History of Priapism
The term Priapism is derived from Priapus, the Greek God of fertility, the son of Zeus (or Dionysus) and Aphrodite. He is considered the god of fertility.
Priapus is depicted with an oversized, permanent erection, thus giving the name priapism to the condition.
Priapism is persistent unwanted erection lasting >4hrs.
Description of Priapism can be traced back to ancient Egypt to the Egyptian Ebers papyrus originating from 1550 BC.
Earliest reported cases of Priaspism as modern medical case reports include a case report by Mr Tripe in 1844, which further references a report by Mr Calloway in 1824.
Definition of Priapism
As defined in the BAUS Consensus 2018
Priapism is defined as a prolonged penile erection (>4 h) which is maintained without sexual stimulation and persists despite ejaculation and orgasm
EAU defines priapism as
Priapism is a persistent or prolonged erection in the absence of sexual stimulation that fails to subside.
Campbell says, prolonged penile erection >4hr ‘unrelated’ to sexual stimulation.
Anatomy of Penis
Penile Structures
From the Outside to Inside
- Skin
- Dartos Fascia
- Bucks Fascia
- Tunica Albuginea
- Corpora Cavernosa
- Corpus Spongiosum
- Urethra
Image: Grays 1918
Penis has
- 3 Erectile tissues
- Corpora Cavernosa x 2
- Corpus Spongiosum x 1
- 3 Muscles
- Bulbospongiosus
- Ischiocavernosis x 2
- 2 Ligaments
- Suspensory ligament
- Fundiform ligament
- 3 principle Arteries (paired)
- Dorsal Penile Artery
- Deep Penile Artery (or Cavernous Artery)
- Urethral Artery (or Bulbourethral Artery)
- 3 main veins
- Superficial Dorsal vein
- Deep Dorsal vein
- Bulbourethral vein
- 2 Nerves
- Dorsal penile nerve (Somatic supply from Pudendal Nerve)
- Cavernous Nerve (Autonomic supply)
Image: Moore
Image: Grays 1918
Image: Bourgey 1840
Image: Testut 1905
Image: Grays 1918
Image: Grays 1918
Image: Grays 1918
Image: Grays 1918
Image: Testut 1905
Image: Grays 1918
Penile & Perineal Fascia and their relations
Penile Vasculature
Arterial Supply
Internal Pudendal Artery (branch of Ant. Div. of Internal Iliac Artery) terminates into 2 terminal branches on both sides
- Bulbo-urethral artery (single or paired) which supplies the corpus spongiosum and urethra and giving terminal branches to the glans
- Dorsal Penile Artery (paired) which gives an early branch the Cavernosal artery aka Deep Artery of Penis (supplying the cavernosa of the respective side) and it also gives multiple circumflex arteries (also supplying the cavernous of the respective side) and it terminates by giving branches to the glans penis.
Image: Grays 1918
Image: Moore 1933
Image: Sobota 1909
Image: Grays 1918
Image: Grays 1918
Venous Drainage
SUPERFICIAL DORSAL
- Superficial Dorsal Vein → Great Saphenous Vein → Ext. Iliac Vein
DEEP DORSAL
- Subtunical plexus → Emissary veins → Circumflex veins → Deep Dorsal vein → Peri-prostatic Venous Plexus of Santorini → Internal Iliac Vein
VENTRAL
- Cavernous vein + Crural vein + Bulbar vein + Urethral Vein = Internal Pudendal Vein → Internal Iliac Vein
Image: Grays 1918
Image: Grays 1918
Image: Testut 1905
Subtunical Pelxus
You also have the Subtunical Plexus that plays an important role in Erection and Detumescence.
Penile Nerves
There are 2 Nerves that supply the penis,
- Dorsal penile nerve (Somatic supply from Pudendal Nerve)
- Cavernous Nerve (Autonomic supply)
Image: Grays 1918
Image: Grays 1918
Mechanism of Erection
Types of Erection
- Reflexogenic
- Direct touch or stimulation
- Psychogenic
- Indirect stimulation via visual, auditory or imaginary stimulus
- Nocturnal
- During sleep at night
Neurological control
- Parasympathetic Stