A 23-year-old man undergoing systemic therapy for diffuse large B-cell lymphoma presented for a routine interim 18F-FDG PET/CT. PET/CT demonstrated a fully erect penis without internal FDG uptake. The patient was subsequently evaluated at the emergency department for persistent, painful erection. After successful surgical management for ischemic priapism, follow-up 18F-FDG PET/CT showed a non-erect penis with physiological uptake. An erect, internally photopenic penis is a potentially acute finding on 18F-FDG PET that may represent ischemic priapism.

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Priapism is a rare urological condition characterized by a persistent penile erection unrelated to sexual stimulation, most commonly affecting adults, while in children it is frequently associated with sickle cell anemia or trauma. The Al-Ghorab shunt is an open distal shunt technique that may be utilized as a first-line surgical intervention. We report the case of a 58-year-old male who presented with a one-month history of painful persistent erection, with no history of sexual stimulation, medication use, or genital and perineal trauma. Based on clinical evaluation, the patient was diagnosed with ischemic (low-flow) priapism and was scheduled for open distal shunting using the Al-Ghorab (corporoglandular) shunt technique. The operative duration was 120 minutes, and the patient was managed postoperatively in a non-intensive care ward without complications, with an Erection Hardness Score (EHS) of 1. The patient was discharged on postoperative day five and returned for follow-up on postoperative day twelve, at which time the surgical wounds on the glans and ventral penis were noted to be dry, indicating that although surgical preference may vary among surgeons, the Al-Ghorab shunt can be considered as a first- or second-line option following percutaneous distal shunting based on its success rate and side-effect profile.</em></p><p> </p></td></tr></tbody></table></div><p><strong><em>Keywords: Ischemic Priapism, Low-Flow Priapism, Al-Ghorab Shunt, Distal </em></strong> <strong><em>Corporoglanular Shunt.</em></strong></p>

Predicting major ischemic priapism: a novel dynamic nomogram based on recurrent ischemic priapism risk factors.

BackgroundNeonatal priapism is a rare and typically benign condition characterized by a persistent penile erection unrelated to stimulation. Unlike priapism beyond the neonatal period, which is more frequently ischemic, most neonatal cases are non-ischemic and idiopathic, although associations with polycythemia have been reported.Case presentationWe report the case of a male neonate born at 37 + 3 weeks of gestation who developed painless priapism on the first day of life, persisting for approximately 48h. Clinical examination showed no penile discoloration or distress. Color Doppler ultrasound demonstrated preserved arterial and venous flow consistent with high-flow, non-ischemic priapism. A simple therapeutic phlebotomy was performed, resulting in complete detumescence within 24h and normalization of hematologic parameters. The infant remained clinically stable, and 3-month follow-up showed no recurrence or complications.ConclusionThis case highlights the importance of considering polycythemia in the etiological assessment of neonatal priapism and supports a conservative approach when vascular flow is preserved. Early recognition and appropriate management can lead to favorable outcomes without long-term sequelae.

Priapism is a urologic emergency involving a sustained and painful penile erection resulting in tissue hypoxia and ischemia. This requires emergent intervention to preserve penile function and avoid complications including fibrosis and permanent erectile dysfunction. Ischemic priapism, or low-flow priapism, accounts for most cases and can be caused by numerous factors including pharmaceuticals. Typical antipsychotics are most often the causative agent, but antidepressants and other psychotropics similarly increase risk for ischemic priapism and must be acknowledged to prevent significant morbidity. This review (1) identifies common psychotropic medications associated with ischemic priapism through a narrative literature review and presentation of unique cases, (2) proposes the likely mechanisms of action for the implicated drug classes, and (3) outlines current evidence on the prevention and management of pharmacologically induced ischemic priapism. We conducted a narrative literature review of PubMed's database using MeSH Terms to identify relevant cases of priapism associated with psychotropic medications. 117 cases were identified, of which 85 had a clear association between medication usage and priapism. We also present 5 additional, unique cases of pharmacologically induced priapism involving less commonly implicated medications. Pharmacologically induced priapism is often a consequence of alpha-adrenergic antagonism which inhibits the sympathetic response necessary for penile detumescence and allows for a relative excess of parasympathetic response resulting in priapism. Treatment of ischemic priapism includes supportive measures, urology consultation for corporal irrigation and intracavernosal phenylephrine, or other surgical interventions. Medications implicated in causing ischemic priapism must be discontinued or at minimum dose reduced.

