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  • Review Article
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Evaluation and management of priapism: 2009 update

Nature Reviews Urology volume 6, pages 262–271 (2009)Cite this article

Abstract

Priapism is defined as a persistent penile erection (typically 4 h or longer) that is unrelated to sexual stimulation. Priapism can be classified as either ischemic or nonischemic. Ischemic priapism, the most common subtype, is typically accompanied by pain and is associated with a substantial risk of subsequent erectile dysfunction. Prompt medical attention is indicated in cases of ischemic priapism. The initial management of choice is corporal aspiration with injection of sympathomimetic agents. If medical management fails, a cavernosal shunt procedure is indicated. Stuttering (recurrent) ischemic priapism is a challenging and poorly understood condition; new management strategies currently under investigation may improve our ability to care for men with this condition. Nonischemic priapism occurs more rarely than ischemic priapism, and is most often the result of trauma. This subtype of priapism, which is generally not painful, is usually initially managed with conservative treatment.

Key Points

  • Ischemic priapism is a medical emergency; prompt diagnosis and immediate, direct treatment are required

  • Injection of sympathomimetic agents is the first-line treatment of choice for ischemic priapism

  • If sympathomimetics fail, surgical shunt should be used to treat ischemic priapism

  • Androgen ablation is commonly used to treat recurrent, stuttering priapism, although PDE5 inhibitors might provide a novel means of managing this condition

  • Management of priapism in children is generally similar to its management in adults, although hormonal modulation is deemed unsuitable for use in prepubertal or pubertal boys

  • Conservative management might be adequate for nonischemic priapism

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Figure 1: Management algorithm for priapism.
Figure 2: Color duplex ultrasound image of nonischemic priapism following a straddle injury.
Figure 3: Unilateral T-shunt.
Figure 4: TTT-shunt.
Figure 5: In the case of priapism that has lasted for over 3 days, tissue necrosis might cause severe edema in the corpora cavernosa.

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References

  1. Papadopoulos, I. & Kelami, A. Priapus and priapism from mythology to medicine. Urology 32, 385–386 (1988).

    Article  CAS  PubMed  Google Scholar 

  2. Hinman, F. Priapism. Ann. Surg. 60, 689–716 (1914).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Montague, D. K. et al. American Urological Association guideline on the management of priapism. J. Urol. 70, 1318–1324 (2003).

    Article  Google Scholar 

  4. Eland, I. A., van der Lei, J., Stricker, B. H. & Sturkenboom, M. J. Incidence of priapism in the general population. Urology 57, 970–972 (2001).

    Article  CAS  PubMed  Google Scholar 

  5. Earle, C. M., Stuckey, B. G., Ching, H. L. & Wisniewski, Z. S. The incidence and management of priapism in Western Australia: a 16 year audit. Int. J. Impot. Res. 15, 272–276 (2003).

    Article  CAS  PubMed  Google Scholar 

  6. Emond, A. M., Holman, R., Hayes, R. J. & Serjeant, G. R. Priapism and impotence in homozygous sickle cell disease. Arch. Intern. Med. 140, 1434–1437 (1980).

    Article  CAS  PubMed  Google Scholar 

  7. Mantadakis, E., Cavender, J. D., Rogers, Z. R., Ewalt, D. H. & Buchanan, G. R. Prevalence of priapism in children and adolescents with sickle cell anemia. J. Pediatr. Hematol. Oncol. 21, 518–522 (1999).

    Article  CAS  PubMed  Google Scholar 

  8. Bennett, N. & Mulhall, J. Sickle cell disease status and outcomes of African-American men presenting with priapism. J. Sex. Med. 5, 1244–1250 (2008).

    Article  PubMed  Google Scholar 

  9. Brant, W. O. et al. Priapism: etiology, diagnosis and management. AUA Update Series 25, 99–107 (2006).

    Google Scholar 

  10. Quigley, M. & Fawcett, D. P. Thrombophilia and priapism. BJU Int. 83, 155 (1999).

    Article  CAS  PubMed  Google Scholar 

  11. Thuret, I. et al. Priapism following splenectomy in an unstable hemoglobin: hemoglobin Olmsted beta 141 (H19) Leu®Arg. Am. J. Hematol. 51, 133–136 (1996).

