Materiały źródłowe

• #1 Priapism: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/10042-priapism

  Priapism is a painful erection that lasts for several hours. It develops when blood remains in your penis and cant drain. It requires immediate medical treatment to prevent permanent damage to your penis. […] Priapism needs immediate treatment. Without treatment, it can cause permanent damage. […] If you have an erection that lasts longer than a few hours, its important to get medical care immediately. […] The goal of all priapism treatment is to make your erection go away and preserve your ability to have erections in the future. […] Priapism is a medical emergency. If you have an erection without sexual arousal or stimulation that doesnt go away within a few hours, go to the emergency room immediately. The longer you wait, the greater your risk of permanent damage to your penis. […] Priapism needs immediate treatment to prevent permanent damage to your penis.

• #2 Priapism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/priapism/diagnosis-treatment/drc-20352010

  If you have an erection lasting more than four hours, you need emergency care. […] The emergency room doctor will determine whether you have ischemic priapism or nonischemic priapism. This is necessary because the treatment for each is different, and treatment for ischemic priapism needs to happen as soon as possible. […] To determine what type of priapism you have, your doctor will ask questions and examine your genitals, abdomen, groin and perineum. Your doctor might be able to determine what type of priapism you have based on whether you’re experiencing pain and the rigidity of the penis. […] Diagnostic tests might be needed to determine what type of priapism you have. […] If the blood is black deprived of oxygen the condition is most likely ischemic priapism. If it’s bright red, the priapism is more likely nonischemic.

• #3 Priapism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459178/

  Priapism is a disorder in which the penis maintains a prolonged erection in the absence of appropriate stimulation. […] Ischemic causes of priapism are a true emergency and require prompt intervention to prevent damage to the penis, which can progress to erectile dysfunction and permanent impotence. […] Early intervention is essential for the functional recovery of erectile ability. If left untreated, penile corporal tissue necrosis and eventually fibrosis result along with permanent erectile dysfunction. […] The etiology of priapism can broadly be categorized as low flow (ischemic) and high flow (non-ischemic). […] The causes of ischemic priapism are numerous and include various hemoglobinopathies, such as sickle cell disease and thalassemia, and any hypercoagulable state. […] Priapism is a relatively common complication of sickle cell disease in affected males.

• #3 Priapism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459178/

  Priapism is uncommon in sickle cell patients under 18 years (3.6%) compared to adult sickle cell patients (42%). […] The overall incidence of priapism is estimated at 0.73 to 5.4 cases per 100,000 men per year. […] Evaluation of priapism begins with a thorough and complete history and physical examination. […] If the etiology of priapism cannot be determined based on this information, then penile hemodynamics and intracorporal blood gases should be evaluated. […] Aspirated corporal blood gas in ischemic priapism: pH = 7 (or 7.2), pO2 30 mmHg, and pCO2 60 mmHg. […] The initial approach to ischemic priapism is to treat it as a true emergency. […] Any priapism episode lasting four hours or longer requires early intervention to decrease the likelihood of irreversible corporal damage and future erectile dysfunction. […] Surgical intervention will be required if medical therapy fails. […] Priapism is not a fatal disorder, but it can lead to permanent erectile dysfunction in the future. […] The prognosis of patients with priapism depends on age, duration of symptoms, and the underlying cause.

• #4 Priapism – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/priapism/symptoms-causes/syc-20352005

  Priapism is a prolonged erection of the penis. The main types of priapism are ischemic and nonischemic. Ischemic priapism is a medical emergency. […] Priapism occurs when some part of this system the blood, vessels, smooth muscles or nerves changes normal blood flow, and an erection persists. […] If you have an erection lasting more than four hours, you need emergency care. The emergency room doctor will determine whether you have ischemic priapism or nonischemic priapism. […] If you experience recurrent, persistent, painful erections that resolve on their own, see your doctor. You might need treatment to prevent further episodes. […] Ischemic priapism can cause serious complications. The blood trapped in the penis is deprived of oxygen. When an erection lasts for too long usually more than four hours this lack of oxygen can begin to damage or destroy tissues in the penis. Untreated priapism can cause erectile dysfunction.

