Symptoms vary depending on the type of priapism that has occurred. The following is a list of symptoms explaining both type of priapism.

Ischemic (low flow) priapism

• Involuntary erection that lasts for 4 hours or even longer
• Pain during erection
• The penis is tender to touch and is rigid
• Several bouts of involuntary erection – a condition referred to as stuttering priapism [6]

Non-ischemic (high flow) priapism

• Involuntary erection that lasts for at least 4 hours
• The penis is erect but not painful

• Swelling

  We report on a 42-year-old male who presented with priapism, severe scrotal swelling, and left lower extremity pain and swelling. Initial management of priapism failed, and he was noted to have both cavernosal and glandular venous obstruction. [ncbi.nlm.nih.gov]

  Puncture to Treat Priapism After numbing the area, a needle is used to drain the blood from the corpora cavernosa to allow the swelling to subside. [healthcommunities.com]

  Options include: Ice packs: They may bring down swelling for high-flow priapism. Removing the blood: After your doctor numbs your penis, he’ll use a needle to drain blood from the area to ease pressure and swelling. [webmd.com]

• Gangrene

  2011/3/1/37/78470 Penile gangrene is an infrequently encountered disease entity. [1] Penile gangrene complicating priapism seems to be of even rarer occurrence. [2], [3], [4] Several etiological factors have been associated with penile gangrene, ranging [doi.org]

  Priapism progressed to penile gangrene despite decompression and distal shunt procedure leading to total penectomy and perineal urethrostomy. [ncbi.nlm.nih.gov]

  […] penile gangrene in cases of priapism. 3 In our case too, the patient was catheterised and a compressive dressing was applied around his penis. [casereports.bmj.com]

  Penile or perineal trauma and signs of infection, inflammation, or gangrenous change should be noted. [merckmanuals.com]

• Splenomegaly

  Chronic myeloid leukemia (CML) is a chronic myeloproliferative disorder that usually presents with high white blood cell counts and massive splenomegaly. Priapism is a rare manifestation of CML and is mostly due to hyperleukocytosis. [ncbi.nlm.nih.gov]

  The abdomen and suprapubic area should be palpated to detect any masses or splenomegaly, and a digital rectal examination should be done to detect prostatic enlargement or other pathology. [merckmanuals.com]

  An initial working diagnosis of low-flow type priapism was made with splenomegaly. Investigations revealed hemoglobin 10.9 g/dl, white blood count 158,000/ml with polymorph 50%, myelocyte-35%, metamyelocyte- 5%, and myeloblast-2%, respectively. [atmph.org]

• Aspiration

  The corpora communicate, so in most cases, only one side needs to be aspirated. If one side isn’t working, try the other. [nuemblog.com]

  Penile blood aspirated from cavernous spaces appears dark in color. Immediate treatment is necessary or penile fibrosis will ensue. [nature.com]

  Intravenous infusion of low molecular weight dextran for five days following the failed aspiration had no response. [casesjournal.biomedcentral.com]

  Discussion Although aspiration is used in the diagnosis of nonischemic priapism, aspiration with or without injection of vasoconstrictive agents has no demonstrated therapeutic efficacy. [auanet.org]

• Thrombosis

  The thrombosis resolved after two months with incomplete restoration of erectile function (loss of rigidity). [ncbi.nlm.nih.gov]

  Color and spectral Doppler ultrasound is usually most helpful in distinguishing a high-flow priapism from a low-flow priapism: low-flow priapism (typically ischemic) thrombosis of the corpora cavernosa or corpus spongiosum decreased/absent color flow [radiopaedia.org]

• Hypertension

  Black widow bites are commonly associated with pain, muscle cramping, hypertension, and tachycardia. [ncbi.nlm.nih.gov]

  Patients should be placed on a cardiac monitor while administering these medications given the risk of systemic effects (severe hypertension, dysrhythmia). Proceed with caution in those patients with such underlying conditions. [nuemblog.com]

  Autonomic nervous system stimulation by venom produces nausea, vomiting, sweating, hypertension, and tachycardia. [pediatrics.aappublications.org]

