[Diagnosis and therapeutic options for prolonged erection and priapism: up-date review]

To review the pathophysiology, diagnostic methods and treatments of priapism, with special reference to alternative treatment options.

The different surgical options are presented and discussed, with special emphasis on the oral drugs and intracavernous therapy for priapism. The advantages and inconveniences of the different agents and surgical techniques are discussed. The publications in MEDLINE 1980-2000, our experience and the results of our studies previously reported in the literature were reviewed.

Complete detumescence and recovery of normal arterial blood flow can be achieved in a majority of the cases by systematic and standardized management. Sedatives, alpha-adrenergic agents or oral ketamine hydrochlorate can be utilized. However, due to the importance of the time factor, intracavernosal therapy should be the priority for persistent erection, using alpha-adrenergic agonists or other alternatives, such as methylene blue, which do not have the well-recognized risks of the conventional agents. The etiology of the priapism should be clearly established by metabolic and hemodynamic studies, since treatment will be based on the underlying disorder. In veno-occlusive low flow priapism, surgical shunting should be performed if aspiration of intracavernosal blood and other treatments are not successful. Arterial embolization and surgical ligation should be performed for high flow persistent priapism.