Skip to main content

Priapism

  • Chapter
  • First Online:
Cancer and Sexual Health

Part of the book series: Current Clinical Urology ((CCU))

  • 1597 Accesses

Abstract

Priapism represents one of the greatest challenges in therapeutic management among erectile disorders [1]. Priapism is defined as a prolonged and persistent penile erection lasting greater than 4 h, unassociated with sexual interest or stimulation [2, 3]. It constitutes a true disorder of erection physiology, associated with risks of structural damage to the penis and permanent erectile dysfunction. It results from a disturbance in the mechanisms governing the regulatory control of penile detumescence and initiation/maintenance of penile flaccidity. However, the disorder is a poorly recognized condition by many medical professionals [3].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 279.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Berger R, Billups K, Brock G, Brock G, Broderick GA, Dhabuwala CB, et al. Report of the American Foundation for Urologic Disease (AFUD) thought leader panel for evaluation and treatment of priapism. Int J Impot Res. 2001;13 Suppl 5:S39–43.

    PubMed  Google Scholar 

  2. Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. Members of the Erectile Dysfunction Guideline Update Panel. American Urological Association guideline on the management of priapism. J Urol. 2003;170:1318–24.

    Article  PubMed  Google Scholar 

  3. Burnett AL, Bivalacqua TJ. Priapism: current principles and practice. Urol Clin North Am. 2007;34:631–42.

    Article  PubMed  Google Scholar 

  4. Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, Shamloul R. Priapism: pathogenesis, epidemiology and management. J Sex Med. 2009;7(1 Pt 2):476–500.

    Google Scholar 

  5. Monllor J, Tano F, Arteaga PR, Galbis F. Priapism of the clitoris. Eur Urol. 1996;30:521–2.

    PubMed  CAS  Google Scholar 

  6. Sharpsteen Jr JR, Powars D, Johnson C, Rogers ZR, Williams WD, Posch RJ. Multisystem damage associated with tricorporal priapism in sickle cell disease. Am J Med. 1993;94:289–95.

    Article  PubMed  Google Scholar 

  7. Andersson KE, Wagner G. Physiology of penile erection. Physiol Rev. 1995;75:191–236.

    PubMed  CAS  Google Scholar 

  8. Bivalacqua TJ, Burnett AL. Priapism. In: Graham SD, Glenn JF, editors. Glenn’s urologic surgery. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010. p. 487–91.

    Google Scholar 

  9. Pryor JP, Hehir M. The management of priapism. Br J Urol. 1982;54:751.

    Article  PubMed  CAS  Google Scholar 

  10. Emond AM, Holman R, Hayes RJ, Serjeant GR. Priapism and impotence in homozygous sickle cell disease. Arch Intern Med. 1980;140:1434–7.

    Article  PubMed  CAS  Google Scholar 

  11. Burnett AL. Priapism. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia, PA: Saunders Elsevier; 2007. p. 839–49.

    Google Scholar 

  12. Kulmala R, Lehtonen T, Tammela TL. Priapism, its incidence and seasonal disturbances in Finland. Scand J Urol Nephrol. 1995;29:93–6.

    Article  PubMed  CAS  Google Scholar 

  13. Eland IA, Van Der Lei J, Stricker BHC, Sturkenboom MJCM. Incidence of priapism in the general population. Urology. 2001;57:970–2.

    Article  PubMed  CAS  Google Scholar 

  14. Earle CM, Stuckey BGA, Ching HL, Wisniewski ZS. The incidence and management of priapism in western Australia: a 16 year audit. Int J Impot Res. 2003;15:272–6.

    Article  PubMed  CAS  Google Scholar 

  15. Fowler Jr JE, Koshy M, Strub M, Chinn SK. Priapism associated with the sickle cell hemoglobinopathies: prevalence, natural history and sequelae. J Urol. 1991;145:65–8.

    PubMed  Google Scholar 

  16. Mantadakis E, Cavender JD, Rogers ZR, Ewalt DH, Buchanan GR. Prevalence of priapism in children and adolescents with sickle cell anemia. J Pediatr Hematol Oncol. 1999;21:518–22.

    Article  PubMed  CAS  Google Scholar 

  17. Adeyoju AB, Olujohungbe ABK, Morris J, Yardumian A, Bareford D, Akenova A, et al. Priapism in ­sickle-cell disease; incidence, risk factors and ­complications – an international multicentre study. BJU Int. 2002;90:898–902.

