[Diagnosis and treatment of priapism: a report of 15 cases]

To improve the diagnosis and treatment of priapism.

We analyzed the types, causes, treatment and prognosis of 15 cases of priapism. The patients ranged in age from 20 to 66 (mean 46) years, their erection lasting 10-172 (mean 28.4) hours. Among them, 6 cases resulted from in taking vaso-active agents, 1 had transitional cell carcinoma of the bladder metastasized to the penis, 2 had leukemia, 3 had a traumatic history and the other 3 had unknown causes.

Of the total number, 12 fell into the ischemic low-flow type and 3 the non-ischemic high-flow type. Follow-up lasted 1-26 months. In the 12 cases of the ischemic low-flow type, 7 were cured by 2-6 mg metaraminol injection at the root of the cavernous body and, when necessary, the perfusion of heparinized saline at the glans and the root of the cavernous body of the penis, and 2 achieved detumescence after glandular cavernosal shunting. The 2 cases caused by leukemia and 1 by metastasis of transitional cell carcinoma underwent penectomy, but with unfavorable prognosis. Of the 3 high-flow type cases, 1 was cured by selective embolization of the internal pudendal artery and the other 2 discharged after conservative treatment, but developed ED on follow-up.

Cavernous blood gas analysis and color duplex ultrasonography are helpful to the accurate and timely diagnosis of priapism. Cavernosal decompression and intracavernosal injection of aramine can be applied to most of the patients. If conservative treatment fails to achieve detumescence of the penis, surgery should be performed immediately for both types of priapism.