• #5 Priapism Differential Diagnoses

  https://emedicine.medscape.com/article/437237-differential

  The diagnosis of priapism may be straightforward, depending on the physical findings. Pathologic states associated with priapism give rise to the differential diagnosis. Some of the major considerations are as follows: […] Low-flow priapism, which constitutes the large majority of cases, is characterized by a rigid, painful erection; ischemic corpora, as indicated by dark blood upon corporeal aspiration; and no evidence of trauma. […] To provide appropriate treatment, physicians must differentiate between low-flow and high-flow priapism. This is accomplished by taking a thorough history, performing a careful physical examination, and measuring the oxygen content of blood within the corpora cavernosa by penile blood gas (PBG) analysis. […] The presence of bright red blood during aspiration is a helpful but not pathognomonic finding of high-flow priapism. PBG findings approximate normal arterial values.

• #6 Diagnosis and Management of Priapism: AUA/SMSNA Guideline (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-management-of-priapism-aua/smsna-guideline-(2022)

  Diagnosis and Management of Priapism: AUA/SMSNA Guideline (2022) […] Diagnosis of Priapism […] In patients presenting with priapism, clinicians should complete a medical, sexual, and surgical history, and perform a physical examination, which includes the genitalia and perineum. (Clinical Principle) […] Clinicians should obtain a corporal blood gas at the initial presentation of priapism. (Clinical Principle) […] Clinicians may utilize penile duplex Doppler ultrasound when the diagnosis of acute ischemic versus non-ischemic priapism is indeterminate. (Expert Opinion) […] The clinician should order additional diagnostic testing to determine the etiology of diagnosed acute ischemic priapism; however, these tests should not delay, and should be performed simultaneously with, definitive treatment. (Expert Opinion)

• #6 Diagnosis and Management of Priapism: AUA/SMSNA Guideline (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-management-of-priapism-aua/smsna-guideline-(2022)

  Clinicians should counsel patients that non-ischemic priapism is not an emergency condition and should offer patients an initial period of observation. (Expert Opinion) […] In a patient with diagnosed non-ischemic priapism, the clinician should consider penile duplex ultrasound for assessment of fistula location and size. (Expert Opinion) […] In patients with persistent non-ischemic priapism after a trial of observation, and who wish to be treated, the clinician should offer embolization as first-line therapy. (Moderate Recommendation, Evidence Level: Grade C) […] Non-ischemic priapism patients should be informed that embolization carries a risk of erectile dysfunction, recurrence, and failure to correct non-ischemic priapism. (Moderate Recommendation, Evidence Level: Grade C) […] In non-ischemic priapism patients who have failed an attempt embolization of the fistula, the clinician should offer repeat embolization over surgical ligation. (Moderate Recommendation, Evidence Level: Grade C)

• #6 Diagnosis and Management of Priapism: AUA/SMSNA Guideline (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-management-of-priapism-aua/smsna-guideline-(2022)

  Post-Shunting Management of Acute Ischemic Priapism […] In an acute ischemic priapism patient with a persistent erection following shunting, the clinician should perform corporal blood gas or color duplex Doppler ultrasound prior to repeat surgical intervention to determine cavernous oxygenation or arterial inflow. (Moderate Recommendation, Evidence Level: Grade C) […] Penile Prosthesis […] Clinicians may consider placement of a penile prosthesis in a patient with untreated acute ischemic priapism greater than 36 hours or in those who are refractory to shunting, with or without tunneling. (Expert Opinion) […] Clinicians should discuss the risks and benefits of early versus delayed placement with acute ischemic priapism patients who are considering a penile prosthesis. (Moderate Recommendation, Evidence Level: Grade C)

• #6 Diagnosis and Management of Priapism: AUA/SMSNA Guideline (2022) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/diagnosis-and-management-of-priapism-aua/smsna-guideline-(2022)

