Priapism

Priapism is a pathologic condition of persistent penile erection (>4 hours) in the absence of sexual excitation.

Classified as ischemic, nonischemic, or recurrent/stuttering.

Diagnosis is based on history, clinical findings, and assessment of cavernous blood gases and/or color duplex ultrasound.

Treatment of priapism should progress in a stepwise fashion.

Ischemic 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.

Nonischemic priapism is managed by observation. If a patient desires active treatment, selective cavernosal artery embolization may be considered.

Acute episodes of recurrent or stuttering priapism are managed the same as ischemic 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.

Priapism is defined as a prolonged and persistent penile erection lasting >4 hours, unassociated with sexual interest or stimulation.[1]Bivalacqua TJ, Allen BK, Brock G, et al. Acute ischemic priapism: an AUA/SMSNA guideline. J Urol. 2021;206(5):1114-21. https://www.auanet.org/guidelines/guidelines/acute-ischemic-priapism It is a true medical emergency with complications potentially resulting in permanent erectile dysfunction.[2]Burnett AL, Bivalacqua TJ. Priapism: current principles and practice. Urol Clin North Am. 2007 Nov;34(4):631-42. http://www.ncbi.nlm.nih.gov/pubmed/17983902?tool=bestpractice.com In stuttering or recurrent priapism, individual priapic episodes may last <4 hours.