Background and objectives: Ischemic priapism is a rare but serious adverse effect of trazodone, associated with a high risk of long-term sexual dysfunction. While its urological consequences are well described, psychiatric and psychosocial outcomes remain insufficiently explored. This study assessed psychiatric and sexual sequelae following trazodone-associated ischemic priapism and compared clinical characteristics with trazodone-treated patients without priapism. Materials and Methods: In this single-center observational study, 268 adult patients receiving trazodone were analyzed, including 17 patients with ischemic priapism and 251 controls. Data on episode duration and urological management were collected. Psychiatric status and sexual functioning were evaluated through structured clinician-led interviews informed by validated psychometric frameworks during hospitalization and at 1-, 3-, and 6-month follow-up. Nonparametric analyses and Spearman rank correlations were applied. Results: Patients with priapism were significantly older than controls (44.1 ± 5.1 vs. 39.0 ± 4.4 years; p < 0.0001), while trazodone dose distribution did not differ between groups. The mean episode duration was 26.5 ± 16 h (median 24 h). Older age and longer ischemic duration were independently associated with increased treatment intensity, whereas trazodone dose was not. Persistent depressive and anxiety symptoms and impaired sexual functioning were observed in a subset of patients during follow-up. Conclusions: Trazodone-associated ischemic priapism is not only an acute urological emergency but may also lead to sustained psychiatric and sexual sequelae. Interdisciplinary follow-up should be considered to address long-term psychosocial outcomes.

The goal of our analysis is to provide technical information and clinical long-term data on arterial embolization for non-ischemic priapism. Furthermore, this study presents a comprehensive literature review. We analyzed patient data from June 2005 to June 2025 at a large university hospital, focusing on patients with non-ischemic priapism lasting over 1week, unresponsive to conservative treatment, and referred for arterial embolization. Age, symptom etiology, initial diagnostic modality, embolic agent, uni- or bilateral arterial supply of the fistula/pseudoaneurysm, technical success, clinical outcome, need for a second attempt, erectile dysfunction, adverse events, and mean follow-up time needed were assessed. Findings were contextualized with studies from the past two decades. A total of 15 male patients with non-ischemic priapism due to blunt, penetrating trauma or of idiopathic origin, were included in this analysis. The embolic agents chosen included gelatin sponge, polyvinyl alcohol particles, autologous clot, microcoils, and a combination of microcoils with gelatin sponge or polyvinyl alcohol particles. Technical success was achieved in 14 patients (93.3%). A second or third intervention was needed in three cases (20.0%) to achieve clinical success. Documented adverse events included procedure-related findings such as penile skin changes and deviation in two patients (13.3%). No new cases of erectile dysfunction were reported (0%). Our findings support super-selective arterial embolization as a safe, technically successful, and minimally invasive therapy option for non-ischemic priapism after conservative measures fail. Moreover, our data suggest that arterial embolization is associated with long-term symptom improvement without significantly impairing sexual function.

P0500 Comparative outcomes of early versus delayed penile prosthesis insertion in patients with ischaemic priapism

Oral pseudoephedrine in the treatment of recurrent ischemic priapism in sickle cell disease