    Article  CAS  PubMed  Google Scholar 

  12. Morano, S. G. et al. Treatment of long-lasting priapism in chronic myeloid leukemia at onset. Ann. Hematol. 79, 644–645 (2000).

    Article  CAS  PubMed  Google Scholar 

  13. Rosenbaum, E. H., Thompson, H. E. & Glassberg, A. B. Priapism and multiple myeloma. Successful treatment with plasmapheresis. Urology 12, 201–202 (1978).

    Article  CAS  PubMed  Google Scholar 

  14. Nelson, J. H. & Winter, C. C. Priapism: Evolution of management in 48 patients in a 22-year series. J. Urol. 117, 455–458 (1977).

    Article  PubMed  Google Scholar 

  15. Hébuterne, X., Frere, A. M., Bayle, J. & Rampal, P. Priapism in a patient treated with total parenteral nutrition. JPEN J. Parenter. Enteral Nutr. 16, 171–174 (1992).

    Article  PubMed  Google Scholar 

  16. Singhal, P. C., Lynn, R. I. & Scharschmidt, L. A. Priapism and dialysis. Am. J. Nephrol. 6, 358–361 (1986).

    Article  CAS  PubMed  Google Scholar 

  17. Finley, D. S. Glucose-6-phosphate dehydrogenase deficiency associated stuttering priapism: report of a case. J. Sex. Med. 5, 2963–2966 (2008).

    Article  PubMed  Google Scholar 

  18. Chan, P. T. et al. Priapism secondary to penile metastasis: A report of two cases and a review of the literature. J. Surg. Oncol. 68, 51–59 (1998).

    Article  CAS  PubMed  Google Scholar 

  19. Hettiarachchi, J. A. et al. Malignant priapism associated with metastatic urethral carcinoma. Urol. Int. 66, 114–116 (2001).

    Article  CAS  PubMed  Google Scholar 

  20. Cherrie, R. J. & Brosman, S. A. Case profile: priapism secondary to metastatic adenocarcinoma of rectum. Urology 25, 655 (1985).

    Article  CAS  PubMed  Google Scholar 

  21. Nezu, F. M. et al. Malignant priapism as the initial clinical manifestation of metastatic renal cell carcinoma with invasion of both corpora cavernosum and spongiosum. Int. J. Impot. Res. 10, 101 (1998).

    Article  CAS  PubMed  Google Scholar 

  22. Kvarstein, B. Bladder cancer complicated with priapism. A case report. Scand. J. Urol. Nephrol. Suppl. 179, 155–156 (1996).

    CAS  PubMed  Google Scholar 

  23. Schroeder-Printzen, I., Vosshenrich, R., Weidner, W. & Ringert, R. H. Malignant priapism in a patient with metastatic prostate adenocarcinoma. Urol. Int. 52, 52–54 (1994).

    Article  CAS  PubMed  Google Scholar 

  24. Gallagher, J. P. A lesson in neurology from the hangman. JSC Med. Assoc. 91, 38 (1995).

    CAS  Google Scholar 

  25. Greschner, M., Krautschick, A. & Alken, P. High-flow priapism leading to the diagnosis of lung cancer. Urol. Int. 60, 126–127 (1998).

    Article  CAS  PubMed  Google Scholar 

  26. Hopkins, A., Clarke, C. & Brindley, G. Erections on walking as a symptom of spinal canal stenosis. J. Neurol. Neurosurg. Psychiatry 50, 1371–1374 (1987).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Munro, D., Horne, H. W. Jr & Paull, D. P. The effect of injury to the spinal cord and cauda equina on the sexual potency of men. N. Engl. J. Med. 239, 903–911 (1948).

