- Serkan Deveci, MD
Serkan Deveci, MD
- Associate Professor of Urology
- Acibadem Hospital
- Section Editors
- Michael P O'Leary, MD, MPH
Michael P O'Leary, MD, MPH
- Section Editor — Urology
- Professor of Surgery, Harvard Medical School
- Senior Urologic Surgeon, Brigham and Women's Hospital
- Robert S Hockberger, MD, FACEP
Robert S Hockberger, MD, FACEP
- Section Editor — Adult Signs and Symptoms
- Emeritus Professor of Medicine
- David Geffen School of Medicine at UCLA
The term "priapism" is derived from Priapus, the Greek god of fertility, gardening, and lust who is depicted with a massive phallus . Priapus, the illegitimate son of Zeus and Aphrodite, was cursed by Zeus' wife Hera upon learning of Aphrodite's pregnancy. The boy Priapus was born with oversized genitalia and subsequently rejected by Aphrodite. He was raised by shepherds, who noticed that flowers would bloom and animals would copulate in his vicinity.
Priapism is defined as a persistent erection of the penis or clitoris that is not associated with sexual stimulation or desire. The focus of this topic will be penile priapism. Studies differ on the length of time of erection used to define priapism, but most studies identify priapism as an erection lasting at least four hours.
Priapism is relatively rare, but can occur in all age groups and is particularly common in those with sickle cell disease.
Priapism is generally classified as ischemic or nonischemic. Ischemic priapism is a urologic emergency, whereas nonischemic priapism is usually self-limited.
Issues related to epidemiology, pathophysiology, diagnosis, and management of priapism will be reviewed here. Particular issues related to priapism in sickle cell disease are discussed separately. (See "Diagnosis and management of priapism in sickle cell disease".)
- Papadopoulos I, Kelâmi A. Priapus and priapism. From mythology to medicine. Urology 1988; 32:385.
- Roghmann F, Becker A, Sammon JD, et al. Incidence of priapism in emergency departments in the United States. J Urol 2013; 190:1275.
- Medina CA. Clitoral priapism: a rare condition presenting as a cause of vulvar pain. Obstet Gynecol 2002; 100:1089.
- Cherian J, Rao AR, Thwaini A, et al. Medical and surgical management of priapism. Postgrad Med J 2006; 82:89.
- Lewis JH, Javidan J, Keoleian CM, Shetty SD. Management of partial segmental priapism. Urology 2001; 57:169.
- Burnett AL, Bivalacqua TJ. Priapism: current principles and practice. Urol Clin North Am 2007; 34:631.
- Broderick GA, Gordon D, Hypolite J, Levin RM. Anoxia and corporal smooth muscle dysfunction: a model for ischemic priapism. J Urol 1994; 151:259.
- Kim NN, Kim JJ, Hypolite J, et al. Altered contractility of rabbit penile corpus cavernosum smooth muscle by hypoxia. J Urol 1996; 155:772.
- Moon DG, Lee DS, Kim JJ. Altered contractile response of penis under hypoxia with metabolic acidosis. Int J Impot Res 1999; 11:265.
- Pryor J, Akkus E, Alter G, et al. Priapism. J Sex Med 2004; 1:116.
- Coward RM, Carson CC. Tadalafil in the treatment of erectile dysfunction. Ther Clin Risk Manag 2008; 4:1315.
- Burnett AL. Nitric oxide in the penis--science and therapeutic implications from erectile dysfunction to priapism. J Sex Med 2006; 3:578.
- HINMAN F Jr. Priapism; reasons for failure of therapy. J Urol 1960; 83:420.
- BURT FB, SCHIRMER HK, SCOTT WW. A new concept in the management of priapism. J Urol 1960; 83:60.
- Spycher MA, Hauri D. The ultrastructure of the erectile tissue in priapism. J Urol 1986; 135:142.
- Pryor JP, Hehir M. The management of priapism. Br J Urol 1982; 54:751.
- Burnett AL. Pathophysiology of priapism: dysregulatory erection physiology thesis. J Urol 2003; 170:26.
- Burnett AL, Bivalacqua TJ, Champion HC, Musicki B. Feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent priapism. J Sex Med 2006; 3:1077.
- Muneer A, Minhas S, Arya M, Ralph DJ. Stuttering priapism--a review of the therapeutic options. Int J Clin Pract 2008; 62:1265.
