Priapism is a pathological condition of persistent penile erection (>4 hours) 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).
Complications include penile fibrosis and erectile dysfunction.
Priapism is defined as a prolonged and persistent penile erection lasting >4 hours, unassociated with sexual interest or stimulation. It is a true medical emergency with complications potentially resulting in permanent erectile dysfunction. In stuttering or recurrent priapism, individual priapic episodes may last <4 hours.
History and exam
Key diagnostic factors
- history of current systemic disease
- history of vasoactive medication or drug use
- prolonged erection of >4 hours' duration
- painful rigid penis
- penis not fully rigid and not painful
- history of perineal or genitourinary trauma
- vasoactive drugs
- perineal or penile trauma
- malignancies or local infection
- spinal cord disease
1st investigations to order
- corpus cavernosum blood sampling
- FBC and differential
Investigations to consider
- colour duplex ultrasonography
- Hb-solubility testing
- Hb electrophoresis
- medication/toxicology urine screen
- coagulation profile
ischaemic or recurrent (stuttering) priapism
recurrent (stuttering) priapism
- Peyronie's disease
- Penile implant
- Evidence-based management of sickle cell disease
- Sexual and reproductive health: priapism
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