Andrea Salonia1, Ian Eardley2, François Giuliano3, Dimitrios Hatzichristou4, Ignacio Moncada5, Yoram Vardi6, Eric Wespes7, Konstantinos Hatzimouratidis8. 1. Department of Urology, University Vita-Salute San Raffaele, Milan, Italy. 2. Department of Urology, St. James University Hospital, Leeds, UK. 3. Versailles Saint Quentin en Yvelines University, Garches, France, Neurology-Urology-Andrology, Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France. 4. Aristotle University of Thessaloniki, Centre for Sexual and Reproductive Health and 2nd Department of Urology, Thessaloniki, Greece. 5. Department of Urology, Hospital Sanitas La Zarzuela, Madrid, Spain. 6. Neuro-Urology Unit, Rambam Healthcare Campus, and the Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel. 7. Department of Urology, CHU de Charleroi, Hôpital Erasme, Brussels, Belgium. 8. 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: promahon@otenet.gr.
Abstract
CONTEXT: Priapism is defined as a penile erection that persists beyond or is unrelated to sexual interest or stimulation. It can be classified into ischaemic (low flow), arterial (high flow), or stuttering (recurrent or intermittent). OBJECTIVE: To provide guidelines on the diagnosis and treatment of priapism. EVIDENCE ACQUISITION: Systematic literature search on the epidemiology, diagnosis, and treatment of priapism. Articles with highest evidence available were selected to form the basis of these recommendations. EVIDENCE SYNTHESIS: Ischaemic priapism is usually idiopathic and the most common form. Arterial priapism usually occurs after blunt perineal trauma. History is the mainstay of diagnosis and helps determine the pathogenesis. Laboratory testing is used to support clinical findings. Ischaemic priapism is an emergency condition. Intervention should start within 4-6h, including decompression of the corpora cavernosa by aspiration and intracavernous injection of sympathomimetic drugs (e.g. phenylephrine). Surgical treatment is recommended for failed conservative management, although the best procedure is unclear. Immediate implantation of a prosthesis should be considered for long-lasting priapism. Arterial priapism is not an emergency. Selective embolization is the suggested treatment modality and has high success rates. Stuttering priapism is poorly understood and the main therapeutic goal is the prevention of future episodes. This may be achieved pharmacologically, but data on efficacy are limited. CONCLUSIONS: These guidelines summarise current information on priapism. The extended version are available on the European Association of Urology Website (www.uroweb.org/guidelines/). PATIENT SUMMARY: Priapism is a persistent, often painful, penile erection lasting more than 4h unrelated to sexual stimulation. It is more common in patients with sickle cell disease. This article represents the shortened EAU priapism guidelines, based on a systematic literature review. Cases of priapism are classified into ischaemic (low flow), arterial (high flow), or stuttering (recurrent). Treatment for ischaemic priapism must be prompt in order to avoid the risk of permanent erectile dysfunction. This is not the case for arterial priapism.
CONTEXT: Priapism is defined as a penile erection that persists beyond or is unrelated to sexual interest or stimulation. It can be classified into ischaemic (low flow), arterial (high flow), or stuttering (recurrent or intermittent). OBJECTIVE: To provide guidelines on the diagnosis and treatment of priapism. EVIDENCE ACQUISITION: Systematic literature search on the epidemiology, diagnosis, and treatment of priapism. Articles with highest evidence available were selected to form the basis of these recommendations. EVIDENCE SYNTHESIS: Ischaemic priapism is usually idiopathic and the most common form. Arterial priapism usually occurs after blunt perineal trauma. History is the mainstay of diagnosis and helps determine the pathogenesis. Laboratory testing is used to support clinical findings. Ischaemic priapism is an emergency condition. Intervention should start within 4-6h, including decompression of the corpora cavernosa by aspiration and intracavernous injection of sympathomimetic drugs (e.g. phenylephrine). Surgical treatment is recommended for failed conservative management, although the best procedure is unclear. Immediate implantation of a prosthesis should be considered for long-lasting priapism. Arterial priapism is not an emergency. Selective embolization is the suggested treatment modality and has high success rates. Stuttering priapism is poorly understood and the main therapeutic goal is the prevention of future episodes. This may be achieved pharmacologically, but data on efficacy are limited. CONCLUSIONS: These guidelines summarise current information on priapism. The extended version are available on the European Association of Urology Website (www.uroweb.org/guidelines/). PATIENT SUMMARY:Priapism is a persistent, often painful, penile erection lasting more than 4h unrelated to sexual stimulation. It is more common in patients with sickle cell disease. This article represents the shortened EAU priapism guidelines, based on a systematic literature review. Cases of priapism are classified into ischaemic (low flow), arterial (high flow), or stuttering (recurrent). Treatment for ischaemic priapism must be prompt in order to avoid the risk of permanent erectile dysfunction. This is not the case for arterial priapism.
Authors: Fábio H Silva; Serkan Karakus; Biljana Musicki; Hotaka Matsui; Trinity J Bivalacqua; Jean L Dos Santos; Fernando F Costa; Arthur L Burnett Journal: J Pharmacol Exp Ther Date: 2016-08-18 Impact factor: 4.030