    Article  CAS  PubMed  Google Scholar 

  28. Ravindran, M. Cauda equina compression presenting as spontaneous priapism. J. Neurol. Neurosurg. Psychiatry 42, 280–282 (1979).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Dittrich, A., Albrecht, K., Bar-Moshe, O. & Vandendris, M. Treatment of pharmacological priapism with phenylephrine. J. Urol. 146, 323–324 (1991).

    Article  CAS  PubMed  Google Scholar 

  30. Ruan, X. et al. Priapism—a rare complication following continuous epidural morphine and bupivacaine infusion. Pain Physician 10, 707–711 (2007).

    PubMed  Google Scholar 

  31. Burnett, A. L. Pathophysiology of priapism: Dysregulatory erection physiology thesis. J. Urol. 170, 26–34 (2003).

    Article  PubMed  Google Scholar 

  32. Ilkay, A. K. & Levine, L. A. Conservative management of high-flow priapism. Urology 46, 419–424 (1995).

    Article  CAS  PubMed  Google Scholar 

  33. Burt, F. B., Schirmer, H. K. & Scott, W. W. A new concept in the management of priapism. J. Urol. 83, 60–61 (1960).

    Article  CAS  PubMed  Google Scholar 

  34. Witt, M. A., Goldstein, I., Saenz de Tejada, I., Greenfield, A. & Krane, R. J. Traumatic laceration of intracavernosal arteries: The pathophysiology of nonischemic, high flow, arterial priapism. J. Urol. 143, 129–132 (1990).

    Article  CAS  PubMed  Google Scholar 

  35. Towbin, R. et al. Priapism in children: treatment with embolotherapy. Pediatr. Radiol. 37, 483–487 (2007).

    Article  PubMed  Google Scholar 

  36. Kim, S. H. & Kim, S. H. Post-traumatic erectile dysfunction: Doppler US findings. Abdom. Imaging 12, 1–9 (2006).

    Google Scholar 

  37. McMahon, C. G. High flow priapism due to an arterial-lacunar fistula complicating initial veno-occlusive priapism. Int. J. Impot. Res. 14, 195–196 (2002).

    Article  CAS  PubMed  Google Scholar 

  38. Rodríguez, J., Cuadrado, J. M., Frances, A. & Franco, E. High-flow priapism as a complication of a veno-occlusive priapism: two case reports. Int. J. Impot. Res. 18, 215–217 (2006).

    Article  PubMed  Google Scholar 

  39. Bertolotto, M., Ciampalini, S., Martingano, P. & Mucelli, F. P. High-flow priapism complicating ischemic priapism following iatrogenic laceration of the dorsal artery during a Winter procedure. J. Clin. Ultrasound 37, 61–64 (2008).

    Article  Google Scholar 

  40. Tuygun, C., Guvercinci, M., Conkbayir, I., Gucuk, A. & Imamoglu, A. Post-surgical high-flow priapism treated by embolization. Int. J. Urol. 14, 1107–1108 (2007).

    Article  PubMed  Google Scholar 

  41. Liguori, G. et al. High-flow priapism (HFP) secondary to Nesbit operation: management by percutaneous embolization and colour Doppler-guided compression. Int. J. Impot. Res. 17, 304–306 (2005).

    Article  CAS  PubMed  Google Scholar 

  42. Wolf, J. S. Jr & Lue, T. F. High-flow priapism and glans hypervascularization following deep dorsal vein arterialization for vasculogenic impotence. Urol. Int. 49, 227–229 (1992).

    Article  PubMed  Google Scholar 

  43. Kim, K. R. et al. Treatment of high-flow priapism with superselective transcatheter embolization in 27 patients: a multicenter study. J. Vasc. Interv. Radiol. 18, 1222–1226 (2007).

    Article  PubMed  Google Scholar 

  44. Arrigo, T., Crisafulli, G., Salzano, G., Zirilli, G. & De Luca, F. High-flow priapism in testosterone-treated boys with constitutional delay of growth and puberty may occur even when very low doses are used. J. Endocrinol. Invest. 28, 390–391 (2005).

