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SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences
Emergency: requires immediate attention
Priapism
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Priapism

Contributors: John T. Finnell MD, Eric Ingerowski MD, FAAP
Other Resources UpToDate PubMed

Synopsis

Priapism is defined as a penile erection lasting longer than 4 hours without sexual stimulation / excitation.

There are 3 types of priapism: low flow (ischemic), high flow (nonischemic), and stuttering (recurrent):
  • Ischemic priapism is the most common and serious type of priapism. It is characterized by a prolonged, painful erection due to reduced or blocked blood flow. This can cause tissue damage and is a medical emergency that requires prompt treatment.
  • Nonischemic priapism is a less common type that is usually painless. It is caused by unregulated blood flow to the penis, often due to trauma or an arteriovenous fistula. This type of priapism can typically be managed conservatively.
  • Stuttering priapism is characterized by recurrent episodes of ischemic priapism that last less than 4 hours. It is most commonly seen in patients with sickle cell disease and is often self-limited.
The management of ischemic priapism typically involves a combination of local anesthesia, cavernosal aspiration (removal of blood from the corpus cavernosum), and irrigation (flushing the corpus cavernosum with fluid). In some cases, injection with a vasoconstrictor such as phenylephrine may be used to help restore normal blood flow to the penis.

It is important to note that all types of priapism require medical attention, as untreated priapism can cause permanent damage to the penis.

Codes

ICD10CM:
N48.30 – Priapism, unspecified

SNOMEDCT:
6273006 – Priapism

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Ischemic:
  • Hemoglobinopathy (Sickle cell disease, thalassemia [Alpha thalassemia or Beta thalassemia])
  • Leukemia
  • Infection
  • Neurogenic
  • Toxin (Scorpion sting, Spider bite)
  • Immunoglobulin A vasculitis
Nonischemic:
  • Trauma / Spinal cord injury
  • Hematologic (sickle cell disease, leukemia)
  • Fabry disease
  • Iatrogenic (surgery)
Medication induced:
  • Phosphodiesterase-5 (PDE5) inhibitor
  • Hormone (testosterone)
  • Antipsychotic
  • Antidepressant
  • Antihypertensives
  • Alcohol use disorder
  • Cocaine intoxication and use disorder
  • Cannabis use disorder

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:01/04/2023
Last Updated:02/05/2023
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Emergency: requires immediate attention
Priapism
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