  We present a case of occurrence of priapism in a hypertensive patient posted for transurethral resection of prostrate following subarachnoid block and the way we managed it. [apicareonline.com]

• Paresthesia

  Neurologic examination is useful to detect any signs of lower-extremity weakness or saddle paresthesias that might indicate spinal pathology. [merckmanuals.com]

  Side effects like back pain, flu syndrome, arthralgia., hyperglycemia, paresthesia, tremor dyspepsia, photosensitivity reaction, abdominal pain, syncope, tachycardia, palpitation, anemia and leukopenia are observed .Non-arteritic anterior ischemic optic [webmedcentral.com]

  Clinical manifestations of acute limb ischemia (which can be summarized as the "six P's" ) include pain, pallor, pulseless, paresthesia, paralysis, and poikilothermia. [4] Without immediate intervention, ischemia may progress quickly to tissue necrosis [en.wikipedia.org]

• Painful Erection

  Persistent, usually painful erection of the penis, especially as a consequence of disease and not related to sexual arousal. priapism [prī′əpiz′əm] Etymology: Gk, priapos, phallus an abnormal condition of prolonged or constant penile erection, often painful [medical-dictionary.thefreedictionary.com]

  ICD-9-CM Volume 2 Index entries containing back-references to 607.3 : Erection, painful (persistent) 607.3 Painful - see also Pain erection 607.3 Priapism (penis) 607.3 ICD-9-CM codes are used in medical billing and coding to describe diseases, injuries [icd9data.com]

  Painful Erection in Men with Sickle Cell Disease Males with sickle cell disease may experience a pain crisis in the penis, called priapism. [ihtc.org]

• Penile Pain

  A 42-year-old man presented to the emergency room with penile pain and partial erection. Examination revealed partial erection and palpable space-occupying lesion of the corpus cavernosum without lymphadenopathy. Malignant workup was negative. [ncbi.nlm.nih.gov]

  He appears uncomfortable from penile pain but is nontoxic. [pedsinreview.aappublications.org]

  Follow-up: The patient reported complete resolution of the deep, dull penile pain which is characteristic of ischemic priapism pain within 36 hours after surgery. [tau.amegroups.com]

  Penile discomfort rather than severe penile pain is often reported by patients; however, accurately distinguishing this condition from ischaemic priapism, which requires prompt intervention, is imperative. [f1000research.com]

• Dysuria

  Abstract A 51-year-old man presented at our department 2 days after the onset of a painful mass in the perineum and dysuria. [ncbi.nlm.nih.gov]

  Review of systems should seek symptoms suggesting a cause, including dysuria (urinary tract infections), urinary hesitancy or frequency (prostate cancer), fever and night sweats (leukemia), and lower-extremity weakness (spinal cord pathology). [merckmanuals.com]

  He is not sexually active and denies penile discharge or dysuria. In addition, he cannot recall any recent trauma or injury to his penis, scrotum, or perineum. Vitals are notable for a HR of 102. [emdocs.net]

• Kidney Failure

  If not treated, patients may die within 1–2 hours due to circulatory failure. Management is supportive, sometimes with blood transfusion. [en.wikipedia.org]

In the preliminary phase, the individual will be asked about the length of the penile erection and frequency of the condition. Following this, a thorough physical examination will be carried out to understand the cause behind the development of priapism. In addition to this, the following methods will be carried out to diagnose the condition [7]:

• Blood gas measurement: In this blood is drawn from the penis to be analyzed for the type of gases present in the sample. Such a type of test determines the type of priapism present.

• Blood tests would be done to detect the presence of any underlying disease conditions such as sickle cell anemia or leukemia.
• Color duplex ultrasound examination will be carried out to detect presence of tumor or any other abnormality inside the penis. This test would also provide insight into the type of priapism present.

• Toxicology test would help in revealing whether drug abuse is the cause of priapism.

