that we discussed and the blood
rushes into the penis creating the erection and cannot evacuate the penis
because the venous outflow is decreased and so in that circumstance over time
it's particularly after four hours those tissues of the penis actually start
getting hypoxic or there's not enough oxygen to the tissues and if you delay
this for over 24 hours you can actually get irreversible erectile dysfunction
and fibrosis or scarring of the penile tissue the treatment typically is to
evacuate the blood in the penis you're not sure if this is an ischemic or non
ischemic priapism then you can do a blood gas which essentially means you take
some of the blood from the penis to decide if this actually is if ischemic
meaning there's less oxygen in the blood gas or it's nonischemic
and that can help because the treatment options are different in this case we'll
just focus on the treatment for ischemic priapism the treatment for an ischemic
priapism is to actually numb the penis and that's done with a penile block
after you numb the penis you then start with injecting the penis on both sides
with a needle and pulling out the blood actually from the penis itself that's
called corporal aspiration and sometimes you can irrigate fluid into it to help
clear out that blood and that typically resolves the pipe isn't in most cases if
that doesn't work we then have to go to surgery to make a bigger shunt in the
rectal tissue of the penis to get that blood out of the penis so let's see what
happens clearly the enema didn't work because that's not a treatment can quite
work huh excellent enema so what's the next step a needle aspiration finally
they're getting to the needle aspiration a needle my penis you have to drain the
blood so typically you wouldn't just tell a patient you're going to do a
procedure like that you actually have to get what's called an informed consent
you have to have them talk to them about the risks the benefits the alternatives
and they have to verbalize that they understand those risks alternatives and
benefits and they have the right to say no or decide what they want to do best
for them so this would not be an actual situation that occurs no way nope forget
you're looking at impotence penile infarction or gangrene so if you wanted
to fall off no I really don't want that let's get
two again informed consent not these other things that you might have
happened to you without any explanation it goes down feel nauseous just lie back
close your eyes and try to relax yes I could relax I wouldn't be here
just gave him back the key he'll be hurt use it well and if you had no intention
of using it and have taken it in the first place
come on fishing a key out of a coffee cup isn't like some binding legal
contract your boyfriend give you key to his place why is he talking I'm just
saying the guy put himself out there he's taking the next step you can't not
use it do you think you might not be in the best position right now to be
handing out relationship advice Hey he offered the key you took the key just
because I look at that congratulations you're flaccid
all right so they're doing the procedure which is great but honestly very very
common there and the weirdest part about it is that they're both having a
personal conversation right in front of the patient so that is really not
appropriate I mean this is a big deal to this person and granted Meredith kind of
knows this guy it's still really inappropriate to have a personal
conversation while you're actively doing a procedure on a patient who's wide
awake and probably again really freaked out don't tell me the flag is flying
once again hey nothing I did well we've tried everything so it must be neural
neuro she already called for a consult a
consult you called neuro for a consult hey it's not my phone she broke the
boy's penis hello everybody what's up so this is not something that would really
happen you would not call a neurosurgeon without any imaging without having any
idea because priapism again can be caused by idiopathic reason so typically
if you were suspecting a neuro cause which is again extremely rare you would get an
MRI of the spine to see if he actually had a lesion but before I do all that I
would again try to irrigate the penis and if that didn't work that would have
to go to surgery with presumably a urologist to then do a shunt like I
mentioned earlier calling a neurosurgeon would be a much much later down the line
thing and certainly wouldn't be something that would happen in this
emergent situation
so when deceivingly know what he's looking at he typically takes care of
the other brain this problem begin well I had an erection last night and woke up
with one this morning Dr. Shepherd but if you don't need me the other dr. Shepherd
needs a consult on one of the quints yeah so when did you last ejaculate I'm
not sure Meredith oh I'm I want to go with dr. Bailey what time did we yes
Meredith what time did you two your CT shows a tumor on your lower spine which
is pressing against your cabinets nerve which is causing me correction a tumor
right a tumor so I should be scared right that this is this is the time for
scared it's going to be fine dr. Shepherd is gonna schedule a surgery
yes I'll remove the tumor and everything should return to normal normal normal I
have a urologist sometimes we have to talk to you but yes normal normal
can you call my mom her numbers in my wallet tell her to come but but don't
tell her about the tumor I don't want to freak her out when she has to get on a
plane sure I wanted you two been seeing each other we're not seeing each other
we met last night at Joe's Joe's Bar mm-hmm I met a girl once myself very
long time ago
so finally they mentioned calling a urologist but again a CT scan is not
what you would use to look at spinal imaging you would order an MRI and if
this were a tumor causing a priapism it would be extremely rare and you'd
probably go through all the steps of reducing the priapism as I mentioned
earlier take them to surgery and ideally that was here the priapism and then
they may develop what's called a stuttering priapism is an at which point you
would probably then go on to further do some spinal imaging and find this
problem stuttering priapism is when you have an erection related to priapism that
goes through detumesence becomes flaccid and then later has a recurring priapism
again at a later date and lasting for again longer than four hours okay hey
guess I'll just have to tell you I'm happy to see you
so dr. Shepherd removed the tumor without any complications so I just want
to thank you for being there for me I mean normally yeah I expect your
one-night-stand to stick by you through a tumor maybe when I get out of here we
could I don't think so sure but yeah you know when I saw you at
Joe's I was just looking for a replacement looking for something to
make me feel better and you deserve better than that so I'm glad he's better
despite not thinking you're all just on the show they brought up priapism and
they did portray in the show so I'm happier they brought up this problem but
they really didn't do it justice I wish they had talked more about how much of
an emergency it is how serious of a problem it can be so thanks for watching
hope you enjoyed this episode make sure to comment below let me know what you
have anything else you'd like me to react to or any specific episodes or
shows and always remember to take care of yourself because you're worth it