    Article  PubMed  CAS  Google Scholar 

  18. Aliyu ZY, Kato GJ, Taylor J, Babadoko A, Mamman AI, Gordeuk VR, et al. Sickle cell disease and pulmonary hypertension in Africa: a global perspective and review of epidemiology, pathophysiology, and management. Am J Hematol. 2008;83:63–70.

    Article  PubMed  Google Scholar 

  19. Bennett N, Mulhall J. Sickle cell disease status and outcomes of African-American men presenting with priapism. J Sex Med. 2008;5(5):1244–50.

    Article  PubMed  Google Scholar 

  20. Burnett AL. Pathophysiology of priapism: dysregulatory erection physiology thesis. J Urol. 2003;170:26–34.

    Article  PubMed  Google Scholar 

  21. Van Der Horst C, Stuebinger H, Seif C, Melchior D, Martínez-Portillo FJ, Juenemann KP. Priapism – etiology, pathophysiology and management. Int Braz J Urol. 2003;29:391–400.

    PubMed  Google Scholar 

  22. Bivalacqua TJ, Burnett AL. Priapism: new concepts in the pathophysiology and new treatment stratagies. Curr Urol Rep. 2006;7:497–502.

    Article  PubMed  Google Scholar 

  23. Hinman Jr F. Priapism; reasons for failure of therapy. J Urol. 1960;83:420–8.

    PubMed  Google Scholar 

  24. Winter CC, McDowell G. Experience with 105 patients with priapism: update review of all aspects. J Urol. 1988;140:980–3.

    PubMed  CAS  Google Scholar 

  25. Pond HS. Priapism as the presenting complaint of myelogenous leukemia: case report and review of the physiology of erection and the pathophysiology and treatment of priapism. South Med J. 1969;62:465–7.

    Article  PubMed  CAS  Google Scholar 

  26. Larocque MA, Cosgrove MD. Priapism: a review of 46 cases. J Urol. 1974;112:770–3.

    PubMed  CAS  Google Scholar 

  27. Brown JA, Nehra A. Erythropoietin-induced recurrent veno-occlusive priapism associated and end-stage renal disease. Urology. 1998;52:328–30.

    Article  PubMed  CAS  Google Scholar 

  28. Klein EA, Montague DK, Steiger E. Priapism associated with the use of intravenous fat emulsion: case reports and postulated pathogenesis. J Urol. 1985;133:857–9.

    PubMed  CAS  Google Scholar 

  29. Hebuterne X, Frere AM, Bayle J, Rampal P. Priapism in a patient treated with total parenteral nutrition. JPEN J Parenter Enteral Nutr. 1992;16:171–4.

    Article  PubMed  CAS  Google Scholar 

  30. Fassbinder W, Frei U, Issantier R, Koch KM, Mion C, Shaldon S, et al. Factors predisposing to priapism in haemodialysis patients. Proc Eur Dial Transplant Assoc. 1976;12:380–6.

    PubMed  CAS  Google Scholar 

  31. Bschleipfer TH, Hauck EW, Diemer TH, Bitzer M, Kirkpatrick Ch J, Pust RA, et al. Heparin-induced priapism. Int J Impot Res. 2001;13:357–9.

    Article  PubMed  CAS  Google Scholar 

  32. Burt FB, Schirmer HK, Scott WW. A new concept in the management of priapism. J Urol. 1960;83:60–1.

    PubMed  CAS  Google Scholar 

  33. Hauri D, Spycher M, Brűhlmann W. Erection and priapism: a new physiopathological concept. Urol Int. 1983;38:138–45.

    Article  PubMed  CAS  Google Scholar 

  34. Winter CC. Priapism. Urol Surv. 1978;28:163–6.

    PubMed  CAS  Google Scholar 

  35. Llado J, Peterson LJ, Fair WR. Priapism of the proximal penis. J Urol. 1980;123:779–80.

    PubMed  CAS  Google Scholar 

  36. Witt MA, Goldstein I, Saenz de Tejada I, Greenfield A, Krane RJ. Traumatic laceration of intracavernosal arteries: the pathophysiology of nonischemic, high flow, arterial priapism. J Urol 1990;143:129–32.

    Google Scholar 

  37. Ricciardi Jr R, Bhatt GM, Cynamon J, Bakal CW, Melman A. Delayed high flow priapism: pathophysiology and management. J Urol. 1993;149:119–21.

    PubMed  Google Scholar 

  38. De Jesus LE, Dekermacher S. Priapism in children: review of pathophysiology and treatment. J Pediatr (Rio J). 2009;85(3):194–200.

