Ischemic Priapism

Ischemic priapism is a painful condition affecting the penis, where an erection lasts for several hours without sexual stimulation. It involves the circulatory system, specifically the blood flow within the penile tissue. Normally, blood flows in and out of the penis to regulate erection, but in this condition, blood becomes trapped and cannot leave, causing swelling and pain. This trapped blood is low in oxygen, which can damage the tissue if not treated promptly. The condition can lead to permanent erectile dysfunction if the blood supply is not restored quickly. It is considered a medical emergency due to the risk of lasting damage to the penis.

Ischemic priapism is defined as a prolonged, painful erection lasting more than 4 hours caused by impaired venous outflow from the corpora cavernosa, leading to hypoxic, acidotic, and ischemic penile tissue. The core pathology is veno-occlusive dysfunction, often triggered by conditions such as sickle cell disease, medications (e.g., anticoagulants, antidepressants), or trauma. This results in stagnant, deoxygenated blood trapped in the erectile tissue, causing progressive tissue ischemia. The condition is a urologic emergency because prolonged ischemia can cause fibrosis and irreversible erectile dysfunction. Clinically, it presents with a rigid, tender penis and absence of arterial inflow. Differentiation from non-ischemic priapism, which is usually painless and caused by unregulated arterial inflow, is critical for management.