Advice: All cases need emergency referral.
Refer To: Urologist as an emergency.
Priapism is a persistent erection (often painful) for more than four hours in the absence of stimulation.
Low-flow, ischaemic priapism
Most cases of priapism are low-flow, ischaemic priapism. This is the dangerous form, in that urgent treatment is required if long-term ischaemic damage to the corpora is to be avoided.
Emergency referral to an urologist is needed. Often presentation is delayed, but attempts will still be made to salvage the priapism where appropriate.
High-flow, non-ischaemic priapism
This is a rarer form, and is usually due to perineal trauma, causing a small arterio-venous fistula. It is non normally painful, and as it is non-ischaemic, referral need not be as rushed as for low-flow priapism.
The diagnosis is easy to make in the hospital setting with the availability of corporal blood gas analysis, but may not be quite so clear in the primary care setting.