Priapism: pathophysiology and management

Introduction. Priapism is defined as a persistent erection of the penis not accompanied by sexual desire or stimulation and can be a urological emergency. There are three different types of priapism: low-flow priapism, highflow priapism and recurrent priapism. Unfortunately, clinical guideline does not establish a fixed set of rules for the treatment of this condition. Methods. This review combined an analysis of clinicopathologic reports as well as a summary of clinical and basic science investigations on the subject to date. Moreover, the proposed pathogenesis of priapism is reviewed, and a survey regarding treatment modalities is given. Results. The prognosis depends on the type of priapism and the amount of time that passes before therapeutic intervention. It is important to distinguish between these conditions as the treatment for each is different. Low-flow priapism is a compartment syndrome with intracavernosal anoxia, rising pCO2 and acidosis and urgent medical attention is mandatory to prevent erectile dysfunction. On the contrary in high-flow priapism intervention is not urgent and often unnecessary. Finally, recurrent priapism is a condition which is still not well understood and there is no standardised algorithm for the management of this condition. Conclusions. Urologists should understand the importance of the disorder and be prepared to follow current principles of diagnosis and treatment to reduce or prevent its complications.