title: Priapism.
abstract: 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.
authors.affiliation: Institute of Urology, London University, London, UK. jpryor@andrology.co.uk
authors.forename: John
authors.initials: J
authors.lastname: Pryor
authors.forename: Emre
authors.initials: E
authors.lastname: Akkus
authors.forename: Gary
authors.initials: G
authors.lastname: Alter
authors.forename: Gerald
authors.initials: G
authors.lastname: Jordan
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
authors.forename: Laurence
authors.initials: L
authors.lastname: Levine
authors.forename: John
authors.initials: J
authors.lastname: Mulhall
authors.forename: Sava
authors.initials: S
authors.lastname: Perovic
authors.forename: David
authors.initials: D
authors.lastname: Ralph
authors.forename: Walter
authors.initials: W
authors.lastname: Stackl
mesh_terms: 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*