    Article  Google Scholar 

  39. Dubocq FM, Tefilli MV, Grignon DJ, Ponte JE, Dhabuwala CB. High flow malignant priapism with isolated metastasis to the corpora cavernosa. Urology. 1998;51:324–6.

    Article  PubMed  CAS  Google Scholar 

  40. Brock G, Breza J, Lue TF, Tanagho EA. High flow priapism: a spectrum of disease. J Urol. 1993;150(160):969–71.

    Google Scholar 

  41. Burgu B, Talas H, Erdeve O, Karagol BS, Fitoz S, Soygur TY. Approach to newborn priapism: a rare entity. J Pediatr Urol. 2007;3:509–11.

    Article  PubMed  Google Scholar 

  42. Liguori G et al. High flow priapism secondary to Nesbit operation: management by percutaneous embolization and colour Doppler guided compression. Int J Impot Res. 2005;17:304–6.

    Article  PubMed  CAS  Google Scholar 

  43. Wolf JS, Lue TF. High flow priapism and glans hypervascularization following deep dorsal vein arterialization for vasculogienc impotence. Urol Int. 1992;49:227–9.

    Article  PubMed  Google Scholar 

  44. Burnett AL, Bivalacqua TJ, Champion HC, Musicki B. Long-term oral phosphodiesterase 5 inhibitor therapy alleviates recurrent priapism. Urology. 2006;67:1043–8.

    Article  PubMed  Google Scholar 

  45. Spycher MA, Hauri D. The ultrastructure of the erectile tissue in priapism. J Urol. 1986;135:142–7.

    PubMed  CAS  Google Scholar 

  46. Mantadakis E, Ewalt DH, Cavender JD, Rogers ZR, Buchanan GR. Outpatient penile aspiration and epinephrine irrigation for young patients with sickle cell anemia and prolonged priapism. Blood. 2000;95:78–82.

    PubMed  CAS  Google Scholar 

  47. Chinegwundoh FI, Anie KA. Treatments for priapism in boys and men with sickle cell disease. Cochrane Database Syst Rev. 2004;18(4):CD004198.

    Google Scholar 

  48. Gbadoe AD, Assimadi JK, Segbena YA. Short period of administration of diethylstilbestrol in stuttering priapism in sickle cell anemia. Am J Hematol. 2002;69:297–8.

    Article  PubMed  Google Scholar 

  49. Shamloul R, el Nashaar A. Idiopathic stuttering priapism treated successfully with low-dose ethinyl estradiol: a single case report. J Sex Med. 2005;2:732–4.

    Article  PubMed  Google Scholar 

  50. Levine LA, Guss SP. Gonadotropin releasing hormone analogues in the treatment of sickle cell anemia-associated priapism. J Urol. 1993;150:475–7.

    PubMed  CAS  Google Scholar 

  51. Steinberg J, Eyre RC. Management of recurrent priapism with epinephrine self-injection and gonadotropin-releasing hormone analogue. J Urol. 1995;153:152–3.

    Article  PubMed  CAS  Google Scholar 

  52. Costabile RA. Successful treatment of stutter priapism with an antiandrogen. Tech Urol. 1998;4:167–8.

    PubMed  CAS  Google Scholar 

  53. Dahm P, Rao DS, Donatucci CF. Antiandrogens in the treatment of priapism. Urology. 2002;59:138.

    Article  PubMed  Google Scholar 

  54. Yamashita N, Hisasue S, Kato R, Masumori N, Takahashi A, Itoh N, et al. Idiopathic stuttering priapism: recovery of detumescence mechanism with temporal use of antiandrogen. Urology. 2004;63:1182–4.

    Article  PubMed  Google Scholar 

  55. Rachid-Filho D, Cavalcanti AG, Favorito LA, Costa WS, Sampaio FJ. Treatment of recurrent priapism in sickle cell anemia with finasteride: a new approach. Urology. 2009;74(5):1054–7.

    Article  PubMed  Google Scholar 

  56. Bitran D, Miller SA, McQuade DB, Leipheimer RE, Sachs BD. Inhibition of sexual reflexes by lumbosacral injection of a GABA-B agonist in the male rat. Pharmacol Biochem Behav. 1988;31:657–66.

    Article  PubMed  CAS  Google Scholar 

  57. Paredes RG, Agmo A. The GABA-B antagonist CGP 35348 ingibits the effects of baclofen on sexual behavior and motor coordination. Brain Res Bull. 1995;36:495–7.

    Article  PubMed  CAS  Google Scholar 

  58. Vaidyanathan S, Watt JW, Singh G, Hughes PL, Selmi F, Oo T, et al. Management of recurrent priapism in a cervical spinal cord injury patient with oral baclofen therapy. Spinal Cord. 2004;42(2):134–5.

    Article  PubMed  CAS  Google Scholar 

  59. Denys P, Mane M, Azouvi P, Chartier-Kastler E, Thiebaut JB, Bussel B. Side effects of chronic intrathecal baclofen on erection and ejaculation in patients with spinal cord lesions. Arch Phys Med Rehabil. 1998;79(5):494–6.

    Article  PubMed  CAS  Google Scholar 

  60. Rourke KF, Fischler AH, Jordan GH. Treatment of recurrent idiopathic priapism with oral baclofen. J Urol. 2002;168:2552–3.

    Article  PubMed  CAS  Google Scholar 

  61. D’Aleo G, Rifici C, Kofler M, Saltuari L, Bramanti P. Favorable response to intrathecal, but not oral, baclofen of priapism in a patient with spinal cord injury. Spine. 2009;34(3):E127–9.

    Article  PubMed  Google Scholar 

  62. Bialecki ES, Bridges KR. Sildenafil relieves priapism in patients with sickle cell disease. Am J Med. 2002;113(3):252.

    Article  PubMed  Google Scholar 

  63. Burnett AL, Bivalacqua TJ, Champion HC, Musicki B. Feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent priapism. J Sex Med. 2006;3:1077–84.

    Article  PubMed  CAS  Google Scholar 

  64. Bivalacqua TJ, Musicki B, Hsu LL, Gladwin MT, Burnett AL, Champion HC. Establishment of a transgenic sickle-cell mouse model to study the pathophysiology of priapism. J Sex Med. 2009;6(9):2494–504.

    Article  PubMed  Google Scholar 

  65. Champion HC, Bivalacqua TJ, Takimoto E, Kass DA, Burnett AL. Phosphodiesterase-5A dysregulation in penile erectile tissue is a mechanism of priapism. Proc Natl Acad Sci USA. 2005;102(5):1661–6.

    Article  PubMed  CAS  Google Scholar 

  66. Bivalacqua TJ, Musicki B, Champion HC, Burnett AL. Phosphodiesterase type 5 inhibitor therapy for priapism. In: Carson III CC, Kirby RS, Goldstein I, Wyllie MG, editors. Textbook of erectile dysfunction. Informa Healthcare: New York, NY; 2009. p. 428–33.

    Google Scholar 

  67. Lue TF, Pescatori ES. Distal cavernosum-glans shunts for ischemic priapism. J Sex Med. 2006;3:749–52.

    Article  PubMed  Google Scholar 

  68. Bochinski DJ, Deng DY, Lue TF. The treatment of priapism – when and how? Int J Impot Res. 2003;15 Suppl 5:S86–90.

    Article  PubMed  Google Scholar 

  69. Burnett AL, Pierorazio PM. Corporal “snake” maneuver: corporoglanular shunt surgical modification for ischemic priapism. J Sex Med. 2009;6:1171–6.

    Article  PubMed  Google Scholar 

  70. Rees RW, Kalsi J, Minhas S, Peters J, Kell P, Ralph DJ. The management of low-flow priapism with the immediate insertion of a penile prosthesis. BJU Int. 2002;90:893–7.

    Article  PubMed  CAS  Google Scholar 

  71. Steinhardt GF, Steinhardt E. Priapism in children with leukemia. Urology. 1981;18:604–6.

    Article  PubMed  CAS  Google Scholar 

  72. Morano SG, Latagliata R, Carmosino I, Girmenia C, Dal Forno S, Alimena G. Treatment of long-lasting priapism in chronic myeloid leukemia at onset. Ann Hematol. 2000;79:644–5.

    Article  PubMed  CAS  Google Scholar 

  73. Burgers JK, Badalament RA, Drago JR. Penile cancer: clinical presentation, diagnosis and staging. Urol Clin North Am. 1992;19:247–56.

    PubMed  CAS  Google Scholar 

  74. Hizli F, Berkmen F. Penile metastasis from other malignancies. A study of ten cases and review of the literature. Urol Int. 2006;76(2):118–21.

