Weill Cornell Medicine Urology
Weill Cornell Medicine Urology
Priapism - Symptoms & Evaluation

Priapism - Symptoms & Evaluation

Erections lasting longer than 4-6 hours are associated with permanent erection problems. It has been estimated that priapism of 24 hours duration is associated with an approximately 50% incidence of permanent erectile dysfunction. When such a patient presents to their physician's office or the emergency department, a urologist should be notified immediately and urgent steps should be taken to initiate evaluation and treatment. The most important step in evaluating and treating a man with priapism is differentiating between ischemic and non-ischemic priapism.

The patient with ischemic priapism typically complains of a painful erection, which is fully rigid. Men with non-ischemic priapism have an erection that is usually less than fully rigid and painless. The latter patient routinely gives a history of some form of penile or perineal trauma.

A comprehensive history and physical exam should be performed. A history should focus on possible causes, including the use of prescription, erectogenic, or recreational drugs. Formal laboratory testing routinely includes  peripheral blood tests, a urine toxicology screen, and a blood gas analysis of the penile blood (corporal blood). Analysis of penile blood gas is paramount in differentiating between ischemic and non-ischemic priapism. Additionally, if the initial evaluation of a man with ischemic priapism is negative, a workup for hematologic malignancies (leukemia, multiple myeloma) or blood dyscrasias (sickle cell disease, thalassemia, and glucose-6-phosphate dehydrogenase) may be undertaken. Occasionally, a penile doppler ultrasound may be used to assess for the presence or absence of penile blood flow and to locate the possible location of a fistula.

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Dr. Peter N. Schlegel, MD, FACS | Cornell Urology

Peter N. Schlegel

M.D., F.A.C.S.

212.746.5491
212.746.5491
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The LeFrak Center for Robotic Surgery
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Marc Goldstein

M.D., F.A.C.S.

212.746.5470
212.746.5470
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Brady Urologic Health Center
Dr.  Darius Paduch, M.D., Ph.D.

Darius A. Paduch

M.D., Ph.D.

212.746.5309
212.746.5309
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The LeFrak Center for Robotic Surgery
Dr. James A. Kashanian, M.D.

James A. Kashanian

M.D.

212.746.5309
212.746.5309
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