Priapism: an Update on Principles and Practices

Priapism is an erectile disorder in which erection persists uncontrollably without sexual purpose. It exists in two forms: ischemic (or low-flow) priapism, which represents the majority of cases, and nonischemic (high-flow) priapism. This condition requires prompt evaluation and management to prevent long-term sequelae of ischemic priapism, most notably erectile dysfunction. It is important that initial diagnostic steps identify the proper form of priapism because ischemic priapism is an emergency that must be treated as quickly as possible. Initial evaluation must include a history and physical exam and a corporeal blood gas analysis. Initial treatment is therapeutic aspiration of blood and subsequent intracavernous injection of sympathomimetic drugs. Only after failure of these conservative measures is the use of surgical shunts appropriate. Nonischemic priapism is not an emergency. Initial management is observation, followed by arterial embolization for patients who request intervention.