BackgroundThe development of recurrent ischemic priapism (RIP) is associated with mental health disorders, psychiatric medications, and substance use, but the temporal relationship between the onset of RIP and the development of these risk factors is poorly understood.AimThis study aimed to investigate the chronology of psychosocial and substance use risk factors relative to the initial clinical presentation of RIP.MethodsWe conducted a retrospective cohort study of 73 adult patients diagnosed with RIP at a single academic center, identified via manual chart review of the electronic health record. Patients presenting with RIP between 2004 and 2020 were included, with data collection extending to 2025 to ensure a minimum follow-up of nearly 5 years for all participants to minimize censoring bias and capture delayed risk factor onset.OutcomesThe date of the first RIP presentation (index event) was compared to the first documented date of several risk factors, including anxiety, depression, psychiatric medication use, and substance use.ResultsIn the overall cohort, there was no statistically significant difference in the proportion of any risk factor developing before versus after the onset of RIP. Further, in a sub-analysis of 35 patients with sickle cell disease (SCD), a higher proportion of patients initiated psychiatric medication after the onset of RIP, although this was not statistically significant (P = .0522). No other factors reached statistical significance in the SCD sub-analysis.Clinical implicationsThe findings suggest that RIP may be a psychologically traumatic event that contributes to the development of the same psychosocial risk factors it is associated with.Strengths and limitationsThe primary strength of this study is its novel investigation into the temporal relationship between RIP and psychosocial risk factors, supported by a design that ensured a minimum follow-up period of over 4 years for all participants. Limitations are primarily related to its retrospective, single-center chart-review design.ConclusionOur findings suggest a complex, potentially bidirectional relationship that highlights the need for integrated mental health screening for all patients with RIP, particularly for the high-risk SCD population.

The Role of Pediatric Clinicians in the Diagnosis, Management, and Referral of Priapism in Children and Adolescents with Sickle Cell Disease.

Sickle cell disease (SCD) is an inherited hemoglobinopathy in which hemoglobin S polymerization drives hemolysis and vaso-occlusion with progressive organ morbidity. Male reproductive impairment is increasingly recognized but remains underreported. This narrative review summarizes mechanistic pathways, clinical manifestations, and fertility preservation options relevant to men with SCD. PubMed, the Cochrane Library, and Medscape were searched through 31 December 2025 for human studies addressing endocrine changes, semen quality, priapism and erectile dysfunction, oxidative stress, and treatment-related gonadotoxicity. Evidence supports converging mechanisms: recurrent vaso-occlusion and chronic hypoxia may injure the seminiferous epithelium and impair Leydig cell steroidogenesis; oxidative stress and inflammation contribute to sperm DNA and membrane damage; and disease-modifying or curative therapies such as hydroxyurea and hematopoietic stem cell transplantation can further compromise spermatogenesis. Clinically, men with SCD may present with oligozoospermia, azoospermia, hypogonadism, and sexual dysfunction, particularly after recurrent ischemic priapism. Fertility preservation should be discussed early, ideally before prolonged hydroxyurea exposure or transplantation, and may include semen cryopreservation and testicular sperm extraction (TESE) with assisted reproduction when needed. Prospective longitudinal studies are required to define reproductive trajectories and optimize counseling and management.

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.

Neurogenic priapism is a rare but clinically significant manifestation of disrupted spinal autonomic control of erectile physiology. While most described following acute spinal cord injury (SCI), priapism has also been reported in association with chronic degenerative spinal pathology, suggesting distinct underlying mechanisms. To synthesize reported cases of neurogenic priapism associated with spinal pathology and clarify how lesion level, injury chronicity, and autonomic pathway involvement influence priapism phenotype. A narrative review of the literature was performed to identify published cases of priapism associated with SCI, lumbar spinal stenosis, and cauda equina pathology. Clinical features, spinal lesion characteristics, priapism subtype, management, and outcomes were extracted and qualitatively synthesized. We identified 10 case reports and case series comprising 17 neurogenic priapism cases (3 acute SCI, 14 lumbar stenosis). Onset was immediate with SCI and delayed with stenosis. Priapism following acute cervical or upper thoracic SCI typically occurred immediately after injury and reflected abrupt loss of sympathetic inhibition with preserved sacral parasympathetic outflow, resulting in sustained reflexogenic or, less commonly, ischemic priapism. In contrast, priapism associated with chronic lumbar spinal stenosis or cauda equina compression was uniformly non-ischemic, intermittent, and often activity-provoked, consistent with partial sacral root irritation and preserved arterial inflow. Lesion level, injury chronicity, and the degree of autonomic pathway disruption are key determinants of neurogenic priapism phenotype. Recognition of these mechanistic distinctions may improve diagnostic accuracy, guide etiology-specific management, and reduce the risk of unnecessary invasive intervention in patients with spinal pathology.

