Summary

• Pathological condition of persistent (>4 hours) penile erection in the absence of sexual excitation.
• Classified as ischaemic, non-ischaemic, or recurrent/stuttering.
• Diagnosis is based on history, clinical findings, and assessment of cavernous blood gases and/or colour duplex ultrasound.
• Treatment of priapism should progress in a step-wise fashion.
• Ischaemic priapism warrants emergency management. First-line therapy includes therapeutic aspiration of blood with intracavernous injection of diluted alpha-adrenergic sympathomimetic agents. Surgical shunt procedures are performed in refractory cases.
• Non-ischaemic priapism is managed by observation. If a patient desires active treatment, selective cavernosal artery embolisation may be considered.
• Acute episodes of recurrent or stuttering priapism are managed the same as ischaemic priapism, followed by treatment of any underlying condition (e.g., sickle cell disease). In some patients, hormonal therapy may be of benefit.
• Complications include penile fibrosis and erectile dysfunction.