Priapism is a painful and abnormally long erection (lasting more than 3 hours), during a sexual activity or outside of any sexual desire and not leading to ejaculation. Priapism is an urological emergency. There is not an age group to which to associate the most frequent cases of priapism: it is usually evident between the ages of 25 and 40, but the growth of cases of pharmacological origin widens the range of possible “victims”.

How to diagnose priapism? It is sufficient to carry out an instrumental diagnostic tests, that is, a blood test (blood gas analysis) of the blood taken from the corpora cavernosa and a penile colordoppler ultrasound. The blood gas analysis will verify the state of hypo-oxygenation and district acidosis, so the blood will appear dark and viscous, while the ultrasound will reveal a reduced arterial pulsatility and the absence of venous discharge. When it comes to arterial hyperflux priapism, oxygenation is normal and the blood has a bright red color, but ultrasonography shows an increase in arterial flow associated with insufficient venous discharge.

What is happening? Priapism appears due to the impossibility of cavernous bodies to empty blood that has accumulated during erection. The blood remains trapped due to venous evacuation made impossible for the following reasons:

• Psychological reasons
• Taking medication (neuroleptics, anticoagulants and especially the “erection facilitators” like Viagra and its analogs)
• Alcoholism
• The injection into the cavernous body of an excess dose of a drug to treat impotence by lack of erection: by far the most common
• Exceptionally, some serious diseases such as leukemia, some cancers

It’s an emergency, because:

• Priapism begins with a classical erection. It follows a prolonged engorgement. The glans remains flaccid unlike in case of a normal erection.
• Oxygen depletion of the corpus cavernosum occurs rapidly and an enrichment in carbon dioxide is responsible for the increase of blood viscosity.
• The risk of venous thrombosis, which is rapidly responsible for tissue degeneration (fibrosis / necrosis), is an emergency that must be resolved in the early hours.

Report to the emergency room immediately in the following cases:

An erection occurred outside any sexual desire (usually at night), quickly became painful, unbearable, prolonged abnormally

A penis whose volume is greater than during normal erections during intercourse. with a flaccid glans and with abnormal duration

After trying to cool the skin, with Cryoflurane or ice in a plastic bag, the doctor will immediately establish diagnosis and send you to the hospital for further therapeutic measures. Such measures consist in vasoconstrictive medications injected in the penis, puncture or surgery, if everything else fails. The surgical procedure is aimed at restoring the connection between the blood vessels in the corpora cavernosa and the veins in the body.

Often it is not necessary to resort to surgery, but if it comes to venous priapism a surgical urgency may arise. Post-operative recovery in this case can also last for a few months, as well as being total or partial.