An update on the management algorithms of priapism during the last decade


https://doi.org/10.4081/aiua.2022.2.237
Vol. 94 No. 2 (2022)
Submitted: May 9, 2022
Accepted: May 23, 2022
Published: June 30, 2022
Priapism, ischemic priapism, non-ischemic priapism, stuttering priapism
Abstract Views: 1695
PDF: 1114
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Authors

  • Mohamad Moussa Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon.
  • Mohamad Abou Chakra
    mohamedabouchakra@hotmail.com
    Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon.
  • Athanasios Papatsoris 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
  • Athanasios Dellis 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens; Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens , Greece.
  • Michael Peyromaure Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
  • Nicolas Barry Delongchamps Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
  • Hugo Bailly Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
  • Sabine Roux Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
  • Ahmad Abou Yassine Internal Medicine, Staten Island University Hospital, Staten Island, NY, United States.
  • Igor Duquesne Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.

Priapism is a persistent penile erection lasting longer than 4 hours, that needs emergency management. This disorder can induce irreversible erectile dysfunction. There are three subtypes of priapism: ischemic, non-ischemic, and stuttering priapism. If the patient has ischemic priapism (IP) of less than 24-hours (h) duration, the initial management should be a corporal blood aspiration followed by instillation of phenylephrine into the corpus cavernosum. If sympathomimetic fails or the patient has IP from 24 to 48h, surgical shunts should be performed. It is recommended that distal shunts should be attempted first. If distal shunt failed, proximal, venous shunt, or T-shunt with tunneling could be performed. If the patient had IP for 48 to 72h, proximal and venous shunt or T-shunt with tunneling is indicated, if those therapies failed, a penile prosthesis should be inserted. Non-ischemic priapism (NIP) is not a medical emergency and many patients will recover spontaneously. If the NIP does not resolve spontaneously within six months or the patient requests therapy, selective arterial embolization is indicated. The goal of the management of a patient with stuttering priapism (SP) is the prevention of future episodes. Phosphodiesterase type 5 (PDE5) inhibitor therapy is considered an effective tool to prevent stuttering episodes but it is not validated yet. The management of priapism should follow the guidelines as the future erectile function is dependent on its quick resolution. This review briefly discusses the types, pathophysiology, and diagnosis of priapism. It will discuss an updated approach to treat each type of priapism.


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Moussa, M., Abou Chakra, M., Papatsoris, A. ., Dellis, A. ., Peyromaure, M. ., Barry Delongchamps, N. ., Bailly, H. ., Roux, S. ., Yassine, A. A., & Duquesne, I. (2022). An update on the management algorithms of priapism during the last decade. Archivio Italiano Di Urologia E Andrologia, 94(2), 237–247. https://doi.org/10.4081/aiua.2022.2.237

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