Introduction to Priapism

Priapism is a persistent penile erection that continues beyond, or is not related to sexual stimulation.

Predisposing factors:

  • Thromboembolic disorders e.g. sickle cell disease, leukaemia.
  • Spinal injuries
  • Perineal and genital trauma
  • Drugs e.g. chlorpromazine, prazosin and prostaglandins

Clinical features of Priapism

  • Persistent painful erection lasting several hours
  • Penis is rigid and tender but the glans penis and corpus spongiosum are soft

Complication of Priapism

  • Erectile dysfunction


  • Full Blood Count
  • Haemoglobin electrophoresis.
  • Colour Doppler/duplex ultrasound

Treatment for Priapism

Treatment objectives

  • To increase venous drainage from the corpora cavernosa
  • Decrease arterial inflow in high flow priapism
  • Treat the primary cause(s)

Non-drug treatment

Shunting procedures

  • Caverno-glandular shunt
  • Caverno-spongiosum shunt intensity
  • Caverno-saphenous shunt

Spinal or epidural anaesthesia

Drug treatment

A. Specialist management

Intracavernosal injection of alpha adrenergic agonist:

  • Phenylephrine 250-500 microgram


  • Ephedrine 50-100 mg

B. Conservative management

Evidence Rating: [C]

Sodium Chloride 0.9%, IV,

Adults: 1 L 6 hourly and liberal oral fluids

Children: 500 ml 6 hourly and liberal oral fluids


Pethidine, IM,

Adults: 100 mg 8 hourly if required

Children: 1 mg/kg (max. 50 mg) 8 hourly if required


Diazepam, IV,

Adult: 10 mg stat. (given slowly over 2-3 minutes, approximately 2.5 mg
every 30 seconds) then refer

Children: 0.3 mg/kg stat. (given slowly over 2-3 minutes) then refer


  • Avoid causative drugs

Referral Criteria

Patients not responding to conservative management should be promptly referred to a urologist or surgical specialist

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