Priapism: diagnosis and management

Recent advances in the understanding of erectile physiology have improved the prompt diagnosis and treatment of priapism. During the initial assessment, the physician must distinguish between the two basic types of priapism--low and high flow--because their associated treatment and prognosis differ. To illustrate the diverse manifestation of priapism, we describe the management of four patients with a history of priapism due to varying causes. In addition, we propose an algorithm that provides a systematic and timely approach to treatment. Resumption of erectile function after a prolonged episode of priapism has traditionally been poor but has improved. Patients must be informed that the long-term sequelae of priapism can be avoided with prompt medical or surgical treatment.