Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism: a systematic review by the EAU Sexual and Reproductive Health Guidelines panel. First-line treatment is aspiration that confirms the diagnosis and at the same time decompresses. A medication, such as phenylephrine, might be injected into your penis. If you suspect priapism, please contact your doctor immediately and do not attempt any home treatment. Penile corporal blood gas analysis demonstrated a high-flow, non-ischemic priapism with pH 7.42, pCO 2 35.2 mmHg, and pO 2 93.5 mmHg. Intracavernous vasodilator injections for treatment of ED, Postembolization or surgery for venous leak. ED may result from organic causes, psychological causes, or a combination of both. 2013 Jan;15(1):20-6. doi: 10.1038/aja.2012.83. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Lee JM, Sung AW, Lee HJ, Song JH, Song KH. Savoca G, Pietropaolo F, Scieri F, Bertolotto M, Mucelli FP, Belgrano E. J Urol. Possible organic causes: vascular, neurogenic, hormonal, anatomic, drug-induced.12 Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. The actual site of the arteriolacunar fistula can usually be accurately determined.3,4. Although erectile function can improve after vascular reconstructive surgery or endovascular angioplasty of the internal pudendal/penile arteries,20-23 there is still very little evidence to recommend vascular imaging studies and therapies for ED in the general population. Scherzer ND, et al. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. 2011 May;41(5):627-32. doi: 10.1007/s00247-010-1912-3. Cantasdemir M, Gulsen F, Solak S, Numan F. Pediatr Radiol. This neurovascular function must be integrated with sexual perception and desire.12 Other smooth muscle relaxants (e.g., prostaglandin E1 analogs and -adrenergic antagonists) can cause sufficient cavernosal relaxation to result in erection. New views on ultrasonography in high-flow priapism, with typical cases. American Urological Association guideline on the management of priapism. Penile emergencies. See this image and copyright information in PMC. Mayo Clinic is a not-for-profit organization. Repeat penile corporal blood gas analysis reaffirmed the priapism to be non-ischemic in nature, and it was decided to manage the patient conservatively. Duplex sonography with pulsed Doppler analysis (with and without dynamic erection studies with vasoactive substances) and nocturnal penile tumescence (NPT) are usually performed as first-line studies. If these treatments are insufficient, we may need to use other techniques to normalize blood circulation in the penis. Shapiro RH, Berger RE. This occurs when there is any injury in penis or the area between scrotum and anus stops the flow of blood to penis from moving normally. Embolization Treatment of High-Flow Priapism Priapism is prolonged erection that persists beyond or is unrelated to sexual stimulation. Soft erection. The AUA recommends that the initial evaluation of ED include a complete medical, sexual, and psychosocial history. Are there activities, such as exercise or sex, that should be avoided? Cardiovasc Intervent Radiol 2006; 29:198. sharing sensitive information, make sure youre on a federal ED affects up to one third of men throughout their lives and over 150 million men worldwide. FOIA Trauma to the spinal cord or to the genital area. Tibana TK, Fornazari VAV, Gutierrez Junior W, Marchiori E, Szejnfeld D, Nunes TF. You might also need surgery to repair arteries or tissue damage resulting from an injury. If the priapism is ischemic in nature, there are a number of treatment options, including aspiration, medication, and surgery. Otherwise, low flow priapism showed little or no blood flow in the cavernosal arteries. Its course lies outside the tunica albuginea. . Angiographic embolization of the lacerated artery is currently considered the treatment of choice. The Glickman Urological & Kidney Institute offers innovative treatments in urology and kidney medicine, including minimally invasive, scarless options for urologic procedures and medical management of kidney disease. Ischemic priapism the result of blood not being able to exit the penis is an emergency situation that requires immediate treatment. Clinical Presentation Vascular causes of ED may be arterial and/or venous, and these are the ones amenable to endovascular treatment. Low-Flow/Ischemic/Veno-occlusive Priapism One patient underwent percutaneous embolization and achieved detumescence. Any prothrombotic state Etiology [Treatment using percutaneous arterial embolization of post-traumatic priapism in children]. The authors report a case of post-traumatic priapism due to laceration of the left cavernous artery. Before e81-1). Some authors consider the artery to be called the penile artery from here on, giving rise to: Bulbar artery supplying the bulb of the urethra, posterior corpus cavernosum, and bulbourethral glands (with the normal capillary blush seen within the bulbar spongiosa), Urethral (spongiosal) artery supplying the corpora spongiosa and providing anastomoses with the dorsal artery of the penis at the glans penis, The deep artery of the penis (cavernosal artery), which divides into helicine arteries that enter the lacunar spaces almost at right angles from the cavernosal artery. and transmitted securely. Dec 23, 2015 | Posted by admin in INTERVENTIONAL RADIOLOGY | Comments Off on Treatment of High-Flow Priapism and Erectile Dysfunction, Tiago Bilhim, Joo M. Pisco, Max Kupershmidt and Kenneth R. Thomson. Korean J Urol. Accurate and time-saving, two-step intracavernosal injection procedure to diagnose psychological erectile dysfunction. Federal government websites often end in .gov or .mil. Non-ischemic priapism is a high-flow state that is typically not painful and resolves spontaneously. Vascular Studies in the Patient with Erectile Dysfunction Online ahead of print. Sex Med. This content does not have an English version. Idiopathic Priapism tends to resolve of its own accord in about two-thirds of men with this condition. Superselective embolization of terminal branches of the male internal pudendal artery is a highly successful procedure in the treatment of high-flow arterial priapism. 2020 Mar;125(3):288-295. doi: 10.1007/s11547-019-01113-w. Epub 2019 Dec 10. Vascular imaging and treatment in patients with erectile dysfunction (ED) using cavernosography and internal pudendal artery angiography and angioplasty remains a controversial topic. This cookies is set by Youtube and is used to track the views of embedded videos. Possible organic causes: vascular, neurogenic, hormonal, anatomic, drug-induced. Bethesda, MD 20894, Web Policies Concerta . Signs and symptoms include: Unauthorized use of these marks is strictly prohibited. There are two typeslow-flow/ischemic and high-flow/arterialand these are grouped based on the pathophysiology, with implications for subsequent treatment options and outcomes. Only gold members can continue reading. 2019; doi:10.1016/j.sxmr.2018.09.002. In some cases, the etiology remains unknown. This site complies with the HONcode standard for trustworthy health information: verify here. Additional tests might identify the cause of priapism. Typically a straddle injury to the perineum This is followed by irrigation with a sympathomimetic pharmaceutical agent and, if necessary, a surgical shunt. High-flow or arterial priapism is a fairly rare dysfunction, generally resulting from penile or perineal trauma. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Generalized penile arterial insufficiency may result from stenotic arterial lesions of the internal pudendal arteries or from microangiopathy of the arteries of the corpora cavernosa. . Unauthorized use of these marks is strictly prohibited. 2019 Sep-Oct;52(5):331-336. doi: 10.1590/0100-3984.2018.0035. Up to 70% of men with ED remain undiagnosed and untreated.15 ED has an effect equal to or greater than the effects of family history of myocardial infarction, cigarette smoking, or measures of hyperlipidemia on subsequent cardiovascular events.16 All patients with ED should be considered for screening for undetected cardiovascular disease. You may also need an Radiology appGet it nowRenovascular InterventionsSplenic Embolization in Nontraumatized PatientsChemical Ablation of Liver LesionsManagement of Male VaricoceleSubintimal AngioplastyCervical Artery DissectionLung AblationInfrapopliteal Revascularization 2013 Dec;54(12):816-23. doi: 10.4111/kju.2013.54.12.816. The doctor might suggest that you make a follow-up appointment with a specialist in the urinary tract and male reproductive system, such as a urologist or andrologist. High-flow priapism is typically caused by injury; injury can be to the perineum 1 or to the spinal cord. Have you had an injury to your genitals or groin? Nonischemic priapism, or high-flow priapism, occurs when there's continuous blood flow to the erectile tissue, but the blood flow is unregulated and doesn't become properly stored inside the penis. Priapism Treatment. We describe 4 cases of high flow arterial priapism, ranging from 1 week to 3 years in duration. It stores a true/false value, indicating whether this was the first time Hotjar saw this user. Only gold members can continue reading. Acute onset of severe pain, rigidity, and other compartment syndrome clinical findings are noted. Objectives: In patients with priapism secondary to other disorders, attempt to treat the underlying condition. First-line treatment is aspiration that confirms the diagnosis and at the same time decompresses. High-Flow/Nonischemic/Arterial Priapism If your priapism does not resolve, you may need surgery to block off the offending blood vessels to reduce the blood flow into your penis. 2019 Apr;15(2):187.e1-187.e6. Advertising revenue supports our not-for-profit mission. The goal of all treatment is to make the erection go away and preserve the ability to have erections in the future. Federal government websites often end in .gov or .mil. doi: 10.1016/j.jpurol.2019.01.005. This treatment often relieves pain, removes oxygen-poor blood and might stop the erection. Shearing forces on the endothelium cause release of increased levels of nitric oxide and activation of the cyclic guanosine monophosphate pathway, resulting in relaxation of smooth muscle.6-8, Unlike the low-flow/occlusive type, there is no ischemia or pain, and hence it is not an emergency. 8600 Rockville Pike There are three types of high-flow priapism: traumatic, neurogenic and post-shunting. When a ruptured artery causes priapism, your doctor will perform an operation to tie it off (surgical ligation). Br J Radiol. Evolving concepts in the diagnosis and treatment of arterial high flow priapism. Can priapism resolve on its own? "Stuttering" priapism is a term frequently used to . There are two terminal branches: The cookie is used to store the user consent for the cookies in the category "Analytics". Would you like email updates of new search results? Hakim LS, Kulaksizoglu H, Mulligan R, Greenfield A, Goldstein I. Colombo F, Lovaria A, Saccheri S, Pozzoni F, Montanaris E. Cantasdemir M, Gulsen F, Solak S, Numan F. Pediatr Radiol. Trauma is the commonest reason for high-flow priapism. Vol. He was treated successfully with super-selective embolization with a resorbable material (gel foam). The 16 G needle was first inserted into the central part of the abscess to aspirate 10 mL of yellow pus. Venous Anatomy The site is secure. . Pathophysiology If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction. High-flow priapism might not require emergency treatment because blood flow to the penis is not reduced. Conclusions: An official website of the United States government. Management Same patient with (D) CTA, coronal MIP reformat; (E) CTA, sagittal MIP reformat; and (F, G) after selective DSA. Perineal-scrotal artery, supplying the perineal muscles, structures between anus and scrotum, skin and dartos tunic of the scrotum Its course lies outside the tunica albuginea. This cookie is set when the customer first lands on a page with the Hotjar script. There is unregulated blood flow in an arteriolacunar (not arteriovenous) fistula between one of the terminal branches of the internal pudendal artery (most commonly the cavernosal artery) and lacunar spaces of the corpora cavernosa. This website uses cookies to improve your experience while you navigate through the website. BJU International. Blood gases on blood aspirated from the corpora cavernosa revealed the presence of "high-flow" priapism. PMID: 8126815. There are two types of priapism: low-flow and high-flow. This cookie is set by doubleclick.net. Int J Impot Res 2005; 17:109. Dysregulation of vasorelaxing and vasoconstricting factors often results from injury, affecting nerve innervation and blood supply to the genitals. Doppler studies show no or low velocities in cavernosal arteries. Tags: Image-Guided Interventions Expert Radiology Series . Failure of the veins to close completely during an erection (veno-occlusive dysfunction) may occur in men with large venous channels that drain the corpora cavernosa, and may be studied by cavernosography.13 Evidence is accumulating in favor of ED as a vascular disorder in the majority of patients.14. Transl Androl Urol. 2022 Jan 14;9(1):29. doi: 10.3390/vetsci9010029. No etiologic causes were evident in the other patients. The mode of presentation, evaluation using a duplex scanner, treatment and ultimate resolution are discussed. e81-1). Color Doppler ultrasonography was repeated 1 day, 1 month, and 6 months after the operation. Identification of these characteristics allows to check variations after the treatment. Read more. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. This can help in relieving pain and stopping unwanted erections. Priapism: comorbid factors and treatment outcomes in a contemporary series. Nonischemic (also known as high-flow or arterial) priapism is a non-emergent variant of persistent erections caused by unregulated cavernous arterial inflow and occurs in less than 5% of observed clinical presentations. Inferior rectal (or inferior hemorrhoidal) branches at the level of the ischial tuberosity, Perineal-scrotal artery, supplying the perineal muscles, structures between anus and scrotum, skin and dartos tunic of the scrotum, Some authors consider the artery to be called the, Bulbar artery supplying the bulb of the urethra, posterior corpus cavernosum, and bulbourethral glands (with the normal capillary blush seen within the bulbar spongiosa), Urethral (spongiosal) artery supplying the corpora spongiosa and providing anastomoses with the dorsal artery of the penis at the glans penis, The deep artery of the penis (cavernosal artery), which divides into helicine arteries that enter the lacunar spaces almost at right angles from the cavernosal artery. Montague DK, et al. HHS Vulnerability Disclosure, Help Inferior rectal (or inferior hemorrhoidal) branches at the level of the ischial tuberosity Arterial embolization in the treatment of post-traumatic priapism. Before Venous blood is evident on aspiration of the corpora cavernosa. To evaluate the effectiveness and safety of treatment of high-flow priapism (HFP) with superselective transcatheter embolization at nine university hospitals. This drug constricts blood vessels that carry blood into the penis. Urethral (spongiosal) artery supplying the corpora spongiosa and providing anastomoses with the dorsal artery of the penis at the glans penis 12th ed. doi: 10.1093/jscr/rjab077. In three of these patients, a second embolization procedure was conclusive. In 2 men a vascular pseudocapsule formed around the site of the ruptured cavernous artery that provided an important anatomical landmark for intraoperative localization. The dorsal artery of the penis, the other terminal branch supplying the glans penis and prepuce. Incidence If you have priapism, it is important to get medical care immediately. Sometimes results from complications of low-flow priapism A pathophysiology-based approach to the management of early priapism. Treatment of High-Flow Priapism: Spontaneous resolution of high-flow priapism is likely (60%), ice packs may help in spontaneous thrombosis of the ruptured artery. Failure of the veins to close completely during an erection (veno-occlusive dysfunction) may occur in men with large venous channels that drain the corpora cavernosa, and may be studied by cavernosography. Priapism is a medical emergency, and if not treated within 24 hours, leads to irreversible ischemia and tissue necrosis. Muscular (small branches) The mode of presentation, evaluation using a duplex scanner, treatment and ultimate resolution are discussed. Bulbar artery supplying the bulb of the urethra, posterior corpus cavernosum, and bulbourethral glands (with the normal capillary blush seen within the bulbar spongiosa) Painless in nature. Bookshelf Priapism in a patient with advanced hepatocellular carcinoma. It is the result of a ruptured artery from an injury to the penis or the perineum (the area between the scrotum and anus), which prevents blood in the penis from circulating normally. 2014 Dec;6(6):230-44. doi: 10.1177/1756287214542096. Last reviewed by a Cleveland Clinic medical professional on 10/14/2019. Venous blood is evident on aspiration of the corpora cavernosa. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). If conservative treatment fails, then treatment option includes either surgery or endovascular embolisation. Surgery might be necessary in some cases to insert material, such as an absorbable gel, that temporarily blocks blood flow to your penis. The incidence in the general population is low, between 0.5 and 2.9 per 100,000 person-years, and is higher in patients with sickle cell anemia and in men using intracorporal injections.1,2. During this test, a small needle is placed in the penis, some blood is drawn, and then it is sent to a lab for analysis. This is followed by irrigation with a sympathomimetic pharmaceutical agent and, if necessary, a surgical shunt. Vascular imaging and treatment in patients with erectile dysfunction (ED) using cavernosography and internal pudendal artery angiography and angioplasty remains a controversial topic. Advertising on our site helps support our mission. Clipboard, Search History, and several other advanced features are temporarily unavailable. Epub 2019 Jan 19. Note convex (not concave) trajectory of artery running behind and below pubic bone. Some cases resolve on their own. Your doctor is likely to ask you a number of questions. Gottsch H, Berger R, & Yang C. (2012). National Library of Medicine Sexual function after highly selective embolization of cavernous artery in patients with high flow priapism: long-term followup. The definitive management of traumatic highflow priapism is by selective embolization with autologous blood clot. The actual site of the arteriolacunar fistula can usually be accurately determined.3,4 2022 Sep 23. doi: 10.1038/s41443-022-00604-1. Methods: Trauma was reported in 6 of 10 cases. In: Campbell-Walsh-Wein Urology. 2022 Jul;10(5):852-862. doi: 10.1111/andr.13175. We describe 4 cases of high flow arterial priapism, ranging from 1 week to 3 years in duration. High-flow priapism is a nonsexual, persistent erection caused by unregulated cavernous arterial inflow. Colombo F, Lovaria A, Saccheri S, Pozzoni F, Montanaris E. Kato T, Mizuno K, Nishio H, Iwatsuki S, Nakane A, Akita H, Okamura T, Yasui T, Hayashi Y. J Pediatr Urol. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. . This procedure is a final treatment option if blocking the artery has failed. Prevalence increases with age: 12% are younger than 59 years, 22% are 60 to 69, and 30% are older than 69.11 Venous outflow is not restricted, because there is no compression of subtunical veins, normally produced by neural stimulation; hence, there is a constant state of inflow/outflow without pooling of blood. Disclosure The author has no financial or nonfinancial conflicts relevant to this article. Unable to load your collection due to an error, Unable to load your delegates due to an error, A 21-year-old male with high-flow priapism after blunt perineal trauma. (~25%) for the treatment of priapism, resulting in the need to perform emergency corporal aspiration of blood, saline irrigation, and intracavernous injections. It is a result of imbalance of arterial inflow and venous outflow involving the corpora cavernosa. Federal government websites often end in .gov or .mil. High-Flow Priapism: Long-standing history of the condition. Would you like email updates of new search results? This branch most frequently replaces the dorsal artery of the penis and deep branches of the internal pudendal artery (with the internal pudendal artery terminating as the bulbar artery or with perineal branches). This is set by Hotjar to identify a new users first session. A longitudinal penile scan showed that the 16 G needle (arrow) was inserted into the penile abscess (Fig. Nonischemic (arterial, high flow) priapism is a nonsexual, persistent erection caused by unregulated cavernous arterial inflow. C, Computed tomographic angiography (CTA) 3D reformat of right pelvic side, showing an accessory pudendal artery (long arrows). If you have used any medication or drugs, legal or illegal. The emergency room doctor will determine whether you have ischemic priapism or nonischemic priapism. Erectile dysfunction is defined as inability to reach or maintain erection sufficient for satisfactory sexual performance.10 ED is commonly associated with diabetes mellitus (threefold increased risk of ED), hypertension, vascular disease, dyslipidemia, hypogonadism, and depression. High-flow (nonischemic) Rare Associated with trauma or instrumentation Usually painless Increased arterial flow Usually self-resolves and does not require intervention Usually does not cause ischemia or sexual dysfunction Low-flow (ischemic) Most common type Veno-occlusion causing pooling of deoxygenated blood in cavernous tissue Painful Ischemic . Epub 2018 Jul 29. Used by Google DoubleClick and stores information about how the user uses the website and any other advertisement before visiting the website. The dorsal artery of the penis, the other terminal branch supplying the glans penis and prepuce. high blood flow (non-ischaemic priapism), which is rarer, usually caused by trauma or injury to the genital area ; recurrent or intermittent (stuttering priapism), which can be either due to low or high blood flow, and is when you have recurrent, painful erections lasting around 2-3 hours at a time . If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction. This cookie is set by Hotjar. There are two typeslow-flow/ischemic and high-flow/arterialand these are grouped based on the pathophysiology, with implications for subsequent treatment options and outcomes. and inject sympathomimetics as necessary. Evaluation of these vasculogenic factors ultimately depends on cavernosography and internal pudendal angiography. Thus, the penis has three pairs of arteries: two urethral arteries that run on either side of the penile urethra in the corpus spongiosum, two cavernosal arteries, each running on the center of the corpus cavernosum, and two dorsal arteries of the penis running on either side of the dorsum of the penis between the tunica albuginea and Buck fascia, near the dorsal nerves of the penis.26 1 Typically, the penis is neither fully rigid nor painful in this condition, and trauma is the most commonly reported etiology. Accepted for publication Jun 14, 2012. The bulbar and dorsal penile arteries are less frequently involved. Note typical concave trajectory curving under sciatic notch (thick arrows). Can be idiopathic without a recognizable event Nonischemic priapism, also known as high-flow priapism, is due to an unregulated or disrupted arterial inflow, allowing well-oxygenated blood in the corpora. Hormones (i.e., gonadotropin releasing hormone and testosterone). 2018 Aug;7(4):535-544. doi: 10.21037/tau.2018.05.12. Please enable it to take advantage of the complete set of features! Summary of Current American Urological Association Priapism Treatment Guidelines. However, we believe early interventional radiology management with embolization of the fistula provides a better outcome for high-flow fistulas. De Magistris G, Pane F, Giurazza F, Corvino F, Coppola M, Borzelli A, Silvestre M, Amodio F, Cangiano G, Cavagli E, Niola R. Radiol Med. The type of treatment you have for priapism will depend on whether you have low-flow or high-flow priapism. There are two main types of priapism: high flow and low flow. Splenic Embolization in Nontraumatized Patients, Image-Guided Interventions Expert Radiology Series. High flow priapism: Also known as "nonischemic," high flow priapism is rare and . 1. Being ready to answer them might allow time later to cover other points you want to address. 16 years 9 months 1 day 14 hours 1 minute. Transl Androl Urol. The management is slightly different but follows the same principles for the sickle cell anemia variant of veno-occlusive priapism. Priapism. PMC High-flow priapism: treatment and long-term follow-up - ScienceDirect Urology Volume 59, Issue 1, January 2002, Pages 110-113 Adult urology High-flow priapism: treatment and long-term follow-up Sandro Ciampalini a , Gianfranco Savoca a , Lorenzo Buttazzi a , Ignazio Gattuccio a , Fabio Pozzi Mucelli b , Michele Bertolotto b , Stefano De Stefani a , The flow refers to arterial flow. Note: High-flow (non-ischemic) priapism will present with different signs/symptoms than low-flow priapism. Clinical Presentation Govier FE et al. Don't hesitate to ask other questions that occur to you. Introduction. Elsevier; 2021. https://www.clinicalkey.com. Although erectile function can improve after vascular reconstructive surgery or endovascular angioplasty of the internal pudendal/penile arteries. Go to: Blood flow to the penis is not reduced in high-flow priapism, so it does not require emergency treatment. Etiology The purpose of the cookie is to determine if the user's browser supports cookies. Vet Sci. Material and methods Between 1995 and 2000, 14 patients affected by high-flow priapism were observed at the Urologic Clinic of the University of Trieste. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). There is unregulated blood flow in an arteriolacunar (not arteriovenous) fistula between one of the terminal branches of the internal pudendal artery (most commonly the cavernosal artery) and lacunar spaces of the corpora cavernosa. This site needs JavaScript to work properly. Less common than the low-flow type; in adults, 80% to 90% have a single fistula causing the priapism, but in children, 50% have multiple fistulas. Patients Included status is self-assessed. These cookies ensure basic functionalities and security features of the website, anonymously. Merck Manual Professional Version. J Urol 1994;151: 878-9. Surgery include ligation of internal pudendal artery or its branches. Cleveland Clinic is a non-profit academic medical center. Ischemic or "low-flow" priapism occurs when blood disorders (such as sickle cell anemia or leukemia), prescription medication, or substance use cause the veins in the penis to constrict and keep blood from exiting the erection chambers (corpora cavernosa).
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