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1. PRIAPISM
DR KAYULA
JRMO CHIPATA CENTRAL HOSPITAL

2. OUTLINE
• Introduction
• Aetiology
• Pathophysiology
• Classification
• Investigations
• Management
• References

3. INTRODUCTION
• Persistent erection of the penis that is not related to sexual arousal and is not
relieved by ejaculation
• Urologic emergency
• Requires early intervention to prevent complications
• Can occur at any age but commonly has a bimordal age distribution

4. AETIOLOGY
• Primary/idiopathic
• Secondary
1. Hematologic conditions
2. Pharmacological (psychotropics eg SSIs, intracarvenosal agents
3. Recreational drugs e.g cocaine
4. Trauma

5. PATHOPHYSIOLOGY
• Role of NO
• Normal erection v priapism
• Low flow v high flow
• Low flow- (impaired relaxation of corpora carvenosa, excessive release of
neurotransmitters, or blockage of draining venules
• High flow generally results from uncontrolled influx of blood

6. CLASSIFICATION
• Low flow: commonest type, characterised by pain, rigid erection, ischemic
corpora, no evidence of trauma
• High flow: less common, well oxygenated corpora, evidence of trauma, pain+/-

7. HISTORY AND PHYSICAL EXAMINATION
• Duration
• Pain
• Onset
• Prior episodes
• Drug history
• Recreational drugs
• Penile trauma
• Comobidities

8. WORK UP
• .fbc/dc
• PBG
• Sickling test
• Urine toxicology
• Penile doppler
• Clinical diagnosis

9. MANAGEMENT
• Depends on the type
• Medical and surgical interventions
• Stepwise approach
• American urological association (AUA) algorithm
• Identification and treatment of reversible causes

11. LOW FLOW
Medical
• Intracarvenosal sympathomimetic agents
Aspiration with/or without irrigation
Surgical
• Distal shunts(Winter shunt, El-Ghorab, Barry shunt,
• Proximal shunts(Quarckel shunt, Grayhack shunt,

12. REFERENCES
• Burnett AL, Anele UA, Derogatis LR. Priapism Impact Profile Questionnaire:
Development and Initial Validation. Urology 2015; 85:1376.
• Roberts JR, Price C, Mazzeo T. Intracavernous epinephrine: a minimally invasive
treatment for priapism in the emergency department. J Emerg Med 2009; 36:285.
• Bivalacqua TJ, Allen BK, Brock G, et al. Acute Ischemic Priapism: An AUA/SMSNA
Guideline. J Urol 2021; 206:1114.