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Guidelines

Diagnosis and Management of Priapism

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JAMA

Published Online: July 20, 2023

JAMA Clinical Guidelines Synopsis

Article Information and Disclosures

Richard J. Fantus, MD¹;

Robert E. Brannigan, MD²;

Andrew M. Davis, MD, MPH³

Author Affiliations

¹Department of Urology, University of Kansas Medical Center, Kansas City
²Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
³Section of General Internal Medicine, University of Chicago Medicine, Chicago, Illinois

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Priapism (an erection lasting >4 hours) results in 5.3 emergency department visits per 100 000 patient-years in the US.¹^,2 Acute ischemic priapism (IP) is an emergent condition requiring urgent intervention within 6 to 12 hours of onset to prevent permanent erectile dysfunction, penile fibrosis, and penile shortening.³ Up to 42% of men with SCD experience priapism during their lifetime.⁴ This guideline describes approaches to diagnosis and management of IP and NIP, including in men with hematologic and oncologic disorders.

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Article Information

Corresponding Author: Andrew M. Davis, MD, MPH, Section of General Internal Medicine, University of Chicago Medicine, 5841 S Maryland Ave, Chicago, IL 60637 (amd@uchicago.edu).

Published Online: July 20, 2023. doi:10.1001/jama.2023.13377

Conflict of Interest Disclosures: None reported.

References

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Bivalacqua TJ , Allen BK , Brock GB , et al. The diagnosis and management of recurrent ischemic priapism, priapism in sickle cell patients, and non-ischemic priapism. J Urol. 2022;208(1):43-52. doi:10.1097/JU.0000000000002767 PubMed Google Scholar Crossref

Bivalacqua TJ , Allen BK , Brock G , et al. Acute ischemic priapism. J Urol. 2021;206(5):1114-1121. doi:10.1097/JU.0000000000002236 PubMed Google Scholar Crossref

Nelesen D , Lucas S , Liu C-R , et al. A systematic review to assess the burden of ischemic priapism in patients with sickle cell disease. Sex Med Rev. 2023;11(1):52-60. doi:10.1093/sxmrev/qeac001 Google Scholar Crossref

Cifu AS , Davis AM , Livingston EH . Introducing JAMA Clinical Guidelines Synopsis. JAMA. 2014;312(12):1208-1209. doi:10.1001/jama.2014.12712 Google Scholar Crossref

Reed-Maldonado AB , Kim JS , Lue TF . Avoiding complications: surgery for ischemic priapism. Transl Androl Urol. 2017;6(4):657-665. doi:10.21037/tau.2017.07.23 PubMed Google Scholar Crossref

Martin C , Cocchio C . Effect of phenylephrine and terbutaline on ischemic priapism. Am J Emerg Med. 2016;34(2):222-224. doi:10.1016/j.ajem.2015.10.029 PubMed Google Scholar Crossref

Constantine ST , Gopalsami A , Helland G . Recurrent priapism gone wrong: ST-elevation myocardial infarction and cardiogenic shock after penile corporal phenylephrine irrigation. J Emerg Med. 2017;52(6):859-862. doi:10.1016/j.jemermed.2017.01.055 PubMed Google Scholar Crossref

Ortaç M , Çevik G , Akdere H , et al. Anatomic and functional outcome following distal shunt and tunneling for treatment ischemic priapism. J Sex Med. 2019;16(8):1290-1296. doi:10.1016/j.jsxm.2019.05.011 PubMed Google Scholar Crossref

Milenkovic U , Cocci A , Veeratterapillay R , et al. Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism. Int J Impot Res. Published online September 23, 2022. doi:10.1038/s41443-022-00604-1 PubMed Google Scholar Crossref

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.