Treatment of priapism is geared towards relieving the erection and preserving the erectile function. If treatment is initiated within 4 to 6 hours of erection, then medications should be enough to correct the condition. In addition, the following methods are employed to treat priapism [8]:

• Ice packs: Application of ice packs to the penis and neighboring areas may help relieve the condition.
• Surgical ligation is employed when there is arterial rupture. In this process, the artery is tied in order to restore the blood supply.
• Shunt: In this a shunt is surgically inserted to divert the blood flow in order to restore the normal blood circulation in the penis [9] [10].
• Needle aspiration: In this method, a needle is inserted into the penis to drain out the blood in order to correct the erection.

The prognosis of the condition can be favorable only if prompt treatment is initiated. Failure to do so can result in development of permanent damage to the penis. When priapism continues for more than 24 hours then erectile dysfunction can set in permanently [5].

In many cases, the exact cause of priapism remains a mystery. However individuals with sickle cell anemia are known to fall easy prey to this condition. Sickle cell anemia is a heredity blood disorder in which the abnormally shaped red blood cells inhibit blood flow to the penis giving rise to priapism [2].

In addition to sickle cell anemia, other type of blood disease such as leukemia is also known to play a role in causation of the disease. Research has also pointed towards the fact that certain drugs commonly used for treating sexual dysfunction, depression and psychotic disorder can also lead to development of priapism.

There have been instances that have reported injury to be one of the major causes of non-ischemic priapism. Other causes of priapism include injury to the spinal cord, blood clots or poisonous venom.

Priapism is an uncommon condition accounting for 1.5 cases per 100,000 individuals-years globally. A rise in the rate of incidence of priapism has been noted for men aged 40 years and above. It has been estimated that in this older population the incidence increased to 2.9 cases per 100,000 individuals-years [3]. The condition can strike males at any age, but is more common in boys below 10 years and in men above 20 years.

Under normal conditions, penis erection occurs in response to sexual stimulation. Due to stimulation, the blood vessels relax and expand increasing the blood flow to the penis. Such sequence of events causes the penis to erect. When the stimulation ends, the blood flows out and the penis returns to its normal (flaccid) state [4].

When some kind of disruption occurs in these normal events, priapism develops. Ischemic (low flow) priapism is the most common type and occurs when the blood gets trapped in the penis and is unable to flow out. Such an event does not allow the penis to return to its normal state.

Non-ischemic (high flow) priapism is pretty uncommon compared to the former type. It occurs when an artery gets ruptured that prevents the normal circulation of blood within the penis.

Several steps can be followed to prevent recurrent attacks of priapism. If the cause of the underlying condition is known then appropriate treatment should be initiated to treat the condition. In case, drugs were the cause then attempts should be made to change the medications.

Men are also advised against use of recreational drugs and alcohol which have a known association with priapism episodes. The practice of self-injection of phenylephrine should be discouraged as it can trigger development of priapism.

Priapism is characterized by penile erection that occurs without any kind of sexual stimulation. It is a painful condition requiring prompt treatment. Such condition occurs in young boys aged 5 to 10 years or in adults between 20 to 50 years of age. Priapism can be either ischemic or non-ischemic in nature. The condition can last for as long as 4 hours or even more. Priapism requires immediate medical intervention in order to avoid onset of irreversible conditions. Failure to treat the condition can call for development of erectile dysfunction [1].

Definition

Priapism is prolonged erection of the penis without any physical or psychological stimulation. It is an extremely painful condition that should receive prompt treatment. Priapism can affect males of all age groups, but is more common in young boys and adult males.

Cause

Underlying disease conditions such as sickle cell anemia and leukemia are known to be major contributory factors. In addition, trauma or injury to the genital can also cause development of priapism. Individuals in the habit of using illegal drugs or alcohol are also susceptible. In many cases, it has been noticed that prescription drugs that have been advised for treatment of various disease conditions also predisposes males to develop priapism.

Symptoms

Symptoms of priapism include painful penile erection for 4 hours or more. The penis become rigid and may be tender to touch.

Diagnosis

Diagnosis is made through blood gas measurement in which blood that is trapped in the penis is tested for certain gases which confirms the presence of priapism. In addition, blood tests and ultrasound for detecting the presence of various disease conditions are also done.

Treatment

Treatment of priapism is done through medications and surgical intervention. If the duration of erection is less than 4 hours then medications alone help rectify the condition.

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