World J Mens Health.  2016 Apr;34(1):1-8. 10.5534/wjmh.2016.34.1.1.

Clinical Management of Priapism: A Review

• Shigehara
• Namiki M

• KMID: 2162597
• DOI: http://doi.org/10.5534/wjmh.2016.34.1.1

Abstract

Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. Based on episode history and pathophysiology, priapism is classified into three subtypes: ischemic (low-flow), non-ischemic (high-flow), and stuttering priapism. Ischemic priapism is characterized by a persistent, painful erection with remarkable rigidity of the corpora cavernosa caused by a disorder of venous blood outflow from this tissue mass, and is similar to penile compartment syndrome. Stuttering priapism is characterized by a self-limited, recurrent, and intermittent erection, frequently occurring in patients with sickle cell disease. Non-ischemic priapism is characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. Because ischemic and non-ischemic priapism differ based on emergency status and treatment options, appropriate discrimination of each type of priapism is required to initiate adequate clinical management. The goal of management of priapism is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.

Keyword

Priapism; Penile erection

MeSH Terms

Anemia, Sickle Cell
Compartment Syndromes
Diagnosis
Discrimination (Psychology)
Emergencies
Humans
Male
Penile Erection
Priapism*
Stuttering

Figure

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  Fig. 1 Flowchart of treatment options for ischemic and non-ischemic priapism. CT: computed tomography, MRI: magnetic resonance imaging, 5-AR: 5-alpha reductase inhibitors.

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  Fig. 2 Schemes of surgical shunting for the treatment of ischemic priapism. Data from Japanese Society for Sexual Medicine (JSSM) Guidelines for Erectile Dysfunction, Edition 2012 (JSSM, RichHill Medical Inc., Tokyo, Japan, p.87, 2012) with original copyright holder's permission.

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