Prognosis
Ischaemic priapism
The most common complication of priapism is complete erectile dysfunction, which has been reported to occur in >50% of patients with priapism lasting 24-48 hours.[36] Therefore, the most critical factor in maintaining erectile function is immediate and aggressive treatment of men presenting with priapism and prevention of future episodes.[25]
Patients treated within 12-24 hours will have a more favourable response than those with delayed treatment. Patients with prolonged priapism (>36 hours) and recurrent episodes are more likely to have erectile dysfunction owing to impaired corporal smooth muscle function and fibrosis. Corporal ischaemia lasting >24 hours results in varying degrees of irreversible penile fibrosis with endothelial and smooth muscle cell destruction.[48] If left untreated, ischaemic priapism results in global penile fibrosis with significant impairments in erectile function. This group of patients may need to pursue penile implant surgery because pharmacological therapy will almost certainly fail.[1] Prompt recognition and treatment of ischaemic and recurrent priapism are essential for optimal outcomes.
For priapism episodes refractory to medical therapy and requiring surgical shunting, the success rate of these procedures ranges between 50% and 65%.
For those patients refractory to all treatment strategies or who have irreversible erectile dysfunction, a penile prosthesis is the only management option available.
Prompt recognition and treatment of ischaemic and recurrent priapism are essential for optimal outcomes.
Non-ischaemic priapism
Spontaneous resolution of untreated non-ischaemic priapism is reported in most cases, although subsequent erectile difficulties may occur in some patients.[46]
In cases treated by embolisation, resolution of non-ischaemic priapism is reported in 85% of patients, with 80% retaining functional erections.[1]
Recurrent (stuttering) priapism
The frequency and duration with which the priapic episodes occur will largely determine the amount and extent of damage to the penis and likelihood of erectile dysfunction. Often, penile vascular dysfunction may actually be a consequence of significant fibrosis resulting from repeated and prolonged episodes of priapism, rather than the result of a surgical or shunt procedure itself.[3][21]
Significant fibrosis, which is commonly found in these patients, makes surgery more difficult with higher complication rates.[1][44] This type of priapism should be followed and treated as for ischaemic priapism with the goal of preventing future stuttering episodes.
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