Treatment of priapism: primary results and complications in 207 patients

Priapism is a rare disease that has been treated both by conservative methods and surgically. Its incidence has increased during recent years because of the use of vasoactive drugs for the treatment of impotence. Data on 207 patients treated for priapism in 1973-1990 were collected from Finnish hospitals in order to study the primary results and complications of different treatment modalities. The material was divided into two nine-year periods. Only nine out of 79 patients treated conservatively (11%) gained relief from priapism, whereas surgery was successful in 59% of cases. The duration of symptoms before hospitalization had shortened during the years and surgical procedures had become more popular, with improved results. Priapism caused by the injection of vasoactive drugs or priapism of short duration caused by some other mechanism was treated successfully with aspiration and the injection of sympathomimetic drugs. Nearly all cases of priapism of duration of less than four days were treated successfully with small shunts. The most common complications were infections, but these could be prevented with prophylactic antibiotics. Aspiration and injection of sympathomimetic drugs can be recommended as the primary treatment for priapism, and if this fails, small shunts. Prophylactic antibiotics are necessary.