Last reviewed: 2 Jul 2021
Last updated: 21 Mar 2018

Summary

Definition

History and exam

Key diagnostic factors

  • hx of current systemic disease
  • hx of vasoactive medication or drug use
  • prolonged erection of >4 hours' duration
  • painful rigid penis
  • penis not fully rigid and not painful
  • hx of perineal or genitourinary trauma

Risk factors

  • haemoglobinopathy
  • vasoactive drugs
  • perineal or penile trauma
  • malignancies or local infection
  • spinal cord disease

Diagnostic investigations

1st investigations to order

  • corpus cavernosum blood sampling
  • FBC and differential
  • Hb-solubility testing
  • medication/toxicology urine screen

Investigations to consider

  • colour duplex ultrasonography
  • ultrasound
  • penile arteriography
  • Hb electrophoresis

Treatment algorithm

Contributors

Authors

Helen R. Levey Bernie, DO, MPH
Helen R. Levey Bernie

Urology Resident

Department of Urology

University of Rochester Medical Center

Rochester

NY

Disclosures

HRL declares that she has no competing interests.

John Mulhall, MD

Professor of Urology

Director of the Sexual and Reproductive Medicine Fellowship

Memorial Sloan-Kettering Cancer Center

New York

NY

Disclosures

JM declares that he has no competing interests.

Acknowledgements

Dr Helen Levey and Dr John Mulhall would like to gratefully acknowledge Dr Trinity Bivalacqua, Dr Onder Canguven, and Dr Arthur L. Burnett, previous contributors to this topic. TB is an author of a number of references cited in this topic. ALB has been reimbursed by Pfizer Inc. and Lilly LLC for attending symposia, speaking, organising education, and consulting, and has received research grants that support laboratory staff. OC declares that he has no competing interests.

Peer reviewers

Wayne Hellstrom, MD

Professor of Urology

Department of Urology

Tulane University Health Sciences Center

New Orleans

LA

Disclosures

WH declares that he has no competing interests.

Siam Oottamasathien, MD

Assistant Professor

Division of Pediatric Urology

University of Utah

Primary Children's Medical Center

Salt Lake City

UT

Disclosures

SO declares that she has no competing interests.

Gabriel Rodriguez, MD

Associate Professor

Section Head of Minimally Invasive Surgery

The University of Texas Medical Branch

Galveston

TX

Disclosures

GR declares that he has no competing interests.

Edmund Sabanegh, Jr, MD

Director

Center for Male Fertility

Glickman Urological and Kidney Institute

Cleveland

OH

Disclosures

ES declares that he has no competing interests.

Ates Kadioglu, MD

Professor of Urology

Division of Andrology

Department of Urology

Faculty of Medicine

Istanbul University

Istanbul

Turkey

Disclosures

AK declares that he has no competing interests.

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