56VOL. 12 NO. 1 2010 REVIEWS IN UROLOGY
Diagnostic and Therapeutic Options
for the Management of Ischemic
and Nonischemic Priapism
Jeffrey Bassett, MD, Jacob Rajfer, MD
University of California at Los Angeles, Los Angeles, CA
Priapism is defined as persistent penile erection continuing beyond, or
unrelated to, sexual stimulation. Proper diagnosis encompasses at least 2
very different pathophysiologic processes. Ischemic priapism (“low flow”) is a
disorder of venous outflow and/or stasis. Nonischemic priapism (“high flow”)
is a disorder of arterial flow. We present 2 cases that review each condition.
The first case highlights a 32-year-old man with a medical history of sickle
cell disease who presented to the emergency department complaining of a
persistent, painful erection that had continued for 18 hours. The second case
describes a 24-year-old man with no significant medical history who sus-
tained trauma to his pelvis while skateboarding. Although the initial evalua-
tion of both types of priapism is similar, pathophysiology and resulting inter-
ventions differ for each, underscoring the importance of proper diagnosis.
[Rev Urol. 2010;12(1):56-63 doi: 10.3909/riu0457]
©2010 MedReviews®, LLC
Key words: Ischemic priapism • Nonischemic priapism • Intracorporeal pressure •
Erectile dysfunction • Cavernosal hypoxia • Phosphodiesterase type 5 • Distal shunts •
whose pathophysiology and management continue to evolve. Just as delineation
of ischemic from nonischemic priapism resulted in the formulation of distinct
treatment algorithms, it is expected that new insights and discoveries at the cel-
lular level will continue to alter our understanding and management in the years
ahead. Here we present sample cases of priapism, review the current literature,
and discuss the available diagnostic and therapeutic options.
riapism, a sustained erection of the penis, has a lengthy historical footprint.
Named after the well-endowed Greek god Priapus, it was first described in
the medical literature in 1616. Despite this, priapism is a disease entity
Therapeutic Options for Priapism
VOL. 12 NO. 1 2010 REVIEWS IN UROLOGY 63
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