Highlights & Basics
- 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.
Quick Reference
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Citations
Bivalacqua TJ, Allen BK, Brock GB, et al. The diagnosis and management of recurrent ischemic priapism, priapism in sickle cell patients, and non-ischemic priapism: an AUA/SMSNA guideline. J Urol. 2022 Jul;208(1):43-52.[Abstract][Full Text]
European Association of Urology. Guidelines: sexual and reproductive health. 2022 [internet publication].[Full Text]
National Heart, Lung, and Blood Institute. Evidence-based management of sickle cell disease: expert panel report, 2014. Sep 2014 [internet publication].[Full Text]
1. Bivalacqua TJ, Allen BK, Brock GB, et al. The diagnosis and management of recurrent ischemic priapism, priapism in sickle cell patients, and non-ischemic priapism: an AUA/SMSNA guideline. J Urol. 2022 Jul;208(1):43-52.[Abstract][Full Text]
2. Burnett AL, Bivalacqua TJ. Priapism: current principles and practice. Urol Clin North Am. 2007 Nov;34(4):631-42.[Abstract]
3. Broderick GA, Kadioglu A, Bivalacqua TJ, et al. Priapism: pathogenesis, epidemiology, and management. J Sex Med. 2010 Jan;7(1 Pt 2):476-500.[Abstract]
4. European Association of Urology. Guidelines: sexual and reproductive health. 2022 [internet publication].[Full Text]
5. Berger R, Billups K, Brock G, et al. Report of the American Foundation for Urologic Disease (AFUD) Thought Leader Panel for evaluation and treatment of priapism. Int J Impot Res. 2001 Dec;13(suppl 5):S39-43.[Abstract]
6. Donaldson JF, Rees RW, Steinbrecher HA. Priapism in children: a comprehensive review and clinical guideline. J Pediatr Urol. 2014 Feb;10(1):11-24.[Abstract][Full Text]
7. Cintho Ozahata M, Page GP, Guo Y, et al; International Component of the NHLBI Recipient Epidemiology and Donor Evaluation Study (REDS-III). Clinical and genetic predictors of priapism in sickle cell disease: results from the Recipient Epidemiology and Donor Evaluation Study III Brazil Cohort Study. J Sex Med. 2019 Dec;16(12):1988-9.[Abstract][Full Text]
8. Arduini GAO, Trovó de Marqui AB. Prevalence and characteristics of priapism in sickle cell disease. Hemoglobin. 2018 Mar;42(2):73-7.[Abstract]
9. Bennett N, Mulhall J. Sickle cell disease status and outcomes of African-American men presenting with priapism. J Sex Med. 2008 May;5(5):1244-50.[Abstract]
10. Rezaee ME, Gross MS. Are we overstating the risk of priapism with oral phosphodiesterase type 5 inhibitors? J Sex Med. 2020 Aug;17(8):1579-82.[Abstract]
11. Kulmala RV, Lehtonen TA, Tammela TL. Priapism, its incidence and seasonal distribution in Finland. Scand J Urol Nephrol. 1995 Mar;29(1):93-6.[Abstract]
12. Eland IA, van der Lei J, Stricker BH, et al. Incidence of priapism in the general population. Urology. 2001 May;57(5):970-2.[Abstract]
13. Kovac JR, Mak SK, Garcia MM, et al. A pathophysiology-based approach to the management of early priapism. Asian J Androl. 2013 Jan;15(1):20-6.[Abstract][Full Text]
14. Becerra-Pedraza LC, Jiménez-Martínez LE, Peña-Morfin I, et al. Priapism as the initial sign in hematologic disease: case report and literature review. Int J Surg Case Rep. 2018;43:13-7.[Abstract][Full Text]
15. Mearini L, Colella R, Zucchi A, et al. A review of penile metastasis. Oncol Rev. 2012 Mar 5;6(1):e10.[Abstract]
16. Ali E, Soliman A, De Sanctis V, et al. Priapism in patients with chronic myeloid leukemia (CML): a systematic review. Acta Biomed. 2021 Jul 1;92(3):e2021193.[Abstract][Full Text]
17. Witt MA, Goldstein I, Saenz de Tejada I, et al. Traumatic laceration of intracavernosal arteries: the pathophysiology of nonischemic, high flow, arterial priapism. J Urol. 1990 Jan;143(1):129-32.[Abstract]
18. Jesus LE, Dekermacher S. Priapism in children: review of pathophysiology and treatment. J Pediatr (Rio J). 2009 May-Jun;85(3):194-200.[Abstract]
19. Brock G, Breza J, Lue TF, et al. High flow priapism: a spectrum of disease. J Urol. 1993 Sep;150(3):968-71.[Abstract]
20. Dubocq FM, Tefilli MV, Grignon DJ, et al. High flow malignant priapism with isolated metastasis to the corpora cavernosa. Urology. 1998 Feb;51(2):324-6.[Abstract]
21. Bivalacqua TJ, Burnett AL. Priapism. In: Graham SD, Glen JF, eds. Glenn's urologic surgery. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010:487-91.
22. Levey HR, Segal RL, Bivalacqua TJ. Management of priapism: an update for clinicians. Ther Adv Urol. 2014 Dec;6(6):230-44.[Abstract][Full Text]
23. Ricciardi R Jr, Bhatt GM, Cynamon J, et al. Delayed high flow priapism: pathophysiology and management. J Urol. 1993 Jan;149(1):119-21.[Abstract]
24. Burnett AL. Pathophysiology of priapism: dysregulatory erection physiology thesis. J Urol. 2003 Jul;170(1):26-34.[Abstract]
25. Bivalacqua TJ, Burnett AL. Priapism: new concepts in the pathophysiology and new treatment strategies. Curr Urol Rep. 2006 Nov;7(6):497-502.[Abstract]
26. Bivalacqua TJ, Musicki B, Champion HC, et al. Phosphodiesterase type 5 inhibitor therapy for priapism. In: Carson CC III, Kirby RS, Goldstein R, et al, eds. Textbook of erectile dysfunction. 2nd ed. New York, NY: Informa Healthcare; 2009:428-33.
