Some Causes of Priapism

Medications for erectile dysfunction:

Painful ischemic priapism in men with history of treatment for erectile dysfunction

Clinical evaluation

Illicit drugs:

• Amphetamines

Painful ischemic priapism and psychomotor agitation and anxiety

Clinical evaluation

Sometimes toxicology screen

Other medications:

• Antipsychotics*

• Corticosteroids

• Hypoglycemics (tolbutamide)

• Methaqualone

Painful ischemic priapism in men undergoing treatment for another medical disorder

Clinical evaluation

Hematologic disorders:

• Leukemia

• Lymphoma

• Sickle cell disease (rarely, sickle cell trait)

• Thalassemia

Young males, often of African or Mediterranean descent

Complete blood count

Hemoglobin electrophoresis

Locally advanced prostate cancer

Any metastatic disease

Men > 50 with history of increasing symptoms of bladder outlet obstruction

Prostate-specific antigen testing

CT

Spinal cord stenosis or compression

Continuous epidural infusions

Concomitant lower-extremity weakness

CT or MRI of the spine

Trauma (resulting in unregulated arterial inflow or arterial fistula formation)

Nonischemic, nonpainful priapism in men with recent trauma

Penile duplex ultrasonography

Angiography

MRI

Rare causes:

• Cerebrospinal disorder (eg, syphilis, tumor)

• Genital infection and inflammation (eg, prostatitis, urethritis, cystitis), especially if complicated by a bladder calculus

• Pelvic hematoma or tumor

• Pelvic vein thrombosis

• Total parenteral nutrition

• Carbon monoxide poisoning

Various

Various