Diagnosis and treatment of priapism: Experience with 5 cases

Objectives. Priapism is a rare disease, but needs early intervention and ap propriate management. We present 5 cases, 2 of nonischemic high-flow priapi sm and 3 of ischemic low-flow priapism. Methods. Focusing on the differential diagnosis of priapism between the non ischemic high-few type and the ischemic low-flow type, we reviewed the medi cal records of 5 patients. Results. Of the examinations carried out, cavernosography, blood gas analys is of cavernosal blood, color Doppler ultrasound, and internal pudendal art eriography were useful in differentiating the type of priapism. Complete de tumescence of the penis in 2 cases of high-flow priapism and 5 cases of low -flow priapism was achieved by selective embolization with gelform and by g landular-cavernosal shunting, respectively. No recurrence was observed in a ny patient, and postoperative erectile function was preserved in 4 patients and is unknown in 1. Conclusions. These results indicate that angiographic studies provide the m ost reliable information for the differentiation of the type of priapism. H owever, color flow Doppler ultrasound and cavernosal blood gas determinatio n can obviate the need for angiographic studies and are noninvasive, Althou gh conservative treatment or even expectant management may be feasible with high-flow priapism, aggressive treatment should be carried out for low-flo w priapism immediately after initial treatment fails to achieve detumescenc e of the penis. Selective embolization of the internal pudendal artery may be the treatment of choice for patients with high-flow priapism. UROLOGY 53 : 1019-1023, 1999. (C) 1999, Elsevier Science Inc. All rights reserved.