Commentary on high flow, non-ischemic, priapism

www.amepc.org/tau © Translational Andrology and Urology. All rights reserved. High-flow, non-ischemic priapism is a rare condition, with which many urologists and andrologists are unfamiliar. There are three types of high-flow priapism: traumatic, neurogenic and post-shunting. Traumatic high-flow priapism may arise from penetrating or blunt trauma to the penis resulting in rupture of the cavernous artery or its branches. Despite the unregulated large arterial flow, this does not result in rigid and painful erections, as seen in low-flow, ischemic priapism, because the venous channels are still competent. The neurogenic type is seen after irritation or injury to the central nervous system, and this is typically self-limiting. If this type persists, then it may change to ischemic priapism, and should be treated accordingly. Post-shunting highflow priapism is a result of reactive hyperemia in response to the hypoxic and acidotic state of ischemicpriapism that lasts more than 24 hours. This condition will continue only if the shunt remains open. Once the hyperemic state subsides, the minimal flow in the flaccid penis will not be able to keep the shunt open leading to its spontaneous closure in most cases. In general, since blood circulation into and out of the corpora cavernosa is not impeded in cases of high-flow priapism, the condition is not painful, the penis is not completely rigid, and the prognosis is excellent if it is treated properly. It is important to note that ALL ischemic priapism begins with increased arterial flow to the corpora cavernosa and a blood gas taken in the first few hours of priapism may not reflect the typical findings of hypoxia and acidosis seen in prolonged priapism (1). Moreover, after aspiration or evacuation of the old blood in ischemic priapism, one would see return of fresh blood and blood gases consistent with arterial blood. To mistake this condition for high-flow priapism is erroneous. Case presentation 1