Materiały źródłowe

• #1 The Hard Facts on Drug-induced Priapism (Long-lasting Erections)

  https://www.medsafe.govt.nz/profs/PUArticles/September2014Drug_InducedPriapism.htm

  Priapism is a persistent penile erection not associated with sexual stimulation that lasts more than four hours. […] Drug-induced priapism most commonly occurs with antipsychotics and can also occur with a range of medicines. […] Priapism or any erection lasting longer than four hours requires immediate medical attention to prevent long-term complications. […] Priapism is a persistent, often painful, penile erection lasting more than four hours that is not associated with sexual interest or stimulation. […] At least 95% of all cases of priapism occur by an ischaemic (low-flow or veno-occlusive) mechanism. […] Drug-induced priapism can occur with a range of medicines; antipsychotics are the most common cause. […] The Centre for Adverse Reactions Monitoring (CARM) has received isolated reports of drug-induced priapism, including four reports with chlorpromazine and three reports with citalopram.

• #2 :: 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, and usually needs emergency management. […] Some epidemiological studies have reported the incidence of priapism to be 0.3 to 1.0 per 100,000 males per year. […] Typically, priapism occurs frequently in patients aged 40~50 years. […] The lifetime incidence rate of priapism in the SCD population is as high as 42%, and these episodes result in ED in over 30% of cases. […] Despite the low incidence of priapism, prompt evaluation and emergency management often are required.

• #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. […] Three broad categories exist for this disease: ischemic, nonischemic, and recurrent ischemic. […] 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. […] The overall incidence of priapism is estimated at 0.73 to 5.4 cases per 100,000 men per year. […] The incidence of priapism following intracavernous injection therapy for erectile dysfunction is reportedly between 1.3% and 5.3%. […] Priapism occurs 30% more frequently in the summer. […] Thirteen percent of patients who present to emergency departments with priapism are admitted. […] Priapism, by definition, is exclusively a disease of males, but rare cases of clitoral priapism have also been reported.

• #4 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. […] Priapism is relatively rare overall, but you may be more likely to have it if you have certain conditions. It occurs in 30% to 45% of people with sickle cell disease. […] Without treatment, priapism can permanently damage your penis. […] 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.

• #5 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. […] Although priapism is an uncommon condition overall, it occurs commonly in certain groups, such as people who have sickle cell disease. […] Priapism most commonly affects males in their 30s and older, but can begin in childhood for males with sickle cell disease. […] Ischemic priapism, also called low-flow priapism, is the result of blood not being able to leave the penis. Ischemic priapism is the more common type of priapism and requires immediate medical care to prevent complications caused by not getting enough oxygen to the penile tissue. […] Stuttering priapism also called recurrent or intermittent priapism is a form of ischemic priapism. It occurs more often in males who have an inherited disorder characterized by abnormally shaped red blood cells (sickle cell disease).

• #6 Priapism | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/priapism?lang=us

  The incidence of priapism is around 0.3-1.5 per 100,000 male person-years. The most common pathophysiologic type is ischemic priapism, accounting for 95% of priapism episodes. […] Priapism is a full or partial erection that persists beyond or is unrelated to sexual stimulation or desire. […] If untreated, priapism can lead to permanent damage with potential erectile dysfunction, and ischemic priapism is a surgical emergency.

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

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

  Priapism is a persistent or prolonged erection in the absence of sexual stimulation that fails to subside. It can be divided into ischaemic, non-ischaemic and stuttering priapism. The guidelines are based on three systematic reviews addressing the medical and surgical management of ischaemic and non-ischaemic priapism and the overall management of priapism related to sickle cell disease. […] Ischaemic priapism is the most common subtype of priapism, accounting for 95% of all episodes. In ischaemic priapism, there are time-dependent metabolic alterations within the corpus cavernosum progressively leading to hypoxia, hypercapnia, glucopenia and acidosis. […] Ischaemic priapism that lasts beyond 4 hours is similar to a compartment syndrome and characterised by the development of ischaemia within the closed space of the corpora cavernosa, which severely compromises the cavernosal circulation. Emergency medical intervention is required to minimise irreversible consequences, such as smooth muscle necrosis, corporal fibrosis and the development of permanent erectile dysfunction (ED).

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

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

  Non-ischaemic priapism is significantly less common than the ischaemic type, comprising only 5% of all priapism cases. The most frequent cause of non-ischaemic priapism is blunt perineal or penile trauma. […] Epidemiological data on non-ischaemic priapism are almost exclusively derived from small case series.

• #9 The role of the urologist in managing high flow priapism | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-025-01017-6

  High-flow priapism (arterial) is a prolonged erection caused by irregular cavernous arterial flow, often resulting from blunt perineal or penile trauma, or iatrogenic needle injury. This condition leads to the formation of an arteriolacunar fistula, causing unregulated arterial blood flow into the sinusoidal spaces of the penis. Unlike low-flow priapism, high-flow priapism typically presents with a partially erect, non-painful penis. […] The incidence of priapism is quite low across all types, with rates reported as 0.50.9 per 100,000 per year. HFP is detected much less frequently than low-flow priapism, approximately 5% of all priapism cases. […] While it has been traditionally believed that HFP may not require immediate treatment, prolonged HFP can lead to ED. Increased arterial blood flow and excessively high oxygen levels can result in apoptosis of corporal smooth muscle cells following HFP, affecting up to 3040% of patients. Consequently, the treatment of HFP should not be delayed.

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

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

  The duration of ischaemic priapism represents the most significant predictor for irreversible consequences, thus including ED. In this context, interventions beyond 48-72 hours of onset may help to relieve the erection and pain, but have little clinical benefit in preventing long-term ED. […] Ischaemic priapism is identified as idiopathic in most patients, while sickle cell disease is the most common cause in childhood. Ischaemic priapism occurs relatively often (about 5%) after intracavernous injections of papaverine-based combinations, while it is rare (1%) after prostaglandin E1 monotherapy. […] Priapism is rare in men who have taken PDE5Is, with only sporadic cases reported. The primary aetiology in 23% of adult cases is sickle cell disease. […] Stuttering priapism, also termed intermittent or recurrent priapism, is a distinct condition that is characterised by repetitive and painful episodes of prolonged erections. Robust epidemiological studies of stuttering priapism are lacking. However, recurrent priapism episodes are common in men with SCD (42-64%).

• #11 Outcomes of low-flow priapism and role of integrated penile prosthesis management | African Journal of Urology | Full Text

  https://afju.springeropen.com/articles/10.1186/s12301-020-00114-w

  Priapism is a relatively uncommon medical emergency. Low-flow priapism, also known as ischaemic priapism, is a persistent unwanted painful erection that lasts more than 4 h characterised by little or no cavernosal blood flow and abnormal cavernous blood gases. […] The goal of treatment of men with ischaemic priapism is to regain a detumescence state, relieve compartment syndrome and regain proper erectile function. […] Delays in treatment and refractory cases lead to cellular, molecular and morphological changes in the corpus cavernosum and, finally, permanent ED results from tissue injury. ED is the outcome in 50% of cases. However, recovery of erectile function may be seen in up to 44% of patients who experience ischaemic or low-flow priapism for 2436 h. […] Immediate placement of a penile prosthesis is a good treatment option in the setting of refractory priapism with comparable outcomes to those of patients with post-priapism ED who received prostheses. Immediate penile prosthesis insertion was further justified by the high incidence of post-priapism erectile dysfunction. […] Late post-priapism ED occurred in nearly two-thirds of recovered priapism patients, with nearly one-third requiring penile prostheses.

• #12 Priapism: Practice Essentials, Background, Pathophysiology

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

  A review of United States emergency department visits with a primary diagnosis of priapism from 2006 to 2009 determined that the annual incidence rate was 5.34 per 100,000 males. The rate of visits was 31.4% higher in summer months than in winter months. […] The frequency of priapism varies in different populations. The combination of intracavernosal agents and other drugs is the cause of approximately 67-80% of all adult priapism in the United States. The overall rate of priapism in persons using agents to treat erectile dysfunction ranges from 0.05-6%. This group tends to be better educated about the risk of priapism; therefore, they seek treatment earlier. […] In other population groups, sickle cell disease (SCD) and sickle cell trait predominate as the cause of adult priapism. The rate of priapism in adults with SCD is as high as 89%. In one study, 38-42% of adult males with SCD reported at least one episode of priapism. Approximately two thirds of all pediatric patients who have priapism also have SCD. The rate of priapism among children with SCD is as high as 27%.

• #13 Priapism: Practice Essentials, Background, Pathophysiology

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

  Internationally, the overall incidence of priapism is 1.5 cases per 100,000 person-years. In men older than 40 years, the incidence increases to 2.9 cases per 100,000 person-years. […] No racial predilection toward priapism exists. SCD, which predisposes to the development of priapism, occurs mostly in the African-American population. […] Priapism is almost exclusively a disease of males. Priapism of the clitoris has been reported but is extremely rare. […] Priapism has been described at nearly all ages, from infancy through old age. A bimodal distribution has been noted, with peaks at 5-10 years and 20-50 years. Cases in younger groups are more often associated with SCD, while those in older groups tend to be secondary to pharmacologic agents.

• #14 Priapism – UpToDate

  https://www.uptodate.com/contents/priapism

  Priapism is relatively uncommon. In a study of emergency department visits between 2006 and 2009 in the United States, there were 32,462 visits for priapism, which corresponded to an incidence of 0.73 per 100,000 men per year. Priapism can be seen in any age group. However, there is a bimodal peak distribution of incidence, occurring between 5 and 10 years in children and 20 to 50 years in adults. […] While most cases are idiopathic, the most commonly identified cause of priapism in adults is medication use, especially with intracavernosal injections for erectile dysfunction, accounting for 25 percent of cases.

• #15 Priapism – UpToDate

  https://www.uptodate.com/contents/priapism/print

  Priapism is relatively rare but can occur in all age groups and is particularly common in patients with sickle cell disease. […] Priapism is relatively uncommon. In a study of emergency department visits between 2006 and 2009 in the United States, there were 32,462 visits for priapism, which corresponded to an incidence of 0.73 per 100,000 men per year. […] Priapism can be seen in any age group. However, there is a bimodal peak distribution of incidence, occurring between 5 and 10 years in children and 20 to 50 years in adults. […] While most cases are idiopathic, the most commonly identified cause of priapism in adults is medication use, especially with intracavernosal injections for erectile dysfunction, accounting for 25 percent of cases.

• #16 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. While priapism is an uncommon disease, it is common in men with sickle cell disease. The incidence of priapism is 5.3 cases per 100,000 men annually. The disease is common with sickle cell disease, affecting 36% of males who have the disease. Ischemic priapism is known to cause tissue damage in the penis after 6 hours, making prompt diagnosis and treatment essential for proper recovery. The prognosis for priapism depends on the type of priapism and duration of symptoms. Ischemic priapism has a good prognosis if detumescence is achieved within 6 hours. The longer the duration, the more likely a patient is to develop some degree of erectile dysfunction. Ischemic priapism lasting longer than 36 hours often causes permanent loss of normal erectile function, regardless of the treatment modality. The risk of complications including penile necrosis in extreme cases increases with ischemic priapism duration. Most complications of priapism are seen in ischemic but not nonischemic disease. Erectile dysfunction is perhaps the most common complication. The risk of erectile dysfunction increases with the duration of ischemic priapism. Duration of ischemic priapism is the primary determinant of complication severity. At 6 hours, early damage to penile tissue begins. At 12 hours, irreversible damage to corporal smooth muscle occurs. Cellular damage to the basement membrane and sinusoidal endothelium occurs at 24 hours. Within 36 hours, fibrosis and permanent erectile dysfunction begin.

• #17 Priapism | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/116486/all/Priapism?q=Thalassemia

  Penile (or less common clitoral) erection lasting for 4 hours and unrelated to sexual stimulation or arousal. […] About 5.3 per 100,000 men per year. […] There has been an age shift since 2008 toward men in their 40s. The incidence doubles in men aged 40 years (2.9 vs. 1.5/100,000 person-years). […] 61.1% African American (correlated with incidence of SCD), 30% Caucasian, 6.3% Hispanic.

• #18 Priapism – StatPearls – NCBI Bookshelf

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

  Sickle cell disease also accounts for a large number of cases of adult priapism, with rates reported between 40% and 80%. […] The majority of sickle cell cases of priapism occur in African Americans. […] The disorder has a bimodal presentation with peaks at ages 7 to 10 and 20 to 50 years. […] Younger people tend to have priapism due to sickle cell disease, while medication effects are a more common etiology in older populations. […] Rates of priapism following intracavernous injection therapy are higher in younger men as well as in patients with neurogenic or psychogenic erectile dysfunction.

