Priapism: pathophysiology and the role of the radiologist

Abstract

Priapism is defined as a penile erection that persists for 4 h or longer and is unrelated to sexual activity. Its identification is important as lack of timely treatment (particularly of the low flow/ischaemic subgroup) can result in persisting erectile dysfunction as a consequence of irreversible corporal fibrosis. This review describes the physiology and anatomy of the normal erection, the aetiology and pathophysiology of the different types of priapism, and the role of the radiologist in the management of the condition. The treatment of iatrogenic priapism following intracavernosal injection of pharmacostimulant is discussed.

Embolization Treatment of High-Flow Priapism

“…The penile artery divides into three branches: the bulbar artery (to the corpus spongiosum), the dorsal artery, and the cavernosal artery (main blood supply to the erectile tissue of the corpus cavernosum). 4 In the flaccid penis, the high resting tone of the cavernosal arterioles and sinusoids results in low blood volume inflow and outflow. The onset of an erection is allowed by smooth muscle relaxation and consequently a significant increase in cavernosal arterial blood flow.…”

“…In high-flow priapism, CDU demonstrates a "low-resistance, high-velocity" arterial waveform. 4,16 The sensitivity of CDU in localizing an arteriocavernosal fistula is nearly 100%. 17 On gray-scale ultrasonography, the arteriocavernosal fistula is a hypoechoic area surrounded by echogenic tissue.…”

“…His image was adopted as a symbol of fertility. 4 The first reported case of priapism in the English medical literature was published in the Lancet by Tripe in 1845. 5 Subsequently in 1914, Frank Hinman Sr. published a landmark article describing the natural history of priapism.…”

Recurrent ischemic priapism: A rare adverse event after human chorionic gonadotropin treatment in a three years-old boy with cryptorchidism

“…These radiological findings suggested low flow (ischemic) priapism [5]. SCD and leukemia were excluded by normal hemoglobin electrophoresis and peripheral blood smear.…”

Male urogenital disorders

“…This review details the method for performing PDS and features of specific causes of ED, and also considers the alternative imaging modalities available. This group [8] then reviews the aetiology and pathophysiology of different types of priapism and the role of the radiologist in the diagnosis and treatment of priapism.…”