Priapism.
BACKGROUND
There are three different types of priapism: low-flow, ischemic, anoxic or veno-occlusive priapism; high-flow, arterial or nonischemic priapism; and recurrent or stuttering priapism.


OBJECTIVE
To provide recommendations/guidelines concerning state-of-the-art knowledge for the diagnosis and treatment of priapism.


METHODS
An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Priapism Committee, there were 10 experts from six countries.


METHODS
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate.


RESULTS
Concerning ischemic priapism, persistent cavernous smooth muscle relaxation and failure of contraction is a compartment syndrome with increasing intracavernosal anoxia, rising pCO2 and acidosis. Urgent medical attention should be sought for an erection lasting >4 hours; 90% with priapism >24 hours develop complete erectile dysfunction. After diagnosis and counselling, intracavernosal aspiration and alpha-blockers should precede surgical shunting. Concerning high-flow priapism (congenital, traumatic or iatrogenic), intervention is not urgent and often unnecessary. Definitive management is by selective embolization with autologous blood clot. Concerning recurrent/stuttering priapism, the pathophysiology may be central or local (sickle cell disease). Management needs to be individualized; androgen deprivation has proved useful but has adverse effects.


CONCLUSIONS
There is need for prospective, clinical trials to define safe and effective management strategies for patients with low-flow, high-flow or recurrent priapism.
Pryor
John
J
Institute of Urology, London University, London, UK. jpryor@andrology.co.uk
Akkus
Emre
E
Alter
Gary
G
Jordan
Gerald
G
Lebret
Thierry
T
Levine
Laurence
L
Mulhall
John
J
Perovic
Sava
S
Ralph
David
D
Stackl
Walter
W
D032921:Consensus; D019317:Evidence-Based Medicine; D006801:Humans; D008297:Male; D010410:Penile Erection; D010413:Penis / Q000098:blood supply*; D017410:Practice Guidelines as Topic / Q000592:standards; D011317:Priapism / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*