ABSTRACT
Introduction
Priapism is a compartment syndrome, defined as an unwanted penile erection lasting longer than 4 h, unrelated to sexual stimulation, and persistent even after ejaculation/orgasm. Ischemic priapism is considered a urologic emergency requiring time-sensitive management. Studies have documented that untreated priapism is associated with progressive ischemic histological changes in the corpora cavernosa, such as widespread smooth muscle necrosis, blood vessel and nerve attrition, and trabecular fibrosis. Treatment options include conservative management, corporal irrigation, pharmacologic therapy, and surgery. We herein provide an overview of the emergency pharmacology for priapism.
Areas Covered
The American Urological Association (AUA) and the European Association of Urology (EAU) both recommend penile aspiration in conjunction with intracavernosal injection of sympathomimetics as the initial management of ischemic priapism. We have performed a retrospective review of the literature from 1914 to 2022 by using PubMed and a review of the treatment guidelines from the AUA and the EAU to discuss the various therapies for ischemic priapism in the emergent setting.
Expert Opinion
After a thorough overview of the literature regarding the treatment of ischemic priapism in the emergent setting, we conclude that intracavernosal phenylephrine is superior to other agents due to its demonstrated efficacy and limited systemic side effects.
Acknowledgments
The authors wish to thank Dr. Scott Bailey (Tulane University School of Medicine, Department of Urology) for his efforts in editing and preparing this manuscript.
Article highlights
Priapism is a compartment syndrome, defined as an undesired penile erection lasting longer than 4 h, unrelated to sexual stimulation, and persistent even after ejaculation/orgasm.
We performed a retrospective review of the literature from 1914 to 2022 by using PubMed and a review of the treatment guidelines from the AUA and the EAU to discuss the various therapies for ischemic priapism in the emergent setting.
The American Urological Association (AUA) and the European Association of Urology (EAU) both recommend corporal aspiration and sympathomimetic injections as the initial management of ischemic priapism.
Of the agents reviewed, phenylephrine has consistently proven to be superior in the treatment of ischemic priapism.
Future directions of therapy should focus on the prevention of future episodes of priapism, especially for individuals who are at increased risk of recurrent ischemic priapism.
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Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Correction Statement
This article has been republished with minor changes. These changes do not impact the academic content of the article.