Which clinical history findings are characteristic of 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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Patients with priapism report a persistent erection. Accompanying symptoms depend on the type of priapism and the duration of engorgement. Low-flow, ischemic-type priapism is generally painful, although the pain may disappear with prolonged priapism.

High-flow, nonischemic priapism is generally not painful. This type of priapism is associated with blunt or penetrating injury to the perineum. It may manifest in an episodic manner.

Points to address in the history are as follows:

  • Duration of erection (longer than 4 hours is consistent with priapism)
  • Duration of pain
  • Similar prior episodes (ie, stuttering priapism)
  • Genitourinary (GU) trauma
  • Medical history (eg, sickle cell disease [SCD]): Onset occurs during sleep, when relative oxygenation decreases
  • Medication and/or recreational drug use, especially the antidepressant trazodone, intracavernosal injections of prostaglandin E1 used to treat impotence, and illicit cocaine injection into the penis
  • History of malignancy (eg, prostate cancer, bladder cancer)
  • Penile prosthesis: The permanent erection that occurs with some penile prostheses may mimic priapism
  • Recent urologic surgery

Historical features of low-flow priapism include the following:

  • Painful
  • Patient is inactive sexually and without desire
  • No history of trauma
  • Patient usually presents to emergency department (ED) within hours
  • Associated with substance abuse or vasoactive penile injections
  • Rare causes include leukemia, fat embolism, acute spinal cord injury, or (extremely rare) cancer metastases to the corporeal bodies

Historical features of high-flow priapism include the following:

  • Not painful
  • The patient may be sexually active
  • Straddle injury usually the initiating event
  • Chronic recurrent presentation
  • Generally not caused by medication
  • Delay may exist between the initiating injury and the onset of priapism (eg, because of initial vessel spasm or to the formation of a clot that is gradually reabsorbed over a period of days)

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