Priapism

Summary: Immediate urological referral indicated

Advice: Priapism is a genuine medical emergency and requires immediate referral to reduce the risk of subsequent impotence
Refer To: On-call Urology Specialist Registrar

Contents:

Idiopathic (low-flow) priapism

Patients with idiopathic priapism should be referred as soon as possible after the onset of the priapism. Delay of >12 hours before treatment is associated with permanent loss of erections in 100% of patients.

Aspiration and shunting may be considered but, if diagnosis is delayed, implantation of penile prostheses may be the best option available

PLEASE NOTE: Penile prostheses are not available in the Urology Department at Addenbrooke’s and patients who require them will be referred to the Institute of Urology in London or to the Norfolk & Norwich Hospital

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Stuttering (low-flow) priapism

This is commonly seen in patients taking e.g. phenothiazines. It is best managed by vasoconstrictors and cessation of the precipitating drug. This condition is also typically seen in patients with sickle-cell anaemia and sickle-cell trait, usually following sexual activity

Prophylactic treatment with beta-blockers, phenylpropanolamine (e.g. SudafedĀ® linctus), digoxin and cimetidine has been recommended in patients with recurrent episodes of priapism

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Drug-induced (low-flow) priapism

This is usually induced by self-administered injections for impotence. Urgent decompression is necessary to preserve potency.

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Traumatic (high-flow) priapism

This is due to a traumatic fistula and is best treated by embolisation of the affected artery. Immediate referral is essential although corporal fibrosis and impotence are only seen in 20% of patients with high-flow priapism.

Patients are usually managed by internal iliac artery arteriography and embolisation.

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