- Champion HC, Bivalacqua TJ, Takimoto E, et al. Phosphodiesterase-5A dysregulation in penile erectile tissue is a mechanism of priapism. Proc Natl Acad Sci U S A 2005; 102:1661.
- Palese MA, Ferrer F, Perlman E, Gearhart JP. Metanephric stromal tumor: a rare benign pediatric renal mass. Urology 2001; 58:462.
- Montague DK, Jarow J, Broderick GA, et al. American Urological Association guideline on the management of priapism. J Urol 2003; 170:1318.
- Kwok B, Varol C. Priapism and penile gangrene due to thrombotic thrombocytopenic purpura. Urology 2010; 75:71.
- Metawea B, El-Nashar AR, Gad-Allah A, et al. Intracavernous papaverine/phentolamine-induced priapism can be accurately predicted with color Doppler ultrasonography. Urology 2005; 66:858.
- Dittrich A, Albrecht K, Bar-Moshe O, Vandendris M. Treatment of pharmacological priapism with phenylephrine. J Urol 1991; 146:323.
- Siegel JF, Reda E. Intracorporeal phenylephrine reduces thioridazine (Mellaril) induced priapism in a child. J Urol 1997; 157:648.
- Munarriz R, Wen CC, McAuley I, et al. Management of ischemic priapism with high-dose intracavernosal phenylephrine: from bench to bedside. J Sex Med 2006; 3:918.
- Roberts JR, Price C, Mazzeo T. Intracavernous epinephrine: a minimally invasive treatment for priapism in the emergency department. J Emerg Med 2009; 36:285.
- Fuentes EJ, Garcia S, Garrido M, et al. Successful treatment of propofol-induced priapism with distal glans to corporal cavernosal shunt. Urology 2009; 74:113.
- Chiou RK, Aggarwal H, Mues AC, et al. Clinical experience and sexual function outcome of patients with priapism treated with penile cavernosal-dorsal vein shunt using saphenous vein graft. Urology 2009; 73:556.
- Nixon RG, O'Connor JL, Milam DF. Efficacy of shunt surgery for refractory low flow priapism: a report on the incidence of failed detumescence and erectile dysfunction. J Urol 2003; 170:883.
- Brant WO, Garcia MM, Bella AJ, et al. T-shaped shunt and intracavernous tunneling for prolonged ischemic priapism. J Urol 2009; 181:1699.
- Rees RW, Kalsi J, Minhas S, et al. The management of low-flow priapism with the immediate insertion of a penile prosthesis. BJU Int 2002; 90:893.
- Ralph DJ, Garaffa G, Muneer A, et al. The immediate insertion of a penile prosthesis for acute ischaemic priapism. Eur Urol 2009; 56:1033.
- Kang BC, Lee DY, Byun JY, et al. Post-traumatic arterial priapism: colour Doppler examination and superselective arterial embolization. Clin Radiol 1998; 53:830.
- Bartsch G Jr, Kuefer R, Engel O, Volkmer BG. High-flow priapism: colour-Doppler ultrasound-guided supraselective embolization therapy. World J Urol 2004; 22:368.
- O'Sullivan P, Browne R, McEniff N, Lee MJ. Treatment of "high-flow" priapism with superselective transcatheter embolization: a useful alternative to surgery. Cardiovasc Intervent Radiol 2006; 29:198.
- Kuefer R, Bartsch G Jr, Herkommer K, et al. Changing diagnostic and therapeutic concepts in high-flow priapism. Int J Impot Res 2005; 17:109.
- Shapiro RH, Berger RE. Post-traumatic priapism treated with selective cavernosal artery ligation. Urology 1997; 49:638.
- Ricciardi R Jr, Bhatt GM, Cynamon J, et al. Delayed high flow priapism: pathophysiology and management. J Urol 1993; 149:119.
- Brock G, Breza J, Lue TF, Tanagho EA. High flow priapism: a spectrum of disease. J Urol 1993; 150:968.
- Ischemic priapism
- - Recurrent priapism
- Nonischemic (high flow) priapism
- CLINICAL MANIFESTATIONS AND DIAGNOSIS
- History and physical examination
- Cavernosal blood gas analysis
- Other blood studies
- Doppler ultrasonography
- Treatment of ischemic priapism
- - Surgical therapy
- Treatment of recurrent priapism
- Treatment of nonischemic (high flow) priapism
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS