Priapism: recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)

Male genital emergencies involving the penis are uncommon and necessitate immediate medical attention as well as surgery. The term "priapism" refers to a persistent erection caused by malfunctioning mechanisms that control rigidity, flaccidity, and penile tumescence. Identification of the underlying hemodynamics is necessary for a prompt and accurate diagnosis of priapism.

To discuss the epidemiology, pathophysiology, and classification of priapism, as well as to give healthcare professionals up-to-date clinical evidence on the management of the priapism.

The members of the Fifth International Consultation for Sexual Medicine (ICSM) Committee 22 have conducted a review of the peer-reviewed scientific literature to present an objective, comprehensive analysis regarding the diagnosis and management of priapism. This report reviews the literature from 2010 to 2025 on priapism and concentrates on guidelines that have been written in the last ten years. Every relevant article was examined critically and discussed.

This manuscript provides evidence-based diagnostic and treatment recommendations for ischemic, non-ischemic, recurrent ischemic priapism, and priapism in patients with sickle cell disease. The role of imaging, laboratory testing, early urologists' involvement when a patient presents to the emergency room, the discussion of conservative therapies, improved data for patient counseling regarding the risks of erectile dysfunction and surgical complications, specific recommendations regarding intra-cavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques, and early penile prosthesis placement are all covered in this recommendation.

Every patient with priapism should have an emergency evaluation to determine whether they have acute ischemic or non-ischemic priapism, and those who have experienced an acute ischemic event should receive early intervention when necessary. Treatment for NIP must be based on the goals of the patient, the resources at hand, and the experience of the clinician; it is not an emergency.