Ischemic priapism (IP) is characterised by prolonged, painful erections that require urgent intervention to prevent corporal fibrosis and erectile dysfunction. Hydrogen sulfide (H₂S), a gaseous mediator, has been shown to exert protective effects against ischemia-reperfusion (IR) injury by reducing oxidative stress, enhancing mitochondrial function, and inhibiting apoptosis. This study aimed to investigate the role of H₂S during IP and reperfusion and its potential protective effects against penile tissue injury. Twenty-eight male Wistar rats were divided into four groups: control, IP, IP-R, and IP-[NaHS]-R. The control group underwent penectomy only. In the IP group, penectomy was performed after 4 h of priapism, whereas in the IP-R group, it was performed after 4 h of priapism followed by 1 h of reperfusion. In the IP-[NaHS]-R group, rats received NaHS (75 µmol/kg, intraperitoneally) 10 min before reperfusion. Endogenous H₂S levels were determined by the methylene blue assay, and hypoxia-inducible factor-1α (HIF-1α) expression was evaluated by immunohistochemistry. Histopathological analyses were performed to assess tissue alterations. The IP and IP-R groups showed edema, inflammation, desquamation, vasocongestion, and increased collagen deposition, and exhibited reduced H₂S levels (p < 0.05) and elevated HIF-1α (p < 0.0001) compared with control group. NaHS administration increased H₂S levels, reduced HIF-1α expression, and alleviated histopathologic changes. Decreased H₂S levels during ischemia and reperfusion were associated with penile tissue injury in IP. NaHS mitigated morphological damage during the initial phase of reperfusion, indicating the potential involvement of H₂S signaling in reperfusion-related corporal tissue injury. However, endpoints related to the resolution of priapism, such as detumescence time and intracavernosal pressure (ICP), have not been evaluated. These assessments are necessary to determine the translational safety and therapeutic applicability of these treatments in cases of IP.

ResumenIntroducción:el priapismo es un trastorno en el que el pene mantiene una erección prolongada y rígida, sin estimulación sexual previa, con potenciales consecuencias físicas y psicosociales. Afecta a hombres de cualquier edad, con picos de incidencia en la infancia y en la adultez joven. Su manejo varía según la etiología, con el objetivo de evitar complicaciones.Objetivo:describir las características epidemiológicas y clínicas, así como el manejo y las complicaciones posquirúrgicas en pacientes con priapismo isquémico.Métodos:estudio transversal analítico en pacientes con diagnóstico de priapismo isquémico, a los que se documentaron datos epidemiológicos, comorbilidades, manejo y complicaciones posoperatorias durante un mes.Resultados:se incluyeron 20 pacientes, con edades entre 25 y 78 años, con una mediana de 32.5 años. El tiempo de evolución osciló entre 10 y 120 horas (± 31.8 horas). En cuanto a los antecedentes, 12 (60%) presentaban tabaquismo, 10 (50%) consumo de alcohol y 3 (15%) consumo de drogas ilícitas. Respecto a las comorbilidades, 10 (50%) presentaban hipertensión arterial, 3 (15%) diabetes mellitus tipo 2 y 1 (5%) dislipidemia. En cuanto al manejo inicial, la punción y drenaje de los cuerpos cavernosos fue el procedimiento más frecuente, realizado en 18 (90%) pacientes. La disfunción eréctil fue la complicación más común, observada en 7 (38.8%) pacientes durante el primer mes de seguimiento.Conclusiones:en nuestra población, la mayoría de los casos de priapismo presentaron antecedente de consumo de medicamentos, particularmente antihipertensivos. Solo un bajo porcentaje acudió dentro del tiempo de evolución adecuado, lo cual puede explicar la elevada frecuencia de disfunción eréctil observada.

