Priapizmus

Priapizmus, often referred to in English as priapism, is a medical condition defined by a prolonged penile erection that persists for four hours or more and is not related to sexual stimulation. It is considered an emergency because extended erection can lead to tissue damage and potential permanent erectile dysfunction if not treated promptly.

There are two main types of priapizmus. Ischemic (low-flow) priapism is the more common and typically painful form. It results from restricted venous outflow from the corpora cavernosa, causing the penis to remain rigid and tender. Nonischemic (high-flow) priapism usually follows penile or perineal trauma and is often less painful; it involves unregulated arterial inflow and typically does not develop the same degree of hypoxia as the ischemic type.

Causes and risk factors vary. Ischemic priapism can be associated with sickle cell disease, leukemia, other hematologic disorders, or medications such as trazodone, certain antipsychotics, and phosphodiesterase-5 inhibitors. Nonischemic priapism may follow pelvic or penile trauma, surgery, or vascular abnormalities. Substance use (cocaine, alcohol) and spinal cord injuries are also implicated. In some cases, the cause remains unknown.

Diagnosis rests on clinical presentation and differentiation between ischemic and nonischemic forms. Physical examination, penile blood gas analysis, and Doppler ultrasound can help distinguish low-flow from high-flow priapism. Imaging may be used to identify a fistula or other vascular problem in nonischemic cases.

Treatment aims to restore normal blood flow and prevent lasting damage. Ischemic priapism often requires urgent urologic intervention, including aspiration of blood from the corpora cavernosa with irrigation, and intracavernosal vasoconstrictors such as phenylephrine. If these measures fail, surgical shunts or reconstruction may be considered. Nonischemic priapism is frequently observed or managed with arterial embolization if persistent. Prognosis improves with prompt treatment; delays increase the risk of erectile dysfunction.