• #19

  https://journals.lww.com/ursc/fulltext/2018/29010/interventional_management_of_low_flow_priapism__a.2.aspx

  Priapism epidemiology is variable and depends on the populations being considered. This regional variation may be multifactorial and could be explained by fluctuations in black and Hispanic populations, as well as by climatic variability. In Western populations, agents to treat erectile dysfunction are common causes of adult priapism. In other populations, sickle cell disease predominates as the cause of adult priapism. […] Studies have shown that priapism occurs at nearly all ages with a bimodal distribution with peaks at 5-10 years and 20-50 years. Kulmala et al., in a study of 193 cases of priapism over 26 years in the Finnish population, showed a baseline incidence of 0.30-0.52/100,000 person-years. In the United States, the incidence of priapism has been estimated to be 5.3/100,000 person-years, with ischemic priapism (associated with hyperviscosity syndromes such as sickle cell disease) being the most frequent type of priapism. In the Netherlands, a retrospective cohort composed of 145,071 males found that priapism occurred mainly in men 40 years or older and that the overall incidence rate was 1.5/100,000 person-years. Similar results were found in Australia, where the reported incidence was 0.84/100,000 person-years. In Japan, the incidence of priapism has been estimated to be 0.13/100,000 person-years, which is lower than that in other parts of the world; the lower incidence may be explained by racial differences since there were no patients with sickle cell disease among the Japanese population.

• #20 What Are the Most Common Causes of Painful Erections? – ISSM

  https://www.issm.info/sexual-health-qa/what-are-the-most-common-causes-of-painful-erections

  Painful erections can cause distress and significantly affect a mans sexual health and quality of life. While it may not be a frequent topic of conversation, the issue is more common than many might think. Understanding the most common causes of painful erections can help men seek appropriate treatment and alleviate discomfort. […] Priapism is a condition characterized by prolonged and often painful erections that last for more than four hours and occur without sexual stimulation. There are two types of priapism: ischemic and non-ischemic. Ischemic priapism, also known as low-flow priapism, occurs when blood becomes trapped in the erectile tissue of the penis and cannot flow out. This form of priapism is often painful and considered a medical emergency because prolonged ischemia (lack of blood flow) can cause permanent damage to the tissue.

• #21 Epidemiology and treatment of priapism in sickle cell disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9820196/

  Ischemic priapism is a common but underrecognized morbidity affecting about 33% of adult men with sickle cell disease (SCD). […] The diagnosis of priapism is clinical. Many episodes of priapism will resolve spontaneously, but when an episode lasts longer than 4 hours, the episode is considered a urologic emergency requiring quick intervention with either corporal aspiration or shunt surgery. […] The current molecular understanding of the pathobiology of priapism suggests a relative nitric oxide (NO) deficiency secondary to chronic hemolysis in SCD and associated phosphodiesterase type 5 dysregulation. […] Priapism is associated with mental health morbidity, including anxiety and depression. […] An individual’s inadequate knowledge of priapism, in addition to the shame and embarrassment, may contribute to about 50% of affected individuals failing to seek medical intervention or even discuss the complication with their clinicians and relatives.

• #22 Epidemiology and treatment of priapism in sickle cell disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9820196/

  The burden of severe erectile dysfunction is 2.5-fold higher among men with SCD compared with men without SCD and about 5-fold higher among those with a history of priapism. […] There are no clinical algorithms to predict who would have priapism; however, a history of recent priapism in the past 12 months is a risk factor for recurrence in SCD. […] Men with SCD benefit from secondary prevention to forestall catastrophic complications associated with priapism, such as erectile dysfunction, penile scarring, and mental health morbidity. […] The double-blind, placebo-controlled trial comparing a 50-mg morning dose of sildenafil with equivalent placebo failed to demonstrate the primary efficacy end point of 50% reduction in priapism frequency. […] The US Food and Drug Administration approved hydroxyurea for preventing vaso-occlusive events in children and adults with SCA. Additionally, hydroxyurea has been reported to reduce priapism events in small case series.

• #23 Priapism | Diagnosis & Disease Information

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

  In addition to sickle cell disease, other hematologic disorders have been linked to ischemic (acute and recurrent) priapism. These include thalassemia and polycythemia. Oncologic disorders associated with ischemic priapism include multiple myeloma and chronic myelogenous or lymphocytic leukemias. Conditions that lead to hypercoagulable states including COVID-19 have also been associated with ischemic priapism.

• #24 Priapism at Diagnosis of Pediatric Chronic Myeloid Leukemia: Data Derived from a Large Cohort of Children and Teenagers and a Narrative Review on Priapism Management

  https://www.mdpi.com/2077-0383/12/14/4776

  Priapism is observed in all age groups from newborn to elderly and has an incidence of 1.5 per 100,000. […] While mostly seen in males with sickle cell disease, it may be the initial symptom of hyperleukocytosis in leukemias such as CML. […] In a recent literature-based analysis covering the period from 1960 to 2020, E. Ali and coworkers analyzed 68 publications including case reports and case series on a total of 102 patients with priapism and CML. […] In the, so far, largest pediatric cohort described and analyzed here, 16 out of 491 (3.2%) boys presented with priapism at diagnosis of CML, a proportion which is twice as high compared with the report from Japan. […] Priapism can be the first manifestation of previously undetected CML. It is a very rare event in boys requiring urgent emergency therapy to avoid the risk of erectile dysfunction.

• #25 Case Report: Severe ischemic priapism as the… | F1000Research

  https://f1000research.com/articles/12-1487

  Priapism in leukemia is caused by a buildup of white blood cells that slows down blood flow, disrupting the balance of nitric oxide and cGMP, leading to an occlusion and prolonged lack of blood flow. […] Early and timely intervention is necessary to treat priapism, which can negatively impact response to treatment and erectile function.

• #26 The assessment and aetiology of drug-induced ischaemic priapism | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-024-01006-1

  Ischaemic priapism is a urological emergency characterised by a prolonged, painful erection unrelated to sexual stimulation. […] Ischaemic priapism has an incidence of 5.34 per 100,000 males and is the most common presentation of priapism, accounting for 95% of cases. […] Today, drug-induced ischaemic priapism is the most common. […] Of the many aetiologies of ischaemic priapism, drug-induced ischaemic priapism is now the most common cause of ischaemic priapism. […] Drug-induced ischaemic priapism is commonly associated with antidepressants, antipsychotics and antihypertensive medications, which account for approximately 15-41% of all cases, of which antipsychotic-induced ischaemic priapism is most common, accounting for 50% of drug-induced instances. […] The timely diagnosis and treatment of ischemic priapism have a direct effect on long-term erectile function.

• #27 Priapism: Symptoms, Causes, and Diagnosis

  https://www.healthline.com/health/priapism

  Priapism is a condition of persistent and painful erections that can last for 4 hours or more without sexual stimulation. It often requires treatment to prevent permanent damage, which may involve cold therapy, medications, or surgery. […] Priapism can be caused by certain medications and health conditions. It is uncommon, but when it occurs, it typically affects males in their 30s. […] An erection that lasts longer than 4 hours is a medical emergency. The oxygen-deprived blood in your penis can damage tissue in the penis. Untreated priapism can result in damage or destruction of the penile tissue and permanent erectile dysfunction. […] In fact, it’s estimated that ischemic priapism affects about 33% of adults with sickle cell anemia. […] According to a 2021 review, drug-induced priapism is the most common cause of priapism. What’s more, antipsychotic medications are considered one of the main drugs that cause priapism and are believed to account for about 50% of all cases of drug-induced priapism.

• #28 Priapism – Symptoms & causes – Mayo Clinic

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

  If you experience recurrent, persistent, painful erections that resolve on their own, see your doctor. You might need treatment to prevent further episodes. […] Priapism occurs when some part of this system the blood, vessels, smooth muscles or nerves changes normal blood flow, and an erection persists. […] Blood-related diseases might contribute to priapism usually ischemic priapism, when blood isn’t able to flow out of the penis. […] Priapism, usually ischemic priapism, is a possible side effect of a number of drugs. […] Alcohol, marijuana, cocaine and other drugs can cause priapism, particularly ischemic priapism. […] A common cause of nonischemic priapism is trauma or injury to your penis, pelvis, or the region between the base of the penis and the anus (perineum). […] Ischemic priapism can cause serious complications. The blood trapped in the penis is deprived of oxygen. […] Untreated priapism can cause erectile dysfunction.

• #29 The Hard Facts on Drug-induced Priapism (Long-lasting Erections)

  https://www.medsafe.govt.nz/profs/PUArticles/September2014Drug_InducedPriapism.htm

  Internationally, there have been published case reports of priapism associated with medicines such as risperidone, quetiapine, sildenafil and olanzapine. […] Although priapism appears to be a very rare reaction, all male patients who are prescribed medicines that may cause priapism should be advised of the signs and symptoms. […] Priapism or any erection lasting longer than four hours with or without sexual stimulation requires immediate medical attention to prevent long-term complications.

• #30 The Hard Facts on Drug-induced Priapism (Long-lasting Erections)

  https://www.medsafe.govt.nz/profs/PUArticles/September2014Drug_InducedPriapism.htm

  Priapism is a persistent penile erection not associated with sexual stimulation that lasts more than four hours. […] Drug-induced priapism most commonly occurs with antipsychotics and can also occur with a range of medicines. […] Priapism or any erection lasting longer than four hours requires immediate medical attention to prevent long-term complications. […] Priapism is a persistent, often painful, penile erection lasting more than four hours that is not associated with sexual interest or stimulation. […] At least 95% of all cases of priapism occur by an ischaemic (low-flow or veno-occlusive) mechanism. […] Drug-induced priapism can occur with a range of medicines; antipsychotics are the most common cause. […] The Centre for Adverse Reactions Monitoring (CARM) has received isolated reports of drug-induced priapism, including four reports with chlorpromazine and three reports with citalopram.

• #31 Emergent Treatment of Ischemic Priapism to Avoid Sexual Dysfunction

  https://www.uspharmacist.com/article/emergent-treatment-of-ischemic-priapism-to-avoid-sexual-dysfunction

  Priapism is the occurrence of a persistent penile erection lasting 4 hours beyond orgasm, or one that is unrelated to sexual stimulation. Most episodes are idiopathic; other contributors include medication therapy or drugs of abuse, perineal trauma, and hematologic dyscrasias such as sickle cell disease. There are three subtypes of priapism, with ischemic priapism causing most cases; treatment may differ by type. Priapism may be a side effect of common medications, including antipsychotics, antidepressants, and antihypertensives, and recreational drugs including alcohol, cocaine, and marijuana. […] An estimated 8.05 per 100,000 emergency department visits, a total of 39,964 encounters, occurred during this period. This was significantly higher than prior estimates and a more accurate estimate of acute episodes of priapism.

• #32 The assessment and aetiology of drug-induced ischaemic priapism | International Journal of Impotence Research

  https://www.nature.com/articles/s41443-024-01006-1

  The prevalence of prescribed and off-label use of antipsychotic medications has been on the rise in recent years. […] Therefore, medical practitioners in all disciplines should know that early intervention and appropriate treatment are essential to prevent permanent ED and fibrosis. […] It is of concern that there has already been a proven increase in incidence in the paediatric population due to antipsychotics. […] Drug-induced ischaemic priapism is the most common cause of ischaemic priapism, and its clinical significance is underestimated, considering the widespread use of these implicated medications.

• #33 Priapism Clinical Presentation: History, Physical Examination, Complications

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

  Patients presenting with priapism will report a persistent erection. […] Low-flow, ischemic-type priapism, which comprises 95% of priapism cases, is generally painful. […] Historical features of low-flow priapism include the following: Painful. […] The most common long-term complication of priapism and its treatment is erectile dysfunction (ED). […] For patients with prolonged ischemic priapism ( 24 h), the expectation of ED should be disclosed early in the treatment course and close followup with a urologist specializing in prosthetic urology should be recommended and coordinated. […] Patients with prolonged ischemic priapism or recurrent episodes of ischemic priapism may eventually require penile implant placement to achieve penetrative intercourse. […] Incidence of priapism in emergency departments in the United States. […] Incidence of priapism in the general population.

• #34 Priapism in the ED: Pearls & Pitfalls – emDocs

  https://www.emdocs.net/priapism-ed-pearls-pitfalls/

  Priapism is a urologic emergency requiring fast and effective management by emergency physicians to prevent significant morbidity. […] Incidence estimated at 0.3 to 1.0 per 100,000 males. […] Bimodal distribution involving ages 5-10 (typically associated with sickle-cell disease or neoplasm) and 40-50 (idiopathic or caused related to pharmacologic agents). […] Lifetime incidence in homozygous sickle-cell disease estimated as high as 42%. […] Timely treatment of priapism is required to prevent erectile dysfunction. […] 90% of men with priapism lasting 24 hours will have permanent erectile dysfunction, and certain case series have reported that all men with erections lasting >36 hours will have abnormal erectile function.

