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Emergency Department Management Of Priapism

January 2017

Abstract

Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents. Evidence-based management and appropriate urologic follow-up of nonischemic and recurrent ischemic priapism maximizes patient outcomes and resource utilization.

Key words: priapism, ischemic, recurrent, stuttering, low flow, high flow, nonischemic, erection, penis, sickle cell disease, hemoglobinopathy, phosphodiesterase type 5 inhibitor, PDE5, ultrasound, prosthesis

Points

  • There are 3 main types of priapism: ischemic (“low-flow”), nonischemic (“high-flow”) and recurrent ischemic (“intermittent” or “stuttering”).
  • Ischemic priapism accounts for 95% of all cases. It is primarily caused by sickle cell disease, but is also caused by other blood dyscrasias, penile intracorporeal injections, and medications (eg, antihypertensives, antipsychotics, antidepressants, oral phosphodiesterase type 5 [PDE-5] inhibitors).

Pearl

  • Ischemic priapism is a compartment syndrome and a true urologic emergency.
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Last Modified: 01/24/2017
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