The Case Report of Priapus and a Modern Approach to an Ancient Affliction.

INTRODUCTION

Priapism, taking its name from God Priapus, is total or partial erection lasting longer than 4 hours independent of sexual stimulus and can result in erectile dysfunction. There are three subtypes of priapism.

AIM

To review the three subtypes of priapism, their pathophysiology, current treatment options, and complications.

METHODS

The literature including priapism guidelines, review articles, and current trial studies was reviewed and the priapism type of God Priapus was investigated according to the mythology.

MAIN OUTCOME MEASURES

All three types of priapism were reviewed for etiology, diagnosis, and management. Medical and surgical treatment options were reviewed in relation to the current literature. Special emphasis concerned current treatment strategies and controversial surgical topics.

RESULTS

Ischemic priapism is the most common type, constituting 95% of all cases, and is an emergency. First-line treatments are blood aspiration and intracavernosal sympathomimetic drug injections. If these fail, then surgical shunt operations are recommended. A T-shunt combined with corporal tunneling is the currently popular option. Immediate penile prosthesis implantation is recommended for patients who present 48 to 72 hours after the onset of a priapism episode. High-flow priapism is caused by irregular arterial cavernosal blood flow, which usually occurs after a blunt perineal trauma. Antiandrogens and selective arterial embolization are the treatment options. Stuttering priapism is repetitive, self-limiting ischemic priapism and frequent in patients with sickle cell anemia. Ketoconazole is safe, cheap, and effective and appears to be a logical and suitable current treatment option to prevent further episodes, which is the primary treatment goal of stuttering priapism.

CONCLUSION

Priapism is a relatively common condition but not well known by clinicians. The lack and delay of treatment result in irreversible complications such as erectile dysfunction. Each type of priapism should be diagnosed and treated correctly with caution.