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. 2015 Jun 4;125(23):3551-8.
doi: 10.1182/blood-2014-09-551887. Epub 2015 Mar 25.

How I treat priapism

Uzoma A Anele  1 , Brian V Le  1 , Linda M S Resar  2 , Arthur L Burnett  1
Affiliations

How I treat priapism

Uzoma A Anele et al. Blood. .

Abstract

Priapism is a disorder of persistent penile erection unrelated to sexual interest or desire. This pathologic condition, specifically the ischemic variant, is often associated with devastating complications, notably erectile dysfunction. Because priapism demonstrates high prevalence in patients with hematologic disorders, most commonly sickle cell disease (SCD), there is significant concern for its sequelae in this affected population. Thus, timely diagnosis and management are critical for the prevention or at least reduction of cavernosal tissue ischemia and potential damage consequent to each episode. Current guidelines and management strategies focus primarily on reactive treatments. However, an increasing understanding of the molecular pathophysiology of SCD-associated priapism has led to the identification of new potential therapeutic targets. Future agents are being developed and explored for use in the prevention of priapism.

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Figures

Figure 1
Figure 1
Schematic representation of the molecular pathophysiologic mechanisms of RIP that has a likely local vasculogenic association. Normal penile erection physiology depicted on top. This schema does not preclude other neurogenic or hormonal factors that may be involved in eliciting priapism. Decreased basal levels of PDE5 enzyme permits uncontrolled erection (priapism) because of the lack of the normal regulatory control mechanism involved in the return of the penis back to its flaccid state. Circular arrows signify the pathway between penile erection states. Horizontal black arrows signify regulation. Horizontal black T-shapes signify inhibition. Downward black arrows signify downregulation.
Figure 2
Figure 2
Algorithm of “How I treat priapism.”
Figure 3
Figure 3
Cavernosal aspiration and irrigation of the penis. For treatment of an acute major ischemic priapism episode, a 16 or 18 gauge needle is inserted into the corpus cavernosum to aspirate blood, irrigate with saline, and inject sympathomimetics as necessary. Professional illustration by Luk Cox, Somersault18:24.
See this image and copyright information in PMC

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