  Initial Management of Acute Ischemic Priapism […] In a patient with diagnosed acute ischemic priapism, conservative therapies (i.e., observation, oral medications, cold compresses, exercise) are unlikely to be successful and should not delay definitive therapies. (Expert Opinion) […] Clinicians should counsel all patients with persistent acute ischemic priapism that there is the chance of erectile dysfunction. (Moderate Recommendation; Evidence Level: Grade B) […] Clinicians should counsel patients with an acute ischemic priapism event 36 hours that the likelihood of erectile function recovery is low. (Moderate Recommendation; Evidence Level: Grade B) […] Pre-Surgical Management of Acute Ischemic Priapism […] Clinicians should manage acute ischemic priapism with intracavernosal phenylephrine and corporal aspiration, with or without irrigation, as first line therapy and prior to operative interventions. (Moderate Recommendation, Evidence Level: Grade C)

• #7 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/priapism

  Taking a comprehensive history is critical in priapism diagnosis and treatment. The medical history must specifically enquire about SCD or any other haematological abnormality and a history of pelvic, genital or perineal trauma. The sexual history must include the duration of the erection; the presence and degree of pain; prior drug treatment and recreational drug use; history of priapism and methods of treatment; and erectile function prior to the last priapism episode. The history can help to determine the underlying priapism subtype. Ischaemic priapism is classically associated with progressive penile pain and the erection is rigid. Conversely, non-ischaemic priapism is often painless and the erections often fluctuate in rigidity. […] In ischaemic priapism, the corpora are fully rigid and tender, but the glans penis is soft. The patient usually complains of severe pain. Laboratory testing should include a complete blood count, white blood cell count with blood cell differential, platelet count and coagulation profile to assess anaemia and detect haematological abnormalities. Aspiration of blood from the corpora cavernosa is compulsory as an entry level investigation. It usually reveals dark ischaemic blood. Blood gas analysis is essential to differentiate between ischaemic and non-ischaemic priapism.

• #7 EAU Guidelines on Sexual and Reproductive Health – Uroweb

  https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/priapism

  Blood gas analysis performed before blood aspiration from the corpora is able to differentiate between ischaemic and non-ischaemic priapism. Full blood count and haemoglobinopathy screen could reveal haematological alterations. Penile Colour Doppler US can differentiate from ischaemic and non-ischaemic priapism when performed before corporal blood aspiration. Penile MRI is able to predict non-viable smooth muscle in patients with ischaemic priapism. […] Acute ischaemic priapism is a medical emergency. Urgent intervention is mandatory and should follow a stepwise approach. The aim of any treatment is to restore penile detumescence, without pain, in order to prevent corporal smooth muscle fibrosis and subsequent ED. First-line medical treatments for ischaemic priapism of more than 4 hours duration are strongly recommended before any surgical treatment. Conversely, first-line treatments initiated beyond 48 hours, while relieving priapism, have little documented benefit in terms of long-term erectile function preservation.

• #8 Priapism – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/priapism/

  Priapism is a prolonged erection of the penis. The main types of priapism are ischemic and nonischemic. Ischemic priapism is a medical emergency. […] Priapism occurs when some part of this system — the blood, vessels, smooth muscles or nerves — changes normal blood flow, and an erection persists. […] If you have an erection lasting more than four hours, you need emergency care. The emergency room doctor will determine whether you have ischemic priapism or nonischemic priapism. This is necessary because the treatment for each is different, and treatment for ischemic priapism needs to happen as soon as possible. […] To determine what type of priapism you have, your doctor will ask questions and examine your genitals, abdomen, groin and perineum. Your doctor might be able to determine what type of priapism you have based on whether you’re experiencing pain and the rigidity of the penis.

• #9 Prolonged erection | healthdirect

  https://www.healthdirect.gov.au/prolonged-erection

  If you have a prolonged painful erection, seek medical help immediately because the sooner you get treatment, the better the outcome. If you cannot see your doctor urgently, go to your closest emergency department. […] A persistent, prolonged erection of the penis that will not go down is called priapism. […] Priapism is a medical emergency. The sooner you treat it, the less risk that the penis will be damaged. If it’s not treated within 24 hours your penis may be permanently damaged and you might have trouble getting an erection in future. […] If your erection is prolonged (lasts longer than 4 hours), seek urgent treatment. […] The main complication of priapism is erectile dysfunction. The longer the episode of priapism lasts, the more likely you are to develop erectile dysfunction.