27. Mantadakis E, Cavender JD, Rogers ZR, et al. Prevalence of priapism in children and adolescents with sickle cell anemia. J Pediatr Hematol Oncol. 1999 Nov-Dec;21(6):518-22.[Abstract]
28. Hamre MR, Harmon EP, Kirkpatrick DV, et al. Priapism as a complication of sickle cell disease. J Urol. 1991 Jan;145(1):1-5.[Abstract]
29. Altman AL, Seftel AD, Brown SL, et al. Cocaine associated priapism. J Urol. 1999 Jun;161(6):1817-8.[Abstract]
30. Myrick H, Markowitz JS, Henderson S. Priapism following trazodone overdose with cocaine use. Ann Clin Psychiatry. 1998 Jun;10(2):81-3.[Abstract]
31. Anele UA, Le BV, Resar LM, et al. How I treat priapism. Blood. 2015 Jun 4;125(23):3551-8.[Abstract][Full Text]
32. Feldstein VA. Posttraumatic "high-flow" priapism evaluation with color flow Doppler sonography. J Ultrasound Med. 1993 Oct;12(10):589-93.[Abstract]
33. Chan PT, Begin LR, Arnold D, et al. Priapism secondary to penile metastasis: a report of two cases and a review of the literature. J Surg Oncol. 1998 May;68(1):51-9.[Abstract]
34. Burnett AL. Priapism. In: Wein AJ, Kavoussi LR, Novick AC, et al, eds. Campbell-Walsh urology. 9th ed. Philadelphia PA: Saunders Elsevier; 2007:839-49.
35. Lue TF, Hellstrom WJ, McAninch JW, et al. Priapism: a refined approach to diagnosis and treatment. J Urol. 1986 Jul;136(1):104-8.[Abstract]
36. Zacharakis E, Raheem AA, Freeman A, et al. The efficacy of the T-shunt procedure and intracavernous tunneling (snake maneuver) for refractory ischemic priapism. J Urol. 2014 Jan;191(1):164-8.[Abstract]
37. National Heart, Lung, and Blood Institute. Evidence-based management of sickle cell disease: expert panel report, 2014. Sep 2014 [internet publication].[Full Text]
38. Mantadakis E, Ewalt DH, Cavender JD, et al. Outpatient penile aspiration and epinephrine irrigation for young patients with sickle cell anemia and prolonged priapism. Blood. 2000 Jan 1;95(1):78-82.[Abstract][Full Text]
39. Burnett AL. Surgical management of ischemic priapism. J Sex Med. 2012 Jan;9(1):114-20.[Abstract]
40. Burnett AL, Pierorazio PM. Corporal "snake" maneuver: corporoglanular shunt surgical modification for ischemic priapism. J Sex Med. 2009 Apr;6(4):1171-6.[Abstract]
41. Ralph DJ, Garaffa G, Muneer A, et al. The immediate insertion of a penile prosthesis for acute ischaemic priapism. Eur Urol. 2009 Dec;56(6):1033-8.[Abstract]
42. Monga M, Broderick GA, Hellstrom WJ. Priapism in sickle cell disease: the case for early implantation of the penile prosthesis. Eur Urol. 1996;30(1):54-9.[Abstract]
43. Montague DK, Angermeier KW. Corporeal excavation: new technique for penile prosthesis implantation in men with severe corporeal fibrosis. Urology. 2006 May;67(5):1072-5.[Abstract]
44. Rees RW, Kalsi J, Minhas S, et al. The management of low-flow priapism with the immediate insertion of a penile prosthesis. BJU Int. 2002 Dec;90(9):893-7.[Abstract]
45. Tausch TJ, Evans LA, Morey AF. Immediate insertion of a semirigid penile prosthesis for refractory ischemic priapism. Mil Med. 2007 Nov;172(11):1211-2.[Abstract]
46. Moussa M, Abou Chakra M, Papatsoris A, et al. An update on the management algorithms of priapism during the last decade. Arch Ital Urol Androl. 2022 Jun 30;94(2):237-47.[Abstract][Full Text]
47. Chinegwundoh FI, Smith S, Anie KA. Treatments for priapism in boys and men with sickle cell disease. Cochrane Database Syst Rev. 2020 Apr 6;(4):CD004198.[Abstract][Full Text]
48. Spycher MA, Hauri D. The ultrastructure of the erectile tissue in priapism. J Urol. 1986 Jan;135(1):142-7.[Abstract]
49. Muneer A, Cellek S, Dogan A, et al. Investigation of cavernosal smooth muscle dysfunction in low flow priapism using an in vitro model. Int J Impot Res. 2005 Jan-Feb;17(1):10-8.[Abstract]
50. Kandel GL, Bender LI, Grove JS. Pulmonary embolism: a complication of corpus-saphenous shunt for priapism. J Urol. 1968 Feb;99(2):196-7.[Abstract]
51. Ochoa Urdangarain O, Hermida Perez JA. Priapism: our experience [in Spanish]. Arch Esp Urol. 1998 Apr;51(3):269-76.[Abstract]
52. De Stefani S, Savoca G, Ciampalini S, et al. Urethrocutaneous fistula as a severe complication of treatment for priapism. BJU Int. 2001 Oct;88(6):642-3.[Abstract]
