The role of the urologist in managing high flow priapism

High-flow priapism (arterial) is a prolonged erection caused by irregular cavernous arterial flow, often resulting from blunt perineal or penile trauma, or iatrogenic needle injury. This condition leads to the formation of an arteriolacunar fistula, causing unregulated arterial blood flow into the sinusoidal spaces of the penis. Unlike low-flow priapism, high-flow priapism typically presents with a partially erect, non-painful penis. The diagnosis is confirmed through characteristic findings on color Doppler ultrasound, which reveals turbulent high-velocity flow pinpointing the fistula's location. Blood gas analysis typically reflects arterial values, helping to differentiate high-flow priapism from its low-flow counterpart. Although high-flow priapism was historically considered non-urgent, recent evidence suggests that delayed treatment may increase the risk of erectile dysfunction. Therefore, prompt intervention by urologists is crucial. The primary goal is to close the fistula, and the treatment plan should be individualized based on the severity and duration of the condition. Urologists play a critical role in managing this condition, offering a range of therapeutic options. These include conservative approaches, such as observation and compression, medical therapy, arterial embolization, and, in some cases, surgical intervention. The choice of treatment depends on the patient's condition, the fistula's location, and the resources available. By ensuring timely and appropriate management, urologists can minimize complications and preserve erectile function.