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AUA, SMSNA Release New Acute Ischemic Priapism Guideline

BALTIMORE, Sept. 9, 2021 /PRNewswire/ --The American Urological Association (AUA) and the Sexual Medicine Society of North America (SMSNA) will be releasing a new clinical practice guideline to aid in the diagnosis, evaluation and treatment of acute ischemic priapism in men.

Priapism is a persistent penile erection that continues hours beyond or is unrelated to sexual stimulation and results in a prolonged and uncontrolled erection. Priapism is a situation both urologists and emergency medicine practitioners must be familiar and comfortable with treating due to its time dependent and progressive nature. Acute ischemic priapism is characterized by little or no cavernous blood flow and abnormal cavernous blood gases, represents a medical emergency, and may lead to cavernosal fibrosis and subsequent erectile dysfunction if left untreated.

The role of the clinician in managing acute ischemic priapism is to conduct appropriate investigation, provide education and offer available treatments that are rational and based on sound scientific data, and the guideline includes 16 recommendation statements to guide this process.

Recommendations are made across the following continuum of priapism: diagnosis, initial management, pre-surgical and surgical management, post shunting management and penile prosthesis.

New additions to the guideline also include greater detail on the role of:

  1. Adjunctive laboratory testing
  2. Early involvement of urologists when presenting to the emergency room
  3. Discussion of conservative therapies
  4. Enhanced data for patient counseling on risks of erectile dysfunction and surgical complications
  5. Specific recommendations on intracavernosal phenylephrine with or without irrigation
  6. Inclusion of novel surgical techniques
  7. Early penile prosthesis placement

"It is imperative all patients with priapism be evaluated emergently to identify the sub-type of priapism, and those with acute ischemic priapism be provided treatment as soon as possible," said Trinity J. Bivalacqua, MD, PhD, chair of the guideline panel and Professor of Urology and Oncology at the Perelman Center for Advanced Medicine, University of Pennsylvania, Abramson Cancer Center, Department of Urology. "We believe this guideline will provide a useful, evidence-based clinical reference for the management of acute ischemic priapism for urologists and emergency medicine practitioners."

The guideline was developed by a panel of experts from the AUA and the SMSNA, as well as representatives from the American College of Emergency Physicians. It was then distributed to peer reviewers of varying backgrounds as part of the AUA's extensive peer review process before being finally approved by the AUA Board of Directors.

This new clinical guideline is now available online at

A summary of the Guideline also appears at:

Members of the Acute Ischemic Priapism Guideline Panel: Trinity J. Bivalacqua, MD; Bryant K. Allen, MD; Gerald Brock, MD; Gregory A. Broderick, MD; Tobias S. Kohler, MD; Jeff Oristaglio, PhD; John P. Mulhall, MD; Zora Rogers, MD; Ryan P. Terlecki, MD; Landon Trost, MD; Faysal A. Yafi, MD; Nelson E. Bennett, Jr., MD; Leila L. Rahimi, MHS

About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has nearly 23,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health care policy.

Taylor Titus

SOURCE American Urological Association