    Article  CAS  PubMed  Google Scholar 

  45. Ramos, C. E., Park, J. S., Ritchey, M. L. & Benson, G. S. High flow priapism associated with sickle cell disease. J. Urol. 153, 1619–1621 (1995).

    Article  CAS  PubMed  Google Scholar 

  46. Poey, C. et al. Non traumatic high flow priapism: arterial embolization treatment [French]. J. Radiol. 87, 115–119 (2006).

    Article  CAS  PubMed  Google Scholar 

  47. Mentzel, H. J. et al. High-flow priapism in acute lymphatic leukaemia. Pediatr. Radiol. 34, 560–563 (2004).

    Article  PubMed  Google Scholar 

  48. Foda, M. M. et al. High-flow priapism associated with Fabry's disease in a child: a case report and review of the literature. Urology 48, 949–952 (1996).

    Article  CAS  PubMed  Google Scholar 

  49. Dubocq, F. M., Tefilli, M. V., Grignon, D. J., Pontes, J. E. & Dhabuwala, C. B. High flow malignant priapism with isolated metastasis to the corpora cavernosa. Urology 51, 324–326 (1998).

    Article  CAS  PubMed  Google Scholar 

  50. El-Assmy, A., Hekal, I. A. & Abou-El-Ghar, M. E. Use of magnetic resonance angiography in diagnosis and decision making of post-traumatic, high-flow priapism. Scientific World Journal 19, 176–181 (2008).

    Article  Google Scholar 

  51. Suzuki, K. et al. Post-traumatic high flow priapism: demonstrable findings of penile enhanced computed tomography. Int. J. Urol. 8, 648–651 (2001).

    Article  CAS  PubMed  Google Scholar 

  52. Hakim, L. S., Kulaksizoglu, H., Mulligan, R., Greenfield, A. & Goldstein, I. Evolving concepts in the diagnosis and treatment of arterial high flow priapism. J. Urol. 155, 541–548 (1996).

    Article  CAS  PubMed  Google Scholar 

  53. Wear, J. B. A new approach to the treatment of priapism. J. Urol. 117, 252–254 (1977).

    Article  PubMed  Google Scholar 

  54. Merritt, A. L., Haiman, C. & Henderson, S. O. Myth: blood transfusion is effective for sickle cell anemia-associated priapism. CJEM 8, 119–122 (2006).

    Article  PubMed  Google Scholar 

  55. Lowe, F. C. & Jarow, J. P. Placebo-controlled study of oral terbutaline and pseudoephedrine in management of prostaglandin E1-induced prolonged erections. Urology 42, 51–53 (1993).

    Article  CAS  PubMed  Google Scholar 

  56. Pryor, J. et al. Priapism. J. Sex. Med. 1, 116–120 (2004).

    Article  PubMed  Google Scholar 

  57. Maan, Z., Arya, M. & Patel, H. R. Priapism—a review of the medical management. Expert Opin. Pharmacother. 4, 2271–2277 (2003).

    Article  CAS  PubMed  Google Scholar 

  58. Muruve, N. & Hosking, D. H. Intracorporeal phenylephrine in the treatment of priapism. J. Urol. 155, 141–143 (1996).

    Article  CAS  PubMed  Google Scholar 

  59. Kulmala, R. V. & Tamella, T. L. Effects of priapism lasting 24 hours or longer caused by intracavernosal injection of vasoactive drugs. Int. J. Impot. Res. 7, 131–136 (1995).

    CAS  PubMed  Google Scholar 

  60. Broderick, G. A. & Harkaway, R. Pharmacologic erection: time-dependent changes in the corporal environment. Int. J. Impot. Res. 6, 9–16 (1994).

    CAS  PubMed  Google Scholar 

  61. Kilinc, M. Temporary cavernosal-cephalic vein shunt in low-flow priapism treatment. Eur. Urol. doi:10.1016/j.eururo.2008.10.009 (2008).

