Table of contents
Priapism
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of priapism are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2024), the American Urological Association (AUA/SMSNA 2022), and the National Heart, Lung, and Blood Institute (NHLBI 2014).
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Diagnostic investigations
History and physical examination
As per EAU 2024 guidelines:
Elicit a comprehensive history to establish the diagnosis to determine the priapism subtype.
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Perform a physical examination of the genitalia, perineum and abdomen in the diagnostic evaluation of patients with priapism. Perform neurological examination if neurogenic non-ischemic priapism is suspected.
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Laboratory tests
Doppler ultrasound
MRI
Selective pudendal arteriography
Diagnostic procedures
Medical management
General principles, ischemic priapism: as per EAU 2024 guidelines, initiate management in patients with ischemic priapism as early as possible (within 4-6 hours) and follow a stepwise approach.
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General principles (non-ischemic priapism)
Androgen deprivation therapy
Nonpharmacologic interventions
Therapeutic procedures
Penile aspiration and irrigation: as per EAU 2024 guidelines, decompress the corpus cavernosum by penile aspiration and washout until fresh red blood is obtained.
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Intracavernous sympathomimetics
Selective arterial embolization
Perioperative care
Perioperative anticoagulation
As per EAU 2024 guidelines:
Consider administering peri- and postoperative anticoagulation to decrease recurrence in patients with ischemic priapism.
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Consider administering the following anticoagulant prophylaxis for the prevention of recurrence in patients with ischemic priapism:
Situation
Guidance
Preoperatively
325 mg acetylsalicylic acid
Intraoperatively
5,000 IU heparin
5 days postoperatively
81 mg acetylsalicylic acid and 75 mg clopidogrel
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Surgical interventions
Surgical shunting: as per EAU 2024 guidelines, proceed to surgical treatment only if blood aspiration and intracavernous injection of sympathomimetic agents have failed.
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Surgical fistula ligation
Penile prosthesis
Specific circumstances
Patients with stuttering priapism: as per EAU 2024 guidelines, manage each episode of stuttering priapism similar to that for ischemic priapism.
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Patients with sickle cell disease