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Volume 15, Issue 1 (January 2013) 15, 20–26; 10.1038/aja.2012.83

A pathophysiology-based approach to the management of early priapism

Jason R Kovac1, Siu K Mak2, Maurice M Garcia3 and Tom F Lue3

1 Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
2 The Chinese University of Hong Kong, Department of Surgery, Prince of Wales Hospital, Hong Kong, China
3 Department of Urology, University of California, San Francisco, CA 94143, USA

Correspondence: Dr TF Lue, (tlue@urology.ucsf.edu)

Received 11 July 2012; Revised 11 August 2012; Accepted 11 September 2012 Advance online publication 3 December 2012


Priapism is a rare condition that involves persistent penile erection for greater than 4 h. Distinct variants exist, each with unique characteristics. Ischemic priapism is a painful medical emergency that may occur as a result of veno-occlusion leading to hypoxia and tissue death. Recurrent bouts of ischemic priapism, or stuttering priapism, require treatment for individual attacks as well as long-term prevention. Non-ischemic priapism is associated with trauma and may be managed conservatively. Recent advances into the pathophysiology of priapism have allowed the development of treatment algorithms that specifically target the mechanisms involved. In this review, we outline the basics of smooth muscle contraction and describe how derangement of these pathways results in priapism. A pathophysiological approach to the treatment of priapism is proposed with duration-based algorithms presented to assist in management.

Keywords: algorithm; ischemic; management; priapism; T-shunt; tunneling

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