  62. Garcia, M. M., Shindel, A. W. & Lue, T. F. T-shunt with or without tunnelling for prolonged ischaemic priapism. BJU Int. 102, 1754–1764 (2008).

    Article  PubMed  Google Scholar 

  63. Brant, W. O., Garcia, M. M., Bella, A. J., Chi, T. & Lue, T. F. T-shaped shunt and intracavernous tunneling for prolonged ischemic priapism. J. Urol. 181, 1699–1705 (2009).

    Article  PubMed  Google Scholar 

  64. Burnett, A. L. & Pierorazio, P. M. Corporal “snake” maneuver. Corporoglanular shunt surgical modification for ischemic priapism. J. Sex. Med. doi:10.1111/j.1743–61092008.01176.x (2009).

  65. Bochinski, D. J., Deng, D. Y. & Lue, T. F. The treatment of priapism: when and how? Int. J. Impot. Res. 15, S86–S90 (2003).

    Article  PubMed  Google Scholar 

  66. Ralph, D. J. et al. The immediate insertion of a penile prosthesis for acute ischaemic priapism. Eur. Urol. doi:10.1016/j.eururo.2008.09.044 (2008).

  67. Rees, R. W. et al. The management of low-flow priapism with immediate insertion of a penile prosthesis. BJU Int. 90, 893–897 (2002).

    Article  CAS  PubMed  Google Scholar 

  68. Steinberg, J. & Eyre, R. C. Management of recurrent priapism with epinephrine self-injection and gonadotropin-releasing hormone analogue. J. Urol. 153, 152–153 (1995).

    Article  CAS  PubMed  Google Scholar 

  69. Dahm, P., Rao, D. S. & Donatucci, C. F. Antiandrogens in the treatment of priapism. Urology 59, 138 (2002).

    Article  PubMed  Google Scholar 

  70. Saad, S. T. et al. Follow-up of sickle cell disease patients with priapism treated by hydroxyurea. Am. J. Hematol. 77, 45–49 (2004).

    Article  CAS  PubMed  Google Scholar 

  71. Perimenis, P., Athanasopoulos, A., Papathanasopoulos, P. & Barbalias, G. Gabapentin in the management of the recurrent, refractory, idiopathic priapism. Int. J. Impot. Res. 16, 84–85 (2004).

    Article  CAS  PubMed  Google Scholar 

  72. Hübler, J., Szántó, A. & Könyves, K. Methylene blue as a means of treatment for priapism caused by intracavernous injection to combat erectile dysfunction. Int. Urol. Nephrol. 35, 519–521 (2003).

    Article  PubMed  Google Scholar 

  73. Rourke, K. F., Fischler, A. H. & Jordan, G. H. Treatment of recurrent idiopathic priapism with oral baclofen. J. Urol. 168, 2552–2553 (2002).

    Article  CAS  PubMed  Google Scholar 

  74. Gupta, S. et al. A possible mechanism for alteration of human erectile function by digoxin: inhibition of corpus cavernosum sodium/potassium adenosine triphosphatase activity. J. Urol. 159, 1529–1536 (1998).

    Article  CAS  PubMed  Google Scholar 

  75. Perimenis, P., Athanasopoulos, A., Geramoutsos, I. & Barbalias, G. The incidence of pharmacologically induced priapism in the diagnostic and therapeutic management of 685 men with erectile dysfunction. Urol. Int. 66, 27–29 (2001).

    Article  CAS  PubMed  Google Scholar 

  76. Muneer, A., Minhas, S., Arya, M. & Ralph, D. J. Stuttering priapism—a review of the therapeutic options. Int. J. Clin. Pract. 62, 1265–1270 (2008).

    Article  CAS  PubMed  Google Scholar 

  77. Shamloul, R. & el Nashaar, A. Idiopathic stuttering priapism treated successfully with low-dose ethinyl estradiol: a single case report. J. Sex. Med. 2, 732–734 (2005).

