Priapism: Pathogenesis, Epidemiology, and Management Gregory A. Broderick, MD,* Ates Kadioglu, MD, † Trinity J. Bivalacqua, MD, PhD, ‡ Hussein Ghanem, MD, § Ajay Nehra, MD, FACS, ¶ and Rany Shamloul, MD** *Department of Urology, Mayo Clinic College of Medicine, Jacksonville, FL, USA; † Department of Urology, I ˙ stanbul University Faculty of Medicine, I ˙ stanbul, Turkey; ‡ Department of Urology, Johns Hopkins Hospital, Baltimore, MD, USA; § Department of Andrology, Sexology & STDs, Cairo University, Cairo, Egypt; ¶ Department of Urology, Mayo Clinic College of Medicine, Rochester, MN, USA; **Department of Andrology, Cairo University, Cairo, Egypt and Department of Pharmacology, Queen’s University, Kingston, Canada and Department of Urology, University of Ottawa, Ottawa, Canada DOI: 10.1111/j.1743-6109.2009.01625.x A B S T R A C T Introduction. Priapism describes a persistent erection arising from dysfunction of mechanisms regulating penile tumescence, rigidity, and flaccidity. A correct diagnosis of priapism is a matter of urgency requiring identification underlying hemodynamics. Aims. To define the types of priapism, address its pathogenesis and epidemiology, and develop an evidence-bas guideline for effective management. Methods. Six experts from four countries developed a consensus document on priapism; this document was pre- sented for peer review and debate in a public forum and revisions were made based on recommendations of chairpersons to the International Consultation on Sexual Medicine. This report focuses on guidelines written over the past decade and reviews the priapism literature from 2003 to 2009. Although the literature is predominantly series,recent reports have more detailed methodology including duration of priapism, etiology of priapism, and erectile function outcomes. Main Outcome Measures. Consensus recommendations were based on evidence-based literature, bestmedical practices, and bench research. Results. Basic science supporting current concepts in the pathophysiology of priapism, and clinical research sup- porting the most effective treatment strategies are summarized in this review. Conclusions. Prompt diagnosis and appropriate management of priapism are necessary to spare patients ineffectiv interventions and maximize erectile function outcomes. Future research is needed to understand corporal smoot muscle pathology associated with genetic and acquired conditions resulting in ischemic priapism. Better underst ing of molecular mechanisms involved in the pathogenesis of stuttering ischemic priapism will offer new avenues medicalintervention. Documenting erectile function outcomes based on duration of ischemic priapism, time to interventions, and types of interventions is needed to establish evidence-based guidance. In contrast, pathogene nonischemic priapism is understood, and largely attributable to trauma. Better documentation of onset of high-fl priapism in relation to time of injury,and response to conservative management vs.angiogroaphic or surgical interventions is needed to establish evidence-based guidance. Broderick GA,Kadioglu A,Bivalacqua TJ, Ghanem H, Nehra A, and Shamloul R. Priapism: Pathogenesis, epidemiology and management. J Sex 2010;7:476–500. Key Words. Priapism; Ischemic Priapism; Nonischemic Priapism; Stuttering Priapism; Sickle-Cell Priapism; Pro- longed Erection; Penile Shunt; Penile Embolization 476 J Sex Med 2010;7:476–500 © 2010 International Society for Sexual Medicine