Fact-sheet: Priapism


Updated on 08/25/2020 at 5:09 PM

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Definition

Prolonged erection (> 4h) unrelated to sexual desire.
Two forms are distinguished:

  • Low-flow priapism (venous outflow obstruction, or stasis), with etiologies including sickle cell disease, leukemias, intracavernosal prostaglandin injections, and neurological causes.
  • High-flow priapism: often due to blunt trauma to the flaccid penis.

Clinical features

If low-flow priapism:

  • acute pain, tender corpora cavernosa
  • rigid erection, flaccid glans

If high-flow priapism

  • prolonged painless erection, sensation of discomfort, tumescence, onset over several days

Ultrasound

High-flow priapism:

  • Hypoechoic lesion
  • Color Doppler: aliasing artifact due to the fistula

Vascular intervention

  • Selective embolization for high-flow priapism

Management

  • Low-flow priapism: emergency, alpha-agonist, corporal aspiration for low-flow priapism
  • Cavernosospongiosal shunt, permanent erectile dysfunction