    Article  PubMed  Google Scholar 

  78. Kumar, R., Shrivastava, D. N. & Seth, A. Spontaneous resolution of delayed onset, posttraumatic high-flow priapism. J. Postgrad. Med. 52, 298–299 (2006).

    CAS  PubMed  Google Scholar 

  79. Ciampalini, S. et al. High-flow priapism: treatment and long-term follow-up. Urology 59, 110–113 (2002).

    Article  PubMed  Google Scholar 

  80. Hatzichristou, D. et al. Management strategy for arterial priapism: therapeutic dilemmas. J. Urol. 168, 2074–2077 (2002).

    Article  PubMed  Google Scholar 

  81. Cakan, M., Altu Gcaron, U. & Aldemir, M. Is the combination of superselective transcatheter autologous clot embolization and duplex sonography-guided compression therapy useful treatment option for the patients with high-flow priapism? Int. J. Impot. Res. 18, 141–145 (2006).

    Article  CAS  PubMed  Google Scholar 

  82. Liu, B. X. et al. High-flow priapism: superselective cavernous artery embolization with microcoils. Urology 72, 571–573 (2008).

    Article  PubMed  Google Scholar 

  83. Lloret, F., Martínez-Cuesta, A., Domínguez, P., Noguera, J. J. & Bilbao, J. I. Arterial microcoil embolization in high flow priapism [Spanish]. Radiologia 50, 163–167 (2008).

    Article  CAS  PubMed  Google Scholar 

  84. Chung, E., McKnight, J. & Hosken, B. Post traumatic prepubertal high-flow priapism: a rare occurrence. Pediatr. Surg. Int. 24, 379–381 (2008).

    Article  PubMed  Google Scholar 

  85. Numan, F. et al. Post-traumatic high-flow priapism treated by N-butyl-cyanoacrylate embolisation. Cardiovasc. Intervent. Radiol. 19, 278–280 (1996).

    Article  CAS  PubMed  Google Scholar 

  86. Hanada, E. et al. Case report of posttraumatic arterial high-flow priapism [Japanese]. Hinyokika Kiyo 54, 633–635 (2008).

    PubMed  Google Scholar 

  87. Numan, F. et al. Post-traumatic nonischemic priapism treated with autologous blood clot embolization. J. Sex. Med. 5, 173–179 (2008).

    Article  PubMed  Google Scholar 

  88. Hellstrom, W. J., Derosa, A. & Lang, E. The use of transcatheter superselective embolization to treat high flow priapism (arteriocavernosal fistula) caused by straddle injury. J. Urol. 178, 1059 (2007).

    Article  PubMed  Google Scholar 

  89. Bertolotto, M., Zappetti, R., Pizzolato, R. & Liguori, G. Color Doppler appearance of penile cavernosal-spongiosal communications in patients with high-flow priapism. Acta Radiol. 49, 710–714 (2008).

    Article  CAS  PubMed  Google Scholar 

  90. Volgger, H., Pfefferkorn, S. & Hobisch, A. Post-traumatic high-flow priapism in children: noninvasive treatment by color Doppler ultrasound-guided perineal compression. Urology 70, 590.e3–5 (2007).

    Article  Google Scholar 

  91. Resim, S., Sahinkanat, T. & Karabiber, H. High-flow priapism of unknown etiology in a prepubertal boy. Pediatr. Int. 46, 492–493 (2004).

    Article  PubMed  Google Scholar 

  92. Volkmer, B. G. et al. High-flow priapism: a combined interventional approach with angiography and colour Doppler. Ultrasound Med. Biol. 28, 165–169 (2002).

    Article  PubMed  Google Scholar 

  93. Bartsch, G. Jr, Kuefer, R., Engel, O. & Volkmer, B. G. High-flow priapism: colour-Doppler ultrasound-guided supraselective embolization therapy. World J. Urol. 22, 368–370 (2004).