• #10 Priapism – Symptoms – Emergency Management – TeachMeSurgery

  https://teachmesurgery.com/urology/other/priapism/

  Priapism is an unwanted erection of the penis, not associated with sexual desire, lasting for more than four hours. […] The diagnosis of priapism is often obvious on presentation, however the main differential is between ischaemic versus non-ischaemic. […] In ischaemic cases, the patient presents with a painful erection and a rigid erection (hard corpus cavernosum with soft glans and spongiosum). […] Obtaining a corporeal blood gas will aid in initial assessment of the priapism, determining whether ischaemic or non-ischaemic. […] The mainstay of initial management is through corporeal aspiration, which achieves detumescence in around 30% of cases. […] If there is no response from aspiration, intracavernosal injection of a sympathomimetic agent, such as phenylephrine, may be trialled. […] Around 90% of cases with priapism lasting more than 24 hours do not regain the ability to have intercourse.

• #11 :: WJMH :: World Journal of Men’s Health

  https://wjmh.org/DOIx.php?id=10.5534/wjmh.2016.34.1.1

  Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. […] The diagnosis of ischemic priapism can be made by a cavernous blood gas analysis to confirm the storage of venous blood within the corpora cavernosa manifesting as a lower partial oxygen pressure (pO2; 30 mmHg), higher partial carbon dioxide pressure (pCO2; 60 mmHg), and a decline of pH (7.25). […] The goal of clinical management for priapism is to make the continuous erection fade away and to preserve the ability to have erections in the future. […] The differentiation can initially be made based on the patient’s history and physical examination. […] The objective in clinical management of ischemic priapism, which is an emergency that may result in permanent ED, is to remove the compartment condition of the ongoing cavernosal hypoxia.

• #12 Q3 Urgent Caring- History of a Painful Penis – A Case Report – Urgent Care Association

  https://urgentcareassociation.org/q3-urgent-caring-history-of-a-painful-penis-a-case-report/

  A cavernous blood gas analysis will provide direct visualization and evaluation of penile blood, serving to provide immediate distinction between the different variants of priapism. In patients with ischemic priapism, the aspirated blood is hypoxic and dark, and typical blood gas values show a partial pressure of oxygen (pO2) of less than 30 mmHg, partial pressure of carbon dioxide (pCO2) of greater than 60 mmHg and a pH of less than 7.25. […] The most common complication of priapism is erectile dysfunction, which can occur in as many as 59% of cases. However, recovery of erectile function may be seen in up to 44% of patients who experience priapism for 2436 h, therefore, time is erectile tissue, and timely treatment is crucial. […] First-line therapy for patients with episodes of acute ischemic priapism is aspiration of blood with irrigation of the corpora cavernosa, in combination with intra-cavernous -agonist injection therapy.

• #13 Review of the role of imaging in the diagnosis of priapism | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-024-00928-0

  Imaging has a specific role in the diagnosis and management of priapism. The primary imaging modality is ultrasound with colour Doppler (CDUS) which can accurately assess the hemodynamics of the cavernosal arteries. […] Diagnosis of priapism primarily relies on clinical history and physical examination. Ischemic priapism presents acutely with pain, constituting a medical emergency, while non-ischemic priapism manifests as non-tender partial tumescence appearing days to weeks after the initial injury. […] Imaging is generally not required in the acute diagnosis of priapism and certainly, at least in ischemic priapism, imaging should not lead to a delay in initializing treatment. However, it does have an important role to play in the confirmation and treatment of non-ischemic priapism and in assessing the viability of the corpora in prolonged ischemic priapism.

• #13 Review of the role of imaging in the diagnosis of priapism | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-024-00928-0

  CDUS has the potential to be the most useful imaging modality. […] MRI of the penis is commonly performed in the management of priapism with a combination of small field of view T2 weighted sequences in three orthogonal planes, larger field of view pelvic sequences, and dynamic post-gadolinium sequences. […] Contrast enhanced MRI of the penis is useful to evaluate the extent of established necrosis and fibrosis in the corpora. […] CDUS of the penis is practically the most useful imaging test in priapism. It should be performed principally to measure the altered hemodynamics and confirm the diagnosis when there is diagnostic doubt between ischemic and non-ischemic priapism.