Priapism is a condition characterized by prolonged erections lasting longer than 4 h, classified as ischemic and nonischemic. This case series is aimed at reporting the therapeutic approaches employed and the outcomes observed in patients with prolonged priapism. We reported seven consecutive cases of prolonged priapism managed by the authors. Collected data included duration of priapism, interventions performed, and posttreatment outcomes. In Cases 1 and 2, drainage procedures and shunts were ineffective, resulting in erectile dysfunction. Cases 3 and 4 involved the implantation of semirigid prostheses after 6 and 40 days. In Case 5, an infectious complication occurred following prosthesis implantation in a patient with previous distal shunts. Case 6 demonstrated a patient with priapism had success with early prosthesis implantation. Case 7 described a patient with cocaine-induced priapism received a prosthesis on the sixth day. The management of ischemic priapism directly depends on the time elapsed since the onset of symptoms. After 48 h, necrosis of the corpora cavernosa becomes inevitable, and surgical shunt procedures show limited efficacy. Early implantation of penile prostheses is an effective strategy to avoid late complications such as penile fibrosis. However, the decision must consider risks such as infection and prosthesis extrusion. Shunt procedures prior to penile implantation should be indicated with caution. The implantation of penile prostheses is a safe and effective therapeutic option for prolonged priapism. Excessive surgical manipulation of the penis with attempts at cavernous shunting in these cases often provides no benefit and may increase the risk of prosthesis infectious complications.

Priapism, a persisting erection not associated with sexual stimulation, can be ischaemic, with the risk of permanent erectile dysfunction, or nonischaemic. Drugs-e.g., injection therapies for erectile dysfunction, as well as neuroleptics, antidepressants and various other medicines-can also cause priapism. This study aimed to describe presentations due to priapism and provide insights into specific causes, clinical presentations, diagnostic strategies and emergency management. A single-centre, retrospective, observational study of patients (≥ 16 years old) presenting to the University Hospital of Bern, Switzerland, between January 2010 and June 2023 due to priapism. The cases were retrieved from the electronic health records using full-text search. During the study period, 40 cases corresponding to 32 patients were included. The mean ± SD age was 48 ± 15 years, and pain was present in 21 cases (53%) on presentation. Median time of erection was 15 h (range: 1-80, n = 23). A penile blood gas analysis was performed in 32 cases (80%), and 29 of these (91%) were of the low-flow type. Most commonly suspected causes were idiopathic (n = 25, 63%) and drug-induced (n = 10, 25%). Suspected agents in the drug-induced cases were corpus cavernosum autoinjection therapy (n = 4), trazodone (n = 3), sildenafil (n = 2) and urapidil (n = 1). Puncture of the corpus cavernosum and injection of noradrenalin and adrenalin were the therapeutic measure in 35 cases (88%). In 13 cases, there was at least one recurrence, including 10 within one week. Drugs given as recurrence prophylaxis included tadalafil (n = 9) and diazepam (n = 4). Presentations due to priapism appear to be rare, but the majority of the cases presented with ischaemic priapism, which is a medical emergency. The findings can be used to identify areas requiring further research (e.g., drugs used as recurrence prophylaxis) and raise awareness of this potentially severe complication-which patients are often ashamed to report.

Non-surgical vs surgical management for major ischemic priapism of 36hours duration.

Objective: To estimate the prevalence of erectile dysfunction (ED) and assess the diagnostic performance of simplified tools - the Erection Hardness Score (EHS), the Massachusetts Male Aging Study (MMAS) single-item scale, and a visual analog “Erectometer” - against the International Index of Erectile Function-5 (IIEF-5) among adult men with sickle cell disease (SCD).Methods: Cross-sectional validation study including 33 adult men with confirmed SCD followed at a regional reference center in Bahia, Brazil (July-December 2021). Sociodemographic, clinical, and laboratory data (total and free testosterone, luteinising hormone (LH), follicle stimulating hormone (FSH), estradiol, ferritin) were collected. Erectile function was assessed using IIEF-5 (reference standard), EHS, MMAS single-item, and the Erectometer. Receiver operating characteristic (ROC) curves and area under the curve (AUC) quantified diagnostic accuracy.Results: Median age was 35 [IQR 28-48] years; 33% reported prior ischemic priapism. By IIEF-5, 15/33 (45.5%) had moderate-severe ED (≤16). AUCs against IIEF-5 were 0.85 for EHS, 0.82 for MMAS, and 0.90 for the Erectometer (all p<0.001), with sensitivities ≥ 81% and specificities ≥ 79%.Conclusion: ED is frequent in Brazilian adults with SCD. Brief instruments (EHS, MMAS single-item, Erectometer) show excellent agreement with IIEF-5 and appear suitable for routine screening, potentially enabling earlier multidisciplinary care.