    Article  PubMed  Google Scholar 

  94. O'Sullivan, P., Browne, R., McEniff, N. & Lee, M. J. Treatment of “high-flow” priapism with superselective transcatheter embolization: a useful alternative to surgery. Cardiovasc. Intervent. Radiol. 29, 198–201 (2006).

    Article  CAS  PubMed  Google Scholar 

  95. Kim, K. R. et al. Treatment of high-flow priapism with superselective transcatheter embolization in 27 patients: a multicenter study. J. Vasc. Interv. Radiol. 18, 1222–1226 (2007).

    Article  PubMed  Google Scholar 

  96. Savoca, G. et al. Sexual function after highly selective embolization of cavernous artery in patients with high flow priapism: long-term followup. J. Urol. 172, 644–647 (2004).

    Article  PubMed  Google Scholar 

  97. Sandock, D. S., Seftel, A. D., Herbener, T. E., Goldstein, I. & Greenfield, A. J. Perineal abscess after embolization for high-flow priapism. Urology 48, 308–311 (1996).

    Article  CAS  PubMed  Google Scholar 

  98. Martínez Portillo, F. J., Fernández Arancibia, M. I., Bach, S., Alken, P. & Jünemann, K. P. Methylene blue: an effective therapeutic alternative for priapism induced by intracavernous injection of vasoactive agents [Spanish]. Arch. Esp. Urol. 55, 303–308 (2002).

    PubMed  Google Scholar 

  99. Imamoglu, A., Bakírtas, H., Conkbayír, I., Tuygun, C. & Sarící, H. An alternative noninvasive approach for the treatment of high-flow priapism in a child: duplex ultrasound-guided compression. J. Pediatr. Surg. 41, 446–448 (2006).

    Article  PubMed  Google Scholar 

  100. Sancak, T. & Conkbayir, I. Post-traumatic high-flow priapism: management by superselective transcatheter autologous clot embolization and duplex sonography-guided compression. J. Clin. Ultrasound 29, 349–353 (2001).

    Article  CAS  PubMed  Google Scholar 

  101. Kiss, A. et al. Treatment of post-traumatic high-flow priapism in 8-year-old boy with percutaneous ultrasound-guided thrombin injection. Urology 69, 779.e7–9 (2007).

    Article  Google Scholar 

  102. Shapiro, R. H. & Berger, R. E. Post-traumatic priapism treated with selective cavernosal artery ligation. Urology 49, 638–643 (1997).

    Article  CAS  PubMed  Google Scholar 

  103. Champion, H. C., Bivalacqua, T. J., Takimoto, E., Kass, D. A. & Burnett, A. L. Phosphodiesterase-5A dysregulation in penile erectile tissue is a mechanism of priapism. Proc. Natl Acad. Sci. USA 102, 1661–1666 (2005).

    Article  CAS  PubMed  Google Scholar 

  104. Lin, G., Xin, Z. C., Lue, T. F. & Lin, C. S. Up and down-regulation of phosphodiesterase-5 as related to tachyphylaxis and priapism. J. Urol. 2, S15–S18 (2003).

    Google Scholar 

  105. Burnett, A. L., Bivalacqua, T. J., Champion, H. C. & Musicki, B. Feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent priapism. J. Sex. Med. 3, 1077–1084 (2006).

    Article  CAS  PubMed  Google Scholar 

  106. Lue, T. F. Priapism after transurethral alprostadil. J. Urol. 161, 725–726 (1999).

    Article  CAS  PubMed  Google Scholar 

  107. Wills, B. K., Albinson, C., Wahl, M. & Clifton, J. Sildenafil citrate ingestion and prolonged priapism and tachycardia in a pediatric patient. Clin. Toxicol. 45, 798–800 (2007).

    Article  CAS  Google Scholar 

  108. King, S. H., Hallock, M., Strote, J. & Wessells, H. Tadalafil-associated priapism. Urology 66, 432 (2005).

    Article  PubMed  Google Scholar 

  109. Rubin, S. O. Priapism as a probable sequel to medication. Scand. J. Urol. Nephrol. 2, 81–85 (1968).

    Article  CAS  PubMed  Google Scholar 

  110. Siegel, S., Streem, S. B. & Steinmuller, D. R. Prazosin-induced priapism. Pathogenic and therapeutic implications. Br. J. Urol. 61, 165 (1988).

    Article  CAS  PubMed  Google Scholar 

  111. Sadeghi-Nejad, H. & Jackson, I. New-onset priapism associated with ingestion of terazosin in an otherwise healthy man. J. Sex. Med. 4, 1766–1768 (2007).

    Article  PubMed  Google Scholar 

  112. Avisrror, M. U. et al. Doxazosin and priapism. J. Urol. 163, 238 (2000).

    Article  CAS  PubMed  Google Scholar 

  113. Pahuja, A., Bashir, J., Williamson, E. M. & Barber, N. Unresolved priapism secondary to tamsulosin. Int. J. Impot. Res. 17, 293–294 (2005).

    Article  CAS  PubMed  Google Scholar 

  114. Qazi, H. A., Ananthakrishnan, K., Manikandan, R. & Fordham, M. V. Stuttering priapism after ingestion of alfuzosin. Urology 68, 890.e5–6 (2006).

    Google Scholar 

  115. Compton, M. T. & Miller, A. H. Priapism associated with conventional and atypical antipsychotic medications: a review. J. Clin. Psychiatry 62, 362–366 (2001).

    Article  CAS  PubMed  Google Scholar 

  116. Kulmala, R., Lehtonen, T., Nieminen, P. & Tammela, T. Aetiology of priapism in 207 patients. Eur. Urol. 28, 241–245 (1995).

    Article  CAS  PubMed  Google Scholar 

  117. Saenz de Tejada, I. et al. Pathophysiology of prolonged penile erection associated with trazodone use. J. Urol. 145, 60–64 (1991).

    Article  CAS  PubMed  Google Scholar 

  118. Dubin, N. N. & Razack, A. H. Priapism: ecstasy related? Urology 56, 1057 (2000).

    Article  Google Scholar 

  119. Lin, P. H., Bush, R. L. & Lumsden, A. B. Low molecular weight heparin induced priapism. J. Urol. 172, 263 (2004).

    Article  PubMed  Google Scholar 

  120. Salerno, T. A., Charrette, E. J. & Morales, A. Priapism after aortic valve replacement. Can. J. Surg. 24, 202–203 (1981).

    CAS  PubMed  Google Scholar 

  121. Harmon, J. D., Ginsberg, P. C., Nachmann, M. M., Manzarbeita, C. & Harkaway, R. C. Stuttering priapism in a liver transplant patient with toxic levels of FK506. Urology 54, 366 (1999).

    Article  CAS  PubMed  Google Scholar 

  122. Zargooshi, J. Priapism as a complication of high dose testosterone therapy in a man with hypogonadism. J. Urol. 163, 907 (2000).

    Article  CAS  PubMed  Google Scholar 

  123. Teixeira, C. E. et al. Nitric oxide release from human corpus cavernosum induced by a purified scorpion toxin. Urology 63, 184–189 (2004).

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, University of California, San Francisco, CA, USA

    Yun-Ching Huang, Ahmed M. Harraz, Alan W. Shindel & Tom F. Lue

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  1. Yun-Ching Huang
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  2. Ahmed M. Harraz
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Correspondence to Tom F. Lue.

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Competing interests

T. F. Lue has been a consultant for Auxilium, Bayer, Eli Lilly, Medtronic, Pfizer, Inc. and Urodynix, and has received grant/research support from American Medical Systems, Inc., Astellas Pharma, Inc. and Biopharm.

The other authors declared no competing interests.

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Huang, YC., Harraz, A., Shindel, A. et al. Evaluation and management of priapism: 2009 update. Nat Rev Urol 6, 262–271 (2009). https://doi.org/10.1038/nrurol.2009.50

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