Acute management of priapism in men


Daniel Spernat, Department of Urology, Monash Medical Centre, 865 Centre Road, Bentleigh, 3165 Victoria, Melbourne, Australia. e-mail:


What's known on the subject? and What does the study add?

Priapism is a rare event. However, various medications and medical conditions may increase the risk. Priapism can be ischaemic, non-ischaemic or stuttering. It is paramount to distinguish the type of priapism, as misdiagnosis may lead to significant morbidity. Ischaemic priapism represents a compartment syndrome of the penis and is therefore a medical emergency. A delay in management may significantly affect future erectile function. Stuttering priapism represents recurrent subacute episodes of ischaemic priapism, which may lead to erectile dysfunction. Thus episodes must be minimised. Non-ischaemic priapism is not a medical emergency. However, misdiagnosis and injection with sympathomimetic agents can result in system absorption and toxicity.

This review article provides a summary of the evaluation and management of priapism. Furthermore, a step by step flow chart is provided to guide the clinician through the assessment and management of this complex issue.


  • • To review the literature regarding ischaemic, non-ischaemic and stuttering priapism
  • • To provide management recommendations


  • • A Medline search was carried out to identify all relevant papers with management guidelines for priapism.


  • • Ischaemic priapism represents a compartment syndrome of the penis and urgent intervention is required to decrease the risk of erectile dysfunction.
  • • Non-ischaemic priapism is not a medical emergency; however, it can result in erectile dysfunction.
  • • The treatment objective for stuttering priapism is to reduce future episodes with systemic treatments, whilst treating each ischaemic episode as an emergency.


  • • Priapism is a complex condition that requires expert care to prevent complications and irreversible erectile dysfunction