    Article  PubMed  Google Scholar 

  75. Bosch PC, Forbes KA, Kollin J, Golji H, Miller JB. Secondary carcinoma of the penis. J Urol. 1984;132:289–91.

    Google Scholar 

  76. Perez-Mesa C, Oxenhandler R. Metastatic tumors of the penis. J Surg Oncol. 1989;42:11–5.

    Article  PubMed  CAS  Google Scholar 

  77. Adjiman S, Flam TA, Zerbib M, Debré B, Steg A. Delayed non-urothelial metastatic lesions to the penis: a report of two cases. Eur Urol. 1989;16:391–2.

    PubMed  CAS  Google Scholar 

  78. Demuren OA, Koriech O. Isolated penile metastasis from bladder carcinoma. Eur Radiol. 1999;9:1596–8.

    Article  PubMed  CAS  Google Scholar 

  79. Escribano G, Allona A, Burgos FJ, Garcia R, Navio E, Escudero A. Cavernosography in diagnosis of metastatic tumors of the penis: 5 new cases and a review of literature. J Urol. 1987;138:1174–7.

    PubMed  CAS  Google Scholar 

  80. Robey EL, Schellhammer PF. Four cases of metastases to the penis and a review of the literature. J Urol. 1984;132:992–4.

    PubMed  CAS  Google Scholar 

  81. Peacock AH. Malignant priapism due to secondary carcinoma in the corpora cavernosum. Northwest Med. 1938;37:143–5.

    Google Scholar 

  82. Schroder-Printzen I, Vosshenrich R, Weidner W, Ringert RH. Malignant priapism in a patient with metastatic prostate adenocarcinoma. Urol Int. 1994;52:52–4.

    Article  Google Scholar 

  83. Chan PT, Begin LR, Arnold D, Jacobson SA, Corcos J, Brock GB. Priapism secondary to penile ­metastasis: a report of two cases and a review of the literature. J Surg Oncol. 1998;68:51–9.

    Article  PubMed  CAS  Google Scholar 

  84. Morano SG, Latagliata R, Carmosino I, Girmenia C, Dal Forno S, Alimena G. Treatment of long-lasting priapism in chronic myeloid leukemia at onset. Ann Hematol. 2000;79:644–5.

    Article  PubMed  CAS  Google Scholar 

  85. Morga Egea JP, Ferrero Doria R, Guzman Martinez-Valls PL, Navas Pastor J, García Ligero J, García García F, et al. Metastasis priapism. Report of 4 new cases and review of the literature. Arch Esp Urol. 2000;53:447–52.

    PubMed  CAS  Google Scholar 

  86. Hettiarachchi JA, Johnson GB, Panageas E, Drinis S, Konno S, Das AK. Malignant priapism associated with metastatic urethral carcinoma. Urol Int. 2001;66:114–6.

    Article  PubMed  CAS  Google Scholar 

  87. Abeshouse BS, Abeshouse GA. Metastatic tumors of the penis: a review of the literature and a report of two cases. J Urol. 1961;86:99–112.

    PubMed  CAS  Google Scholar 

  88. Muro Bidaurre I, Azpiazu Arnaiz P, Recarte Barriola JA, Iñaki Hernaez Manrique E. Metastatic carcinoma of the penis: clinical assessment, treatment and review of the literature. Arch Esp Urol. 1999;52:994–8.

    PubMed  CAS  Google Scholar 

  89. Paiquin AJ, Roland SI. Secondary carcinoma of the penis: a review of the literature and a report of nine new cases. Cancer. 1956;9:626–32.

    Article  Google Scholar 

  90. Shellhammer PF, Jordan GH, Schlossberg SM. Tumors of the penis. In: Campbell: urology, vol. 3. Philadelphia: Saunders; 1992. p. 1264–98.

    Google Scholar 

  91. Mukamel E, Farrer J, Smith RB, deKernion JB. Metastatic carcinoma of penis: when is total penectomy indicated? Urology. 1987;29:15–8.

    Article  PubMed  CAS  Google Scholar 

  92. Robey EL, Schelhammer PF. Four cases of metastasis to the penis and review of the literature. J Urol. 1984;132:992–4.

    PubMed  CAS  Google Scholar 

  93. Krco MJ, Jacobs SC, Lawson RK. Priapism due to solid malignancy. Urology. 1984;23:264–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Arthur L. Burnett .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Bivalacqua, T.J., Levey, H.R., Burnett, A.L. (2011). Priapism. In: Mulhall, J., Incrocci, L., Goldstein, I., Rosen, R. (eds) Cancer and Sexual Health. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-60761-916-1_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-60761-916-1_17

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60761-915-4

  • Online ISBN: 978-1-60761-916-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics