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Priapism
Medical expert of the article
Last reviewed: 12.07.2025
[ Symptoms priapism
Symptoms of priapism vary and depend on the pathogenetic type.
Ischemic priapism
Ischemic (veno-occlusive, low-flow) variant accounts for 95% of priapism cases. This is usually a rigid painful erection that occurs as a result of blood stagnation and decreased partial pressure of oxygen in the cavernous bodies of the penis (pO2 <30 mm Hg. pCO2 >60 mm Hg. pH <7.3). This type of priapism is characterized by minimal blood flow velocity in the cavernous bodies or its complete cessation. If this disease develops, emergency assistance must be provided. Without treatment, the outcome of ischemic priapism is fibrosis of the cavernous tissue of the penis, which occurs with a clinical picture of erectile dysfunction (impotence).
Ultrastructural changes in the cavernous tissue of the penis develop after 12 hours, and after 24 hours the damage becomes irreversible. If priapism lasts more than 24 hours, erectile dysfunction develops in 89% of cases.
Ischemic priapism can be caused by various blood diseases ( leukemia, sickle cell anemia, erythrocytosis), neoplastic processes of the central nervous system, drug and alcohol intoxication. Priapism develops in 30% of patients with prostate cancer, 30% of bladder cancer and 11% of patients with kidney cancer. Sometimes priapism occurs with malaria and rabies, more often in the acute period. Priapism can also be provoked by taking various medications (psychotropic drugs, androgens, antidepressants, alpha-blockers, antihypertensives, anticoagulants), including those administered intracavernously (pharmacological priapism).
Non-ischemic priapism
Non-ischemic (arterial, high-flow) priapism usually develops as a result of damage to the cavernous arteries of the penis or as a result of trauma to the perineum or penis, which leads to the formation of an arteriolacunar fistula. This type of priapism is not accompanied by acidosis and does not require emergency medical care. The prognosis in terms of preservation of erectile function is favorable. Symptoms of non-ischemic priapism include persistent partial rigidity of the penis, which usually develops several hours after the injury. A full rigid erection develops against the background of sexual or genital stimulation. There is no pain. In some cases, spontaneous resolution of priapism is possible several days or months after its onset.
In a number of cases, the etiological factor in the development of both ischemic and non-ischemic priapism cannot be established, and then we are talking about an idiopathic form of priapism.
Recurrent priapism
Recurrent (recurrent, nocturnal intermittent) priapism is a type of ischemic priapism. With this type of priapism, painful long erections alternate with short periods of detumescence. This type of priapism has been little studied, occurs in diseases of the central nervous system and peripheral nervous system, blood diseases, and can also be psychogenic.
Diagnostics priapism
Diagnosis of priapism is not difficult and is based on anamnestic data, examination data and palpation of the penis.
In case of intermittent priapism, a comprehensive diagnosis with examination of the central nervous system and peripheral nervous system is necessary.
Laboratory diagnostics
- Clinical blood test.
- Determination of the gas composition of the blood in the cavernous bodies of the penis.
- Dopplerography of the vessels of the penis, which in the case of non-ischemic priapism allows the presence of an arterial fistula to be detected.
Differential diagnosis of priapism is carried out on the basis of anamnesis, clinical data (examination of the external genitalia), instrumental and laboratory studies.
What do need to examine?
How to examine?
Treatment priapism
Treatment of priapism (non-ischemic form) can be expectant or can involve selective arteriography with embolization of the arterial fistula. Subsequently, the choice of treatment depends on the state of erectile function.
Treatment of priapism (ischemic form) consists of complex emergency measures, primarily including aspiration-irrigation therapy with intracavernous administration of alpha-adrenergic agonists (epinephrine, phenylephrine, norepinephrine), which increase the probability of stopping priapism in 43-81% of cases. Combined use of anticoagulants and sedatives is advisable. Priapism that has developed against the background of blood diseases is often stopped with active treatment of the underlying disease. During the entire period of conservative treatment of priapism, it is necessary to monitor blood pressure, heart rate, in some cases, continuous ECG is indicated. Attempts to stop priapism with aspiration-irrigation therapy should be made for at least 1 hour.
Of course, it is necessary to take into account the duration of priapism - the effectiveness of conservative measures is minimal after 48 hours or more from the onset of the disease.
Surgical treatment of priapism
If conservative treatment is ineffective, surgical treatment of priapism is indicated, the principle of which is to create adequate venous drainage from the cavernous bodies of the penis. Most often, drainage is performed through intact spongy bodies with preserved venous outflow.
- Percutaneous shunting (distal shunt). The essence of the method is the formation of a fistula between the cavernous bodies and the spongy body. The surgical intervention is performed under local anesthesia. A biopsy needle (Winter method) or scalpel (Ebbehoj method) is used to make a puncture in the apical zone of the cavernous bodies.
- Open bypass (distal bypass) - Al-Ghorab technique. In essence, this is a modification of the Winter operation. Under general anesthesia, parallel to the coronary groove on the dorsal surface of the head of the penis, access is made to the apical parts of the cavernous bodies. Openings with a diameter of 5 mm are formed sharply. The cavernous bodies are washed with a solution of sodium heparin.
- Proximal shunt - Quackles technique. This type of shunting is performed when the distal spongiocavernous fistula is ineffective. Under general anesthesia with preliminary installation of a urethral catheter, the tunica albuginea of the cavernous bodies is isolated by a midline incision (transverse scrotal or perineal). Elliptical windows are formed bilaterally in the tunica albuginea of the cavernous bodies. A similar window is formed in the spongy body of the urethra. The cavernous bodies are washed with a sodium heparin solution and a spongiocavernous fistula is formed.
- Saphenocavernous anastomosis - Grayhack technique. Used quite rarely when proximal shunt is ineffective.
Further management of priapism
In the postoperative period, patients with priapism should be prescribed anti-inflammatory and anticoagulant therapy with active monitoring of blood clotting parameters during the day. In the late postoperative period, it is advisable to carry out complex rehabilitation measures aimed at improving the perfusion of the cavernous bodies in order to prevent the development of erectile dysfunction (impotence).
Treatment of priapism (intermittent form) is a complex task, since priapism and its etiological and pathogenetic aspects have not been sufficiently studied. There is data on the successful use of therapeutic doses of digoxin and gonadotropic hormones. In some cases, complex treatment of priapism, including psychopharmacological and physiotherapeutic treatment and psychotherapy, is not without success.