What is priapism?

Updated: Dec 26, 2019
  • Author: Osama Al-Omar, MD, MBA, FACS, FEBU; Chief Editor: Edward David Kim, MD, FACS  more...
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Priapism is defined as an abnormal persistent erection of the penis. It is usually painful and it is unrelated to sexual stimulation and unrelieved by ejaculation. Priapism is frequently idiopathic in etiology but it is a known complication of a number of important medical conditions and pharmacologic agents (see Etiology). [6]

Priapism must be identified as either low-flow (ischemic) or high-flow (nonischemic), because the causes and treatments for these 2 types are different. Low-flow priapism, which is by far the most common type, results from failure of the detumescence mechanism, whereas high-flow priapism results from uncontrolled arterial inflow, often through fistulas caused by genitourinary trauma.

Treatment of low-flow priapism should progress in a stepwise fashion, starting with therapeutic aspiration, with or without irrigation, or intracavernous injection of a sympathomimetic agent. [7] Treatment of high-flow priapism focuses on identification and obliteration of fistulas.

Priapism is a true urologic emergency that may lead to permanent erectile dysfunction and penile necrosis if left untreated. Early intervention allows the best chance for functional recovery [6] ; as with many medical emergencies, the saying "time is tissue" holds true for priapism.

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