• #14 Priapism – Wikipedia

  https://en.wikipedia.org/wiki/Priapism

  Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended. There are three types: ischemic (low-flow), nonischemic (high-flow), and recurrent ischemic (intermittent). Most cases are ischemic. Ischemic priapism is generally painful while nonischemic priapism is not. Diagnosis may be supported by blood gas analysis of blood aspirated from the penis or an ultrasound. […] The diagnosis is often based on the history of the condition as well as a physical exam. Blood gas testing the blood from the cavernosa of the penis can help in the diagnosis. If the low-flow type of priapism is present, the blood typically has a low pH, while if the high-flow type is present, the pH is typically normal. Color Doppler ultrasound may also help differentiate the two. […] Penile ultrasonography with Doppler is the imaging method of choice, because it is noninvasive, widely available, and highly sensitive. By means of this method, it is possible to diagnose priapism and differentiate between its low- and high-flow forms.

• #15 Priapism | Diagnosis & Disease Information

  https://www.renalandurologynews.com/ddi/priapism/

  Priapism is an uncontrolled, prolonged erection of the penis thats usually painful and continues beyond, or may not even be associated with, sexual stimulation. Priapism often requires intervention and can cause damage if left untreated. […] Ischemic priapism is known to cause tissue damage in the penis after 6 hours, making prompt diagnosis and treatment essential for proper recovery. […] Distinguishing between ischemic priapism and nonischemic priapism is essential for determining treatment and the risk of complications. Urgent treatment is needed in patients with ischemic priapism, while nonischemic priapism can be treated conservatively. […] According to 2022 guidelines from the American Urological Association/Sexual Medicine Society of North America (AUA/SMSNA), obtaining blood gas measurements using corporal blood is the first diagnostic test for priapism. These results can clearly distinguish ischemic priapism from nonischemic priapism.

• #16 Priapism – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/505

  Priapism is a pathologic condition of persistent penile erection (4 hours) in the absence of sexual excitation. […] Diagnosis is based on history, clinical findings, and assessment of cavernous blood gases and/or color duplex ultrasound. […] Priapism is defined as a prolonged and persistent penile erection lasting 4 hours, unassociated with sexual interest or stimulation. […] It is a true medical emergency with complications potentially resulting in permanent erectile dysfunction. […] Key diagnostic factors include history of current systemic disease, history of vasoactive medication or drug use, prolonged erection of 4 hours’ duration, painful rigid penis, and history of perineal or genitourinary trauma. […] 1st tests to order include corpus cavernosum blood sampling and CBC and differential. […] Tests to consider include color duplex ultrasonography, MRI, Hb-solubility testing, Hb electrophoresis, medication/toxicology urine screen, and coagulation profile.

• #17 Risk factors, diagnosis, and long-term erectile dysfunction outcomes in priapism: a retrospective analysis of 186 cases from a single institution | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-025-01076-9

  Priapism is a medical condition defined by a prolonged, usually painful, erection that may lead to corporal fibrosis and subsequent erectile dysfunction (ED) if left untreated. […] Priapism often requires a multidisciplinary approach, including the emergency department, urology, and a primary care provider (PCP). Therefore, this study aims to review the contemporary incidence of priapism, examining epidemiological trends and contributing risk factors to provide a clearer understanding of priapism, profiling diagnostic approaches, management, and ED outcomes. […] A multivariate logistic regression model was created to examine the factors influencing the likelihood of developing de novo ED after ischemic priapism. In this model, the duration of ischemic priapism was found to be the most significant predictor. Patients with durations of 2036h (OR=25.2, p=0.007) and 36+ hours (OR=61.3, p=0.001) had markedly higher odds of developing ED compared to those with a duration of 04h. […] Our multivariate logistic regression supports that ischemic priapism duration is a strong predictor of ED development. This is consistent with AUA guidelines recommending that providers counsel patients that the likelihood of erectile function recovery is low after events lasting 36h or longer.

• #18 Priapism: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/437237-overview

  Prognosis depends on the duration of the episode, the patient’s age, and the underlying pathology. Duration is the single most important factor affecting outcome. A Scandinavian study reported that 92% of patients with priapism for less than 24 hours remained potent, while only 22% of patients with priapism that lasted longer than 7 days remained potent.

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