title: Standard operating procedures for priapism.
abstract: OBJECTIVE
  To provide standard operating procedures for the diagnosis and management of priapism.
  
  
  METHODS
  Review of the literature.
  
  
  METHODS
  Reduction of priapism and preservation of erectile function.
  
  
  RESULTS
  Priapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation. Priapism requires prompt evaluation and usually requires emergency management. There are two types of priapism: (i) ischemic (veno-occlusive or low flow), which is found in 95% of cases, and (ii) nonischemic (arterial or high flow). Stuttering (intermittent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must determine whether the priapism is ischemic or nonischemic. Necessary diagnostic steps are an accurate history, physical examination, and cavernous blood gas analysis and/or color duplex ultrasonography of the corpora cavernosa. Management of ischemic priapism should achieve resolution as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic drugs is the next step. Surgical shunts should be performed if nonsurgical treatment has failed. The initial management of nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in patients who request treatment. The goal of management for a patient with recurrent (stuttering) priapism is prevention of future episodes.
  
  
  CONCLUSIONS
  Management of priapism has become increasingly successful as scientific understanding of the pathophysiology and molecular biology of priapism improves. The key to further success in the treatment of priapism is basic research of this uncommon but potentially devastating condition.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Burnett
authors.forename: Ira D
authors.initials: ID
authors.lastname: Sharlip
mesh_terms: D002985:Clinical Protocols / Q000592:standards; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000502:physiology; D010413:Penis / Q000098:blood supply / Q000503:physiopathology; D010808:Physical Examination / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011317:Priapism / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy