Lecture 3

Report of the American Foundation for Urologic Disease (AFUD) thought leader panel for evaluation and treatment of priapism

R. Berger, K. Billups, G. Brock, G. A. Broderick, C. B. Dhabulawa, I. Goldstein, L. S. Hakim, W. Hellstrom, S. Honig, L. A. Levine, T. Lue, R. Munnariz, D. K. Montague, J. J. Mulcahy, A. Nehra, Z. R. Rogers, R. Rosen, A. D. Seftel, R. Shabsigh, W. Steers

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Purpose: Patients with priapism often develop permanent erectile dysfunction and personal sexual distress. This report is intended to help educate the public by reviewing the varied definitions and classifications of priapism and limited literature reports of pathophysiology, diagnosis and treatment outcomes of priapism. The AUA priapism guidelines committee is responsible for creating consensus as to appropriate individual patient management of priapism by physicians. Materials and methods: A multidisciplinary panel, consisting of 19 thought leaders in priapism, was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease to address pertinent issues concerning the role of the urologist, primary care providers and other health care professionals in the education of the public regarding management of men with priapism. The panel utilized a modified Delphi method and built upon the peer review literature on priapism. Results: The Thought Leader Panel recommended adoption of the definition of priapism as a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is stressed to be an important medical condition that requires evaluation and may require emergency management. The classification system is categorized into ischemic and non-ischemic priapism. Essential elements of the ischemic classification are the inclusion of: (i) clinical characteristics of pain and rigidity; (ii) diagnostic characteristics of absence of cavernosal arterial blood flow; (iii) pathophysiological characteristics of a closed compartment syndrome; (iv) a time limit of 4h prior to emergent medical care; and (v) a description of the potential consequences of delayed treatment. Essential elements of the non-ischemic classification are the inclusion of: (i) clinical characteristics of absence of pain and presence of partial rigidity; (ii) diagnostic and pathophysiological characteristics of unregulated cavernosal arterial inflow; and (iii) the need for evaluation but emphasizing the lack of a medical emergency. The panel recommended adoption of a rational management algorithm for the assessment and treatment of priapism where the cornerstone of initial assessment includes a careful clinical history, a focused physical examination and selected laboratory and/or radiologic tests. The panel recommended that specific criteria and clinical profiles requiring specialist referral should be identified. The panel further recommended that patient (and partner) needs and education concerning priapism should be addressed prior to therapeutic intervention, however only in the case of chronic management or post acute presentation evaluation should this delay intervention. Treatment goals to be discussed include management of the priapism with concomitant prevention of permanent and irreversible erectile dysfunction and associated psychosocial consequences. The panel recommended that when specific therapies for priapism are required, a step-care treatment approach based upon reversibility and invasiveness should be followed. Conclusions: The Thought Leader Panel calls for research to expand our understanding of the prevalence and diagnosis of priapism and education to create awareness among the public of the potential urgency of this condition. Critical areas to be addressed include the multiple pathophysiologies of priapism as well as multi- institutional trials to objectively assess safety and efficacy in the various treatment modalities.

Original languageEnglish (US)
JournalInternational Journal of Impotence Research
Volume13
Issue numberSUPPL. 5
StatePublished - 2001

Fingerprint

Priapism
Urologic Diseases
Therapeutics
Erectile Dysfunction
Emergencies
Penile Erection
Education
Pain
Compartment Syndromes
Professional Education
Peer Review

Keywords

  • Diagnosis and treatment
  • Erectile dysfunction
  • Ischemic priapism
  • Non-ischemic priapism
  • Priapism

ASJC Scopus subject areas

  • Urology

Cite this

Berger, R., Billups, K., Brock, G., Broderick, G. A., Dhabulawa, C. B., Goldstein, I., ... Steers, W. (2001). Lecture 3: Report of the American Foundation for Urologic Disease (AFUD) thought leader panel for evaluation and treatment of priapism. International Journal of Impotence Research, 13(SUPPL. 5).

Lecture 3 : Report of the American Foundation for Urologic Disease (AFUD) thought leader panel for evaluation and treatment of priapism. / Berger, R.; Billups, K.; Brock, G.; Broderick, G. A.; Dhabulawa, C. B.; Goldstein, I.; Hakim, L. S.; Hellstrom, W.; Honig, S.; Levine, L. A.; Lue, T.; Munnariz, R.; Montague, D. K.; Mulcahy, J. J.; Nehra, A.; Rogers, Z. R.; Rosen, R.; Seftel, A. D.; Shabsigh, R.; Steers, W.

In: International Journal of Impotence Research, Vol. 13, No. SUPPL. 5, 2001.

Research output: Contribution to journalArticle

Berger, R, Billups, K, Brock, G, Broderick, GA, Dhabulawa, CB, Goldstein, I, Hakim, LS, Hellstrom, W, Honig, S, Levine, LA, Lue, T, Munnariz, R, Montague, DK, Mulcahy, JJ, Nehra, A, Rogers, ZR, Rosen, R, Seftel, AD, Shabsigh, R & Steers, W 2001, 'Lecture 3: Report of the American Foundation for Urologic Disease (AFUD) thought leader panel for evaluation and treatment of priapism', International Journal of Impotence Research, vol. 13, no. SUPPL. 5.
Berger, R. ; Billups, K. ; Brock, G. ; Broderick, G. A. ; Dhabulawa, C. B. ; Goldstein, I. ; Hakim, L. S. ; Hellstrom, W. ; Honig, S. ; Levine, L. A. ; Lue, T. ; Munnariz, R. ; Montague, D. K. ; Mulcahy, J. J. ; Nehra, A. ; Rogers, Z. R. ; Rosen, R. ; Seftel, A. D. ; Shabsigh, R. ; Steers, W. / Lecture 3 : Report of the American Foundation for Urologic Disease (AFUD) thought leader panel for evaluation and treatment of priapism. In: International Journal of Impotence Research. 2001 ; Vol. 13, No. SUPPL. 5.
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author = "R. Berger and K. Billups and G. Brock and Broderick, {G. A.} and Dhabulawa, {C. B.} and I. Goldstein and Hakim, {L. S.} and W. Hellstrom and S. Honig and Levine, {L. A.} and T. Lue and R. Munnariz and Montague, {D. K.} and Mulcahy, {J. J.} and A. Nehra and Rogers, {Z. R.} and R. Rosen and Seftel, {A. D.} and R. Shabsigh and W. Steers",
year = "2001",
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TY - JOUR

T1 - Lecture 3

T2 - Report of the American Foundation for Urologic Disease (AFUD) thought leader panel for evaluation and treatment of priapism

AU - Berger, R.

AU - Billups, K.

AU - Brock, G.

AU - Broderick, G. A.

AU - Dhabulawa, C. B.

AU - Goldstein, I.

AU - Hakim, L. S.

AU - Hellstrom, W.

AU - Honig, S.

AU - Levine, L. A.

AU - Lue, T.

AU - Munnariz, R.

AU - Montague, D. K.

AU - Mulcahy, J. J.

AU - Nehra, A.

AU - Rogers, Z. R.

AU - Rosen, R.

AU - Seftel, A. D.

AU - Shabsigh, R.

AU - Steers, W.

PY - 2001

Y1 - 2001

N2 - Purpose: Patients with priapism often develop permanent erectile dysfunction and personal sexual distress. This report is intended to help educate the public by reviewing the varied definitions and classifications of priapism and limited literature reports of pathophysiology, diagnosis and treatment outcomes of priapism. The AUA priapism guidelines committee is responsible for creating consensus as to appropriate individual patient management of priapism by physicians. Materials and methods: A multidisciplinary panel, consisting of 19 thought leaders in priapism, was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease to address pertinent issues concerning the role of the urologist, primary care providers and other health care professionals in the education of the public regarding management of men with priapism. The panel utilized a modified Delphi method and built upon the peer review literature on priapism. Results: The Thought Leader Panel recommended adoption of the definition of priapism as a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is stressed to be an important medical condition that requires evaluation and may require emergency management. The classification system is categorized into ischemic and non-ischemic priapism. Essential elements of the ischemic classification are the inclusion of: (i) clinical characteristics of pain and rigidity; (ii) diagnostic characteristics of absence of cavernosal arterial blood flow; (iii) pathophysiological characteristics of a closed compartment syndrome; (iv) a time limit of 4h prior to emergent medical care; and (v) a description of the potential consequences of delayed treatment. Essential elements of the non-ischemic classification are the inclusion of: (i) clinical characteristics of absence of pain and presence of partial rigidity; (ii) diagnostic and pathophysiological characteristics of unregulated cavernosal arterial inflow; and (iii) the need for evaluation but emphasizing the lack of a medical emergency. The panel recommended adoption of a rational management algorithm for the assessment and treatment of priapism where the cornerstone of initial assessment includes a careful clinical history, a focused physical examination and selected laboratory and/or radiologic tests. The panel recommended that specific criteria and clinical profiles requiring specialist referral should be identified. The panel further recommended that patient (and partner) needs and education concerning priapism should be addressed prior to therapeutic intervention, however only in the case of chronic management or post acute presentation evaluation should this delay intervention. Treatment goals to be discussed include management of the priapism with concomitant prevention of permanent and irreversible erectile dysfunction and associated psychosocial consequences. The panel recommended that when specific therapies for priapism are required, a step-care treatment approach based upon reversibility and invasiveness should be followed. Conclusions: The Thought Leader Panel calls for research to expand our understanding of the prevalence and diagnosis of priapism and education to create awareness among the public of the potential urgency of this condition. Critical areas to be addressed include the multiple pathophysiologies of priapism as well as multi- institutional trials to objectively assess safety and efficacy in the various treatment modalities.

AB - Purpose: Patients with priapism often develop permanent erectile dysfunction and personal sexual distress. This report is intended to help educate the public by reviewing the varied definitions and classifications of priapism and limited literature reports of pathophysiology, diagnosis and treatment outcomes of priapism. The AUA priapism guidelines committee is responsible for creating consensus as to appropriate individual patient management of priapism by physicians. Materials and methods: A multidisciplinary panel, consisting of 19 thought leaders in priapism, was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease to address pertinent issues concerning the role of the urologist, primary care providers and other health care professionals in the education of the public regarding management of men with priapism. The panel utilized a modified Delphi method and built upon the peer review literature on priapism. Results: The Thought Leader Panel recommended adoption of the definition of priapism as a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is stressed to be an important medical condition that requires evaluation and may require emergency management. The classification system is categorized into ischemic and non-ischemic priapism. Essential elements of the ischemic classification are the inclusion of: (i) clinical characteristics of pain and rigidity; (ii) diagnostic characteristics of absence of cavernosal arterial blood flow; (iii) pathophysiological characteristics of a closed compartment syndrome; (iv) a time limit of 4h prior to emergent medical care; and (v) a description of the potential consequences of delayed treatment. Essential elements of the non-ischemic classification are the inclusion of: (i) clinical characteristics of absence of pain and presence of partial rigidity; (ii) diagnostic and pathophysiological characteristics of unregulated cavernosal arterial inflow; and (iii) the need for evaluation but emphasizing the lack of a medical emergency. The panel recommended adoption of a rational management algorithm for the assessment and treatment of priapism where the cornerstone of initial assessment includes a careful clinical history, a focused physical examination and selected laboratory and/or radiologic tests. The panel recommended that specific criteria and clinical profiles requiring specialist referral should be identified. The panel further recommended that patient (and partner) needs and education concerning priapism should be addressed prior to therapeutic intervention, however only in the case of chronic management or post acute presentation evaluation should this delay intervention. Treatment goals to be discussed include management of the priapism with concomitant prevention of permanent and irreversible erectile dysfunction and associated psychosocial consequences. The panel recommended that when specific therapies for priapism are required, a step-care treatment approach based upon reversibility and invasiveness should be followed. Conclusions: The Thought Leader Panel calls for research to expand our understanding of the prevalence and diagnosis of priapism and education to create awareness among the public of the potential urgency of this condition. Critical areas to be addressed include the multiple pathophysiologies of priapism as well as multi- institutional trials to objectively assess safety and efficacy in the various treatment modalities.

KW - Diagnosis and treatment

KW - Erectile dysfunction

KW - Ischemic priapism

KW - Non-ischemic priapism

KW - Priapism

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