• #35 Commentary on high flow, non-ischemic, priapism – Wu – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/695/html

  High-flow, non-ischemic priapism is a rare condition, with which many urologists and andrologists are unfamiliar. There are three types of high-flow priapism: traumatic, neurogenic and post-shunting. […] In general, since blood circulation into and out of the corpora cavernosa is not impeded in cases of high-flow priapism, the condition is not painful, the penis is not completely rigid, and the prognosis is excellent if it is treated properly. […] It is important to note that ALL ischemic priapism begins with increased arterial flow to the corpora cavernosa and a blood gas taken in the first few hours of priapism may not reflect the typical findings of hypoxia and acidosis seen in prolonged priapism. […] A diagnosis of high-flow, non-ischemic, priapism was made and he was treated with ketoconazole 200 mg twice per day, and prednisone 5 mg daily to suppress nocturnal erections. […] In high-flow priapism, contusion of erectile tissue around the ruptured artery always occurs. Therefore, we recommend antifibrotic agents such as pentoxifylline for 3 months to reduce fibrosis after the high-flow priapism is corrected.

• #36 Priapism | PPT

  https://www.slideshare.net/slideshow/priapism-seminar-by-drkpriyatham/70774573

  At other centers, sickle cell disease (SCD) and sickle cell trait predominate as the cause of adult priapism. The rate of priapism in adults with SCD is as high as 89%. Approximately two thirds of all pediatric patients who have priapism also have SCD. The rate of priapism among children with SCD is as high as 27%. […] Priapism is painful at onset. Corporeal fibrosis due to persistent priapism can result in deep-tissue infections of the penis. The major chronic morbidity associated with all types of priapism is persistent erectile dysfunction and impotence. The duration of symptoms is the most important factor affecting outcome. A recent 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.

• #37 Priapism | Texas DSHS

  https://www.dshs.texas.gov/newborn-screening-program/sickle-cell-disease/more-about-sickle-cell/priapism

  Priapism is a persistent, unwanted erection of the penis. […] Repeated episodes of this type of priapism are common and occur in up to 40% of patients. […] Without medical treatment, severe priapism can lead to partial or complete impotence in over 80% of cases. […] Specific causes of priapism in patients with sickle cell anemia are unknown. […] There is no current program or therapy to prevent attacks of priapism.

• #38 A Novel Hypothesis Explaining Sleep-related Painful Erections – American Urological Association

  https://auanews.net/issues/articles/2022/december-2022/a-novel-hypothesis-explaining-sleep-related-painful-erections

  In contrast, sleep-related painful erection (SRPE) is a rare form of nocturnal penile tumescence where the patient’s sleep is disrupted (parasomnia), awakening with a bothersome painful erection. […] Epidemiologically, SRPE has been reported in 1% of men presenting with sexual dysfunction. […] The mean age at SRPE diagnosis is 40 years. […] In our experience these painful nocturnal erections range from severe to uncomfortable. […] The disrupted sleep leads to irritability, anxiety, depression, and disturbance of daytime performance. […] While several mechanisms have been proposed, the pathophysiology of SRPE remains unknown. […] We hypothesize that SRPE occurs due to sacral irritative radiculopathy of the visceral afferent and efferent pelvic nerve roots in the cauda equina from lumbosacral disc disease, in conjunction with the reduced sympathetic tone that likely occurs upon awakening from REM sleep.

• #39 Epidemiology and treatment of priapism in sickle cell disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9820196/

  Three controlled clinical trials were conducted in SCD to demonstrate evidence for secondary prevention. None of the trials addressed the treatment effect on acute priapism. […] To our knowledge, no clinical trial has been conducted on primary prevention or acute treatment of priapism in SCD. […] Priapism is an underreported and underrecognized serious complication of SCD among males of all ages, with no evidence-based primary and secondary prevention.

• #40

  https://www.msjonline.org/index.php/ijrms/article/view/12532

  This case report discusses a 23-year-old male with recurrent priapism and its management. Priapism, defined as prolonged and painful penile erection, can lead to severe complications including permanent erectile dysfunction (ED) and penile deformities. […] The report introduces the notion of pre-operative aspirin and post-operative heparin to prevent shunt closure, though guidelines do not currently support this approach. […] This case emphasizes the need for further studies to validate the efficacy of anti-platelet therapy as part of priapism management.

• #41 Advances in the understanding of priapism – Hudnall – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/14428/html

  As the mechanisms underpinning recurrent ischemic priapism become clearer, additional opportunities for pharmacologic intervention and management will arise. The primary goal of pharmacologic management of recurrent ischemic priapism is to prevent additional episodes that increase the risk of progression to a major ischemic priapism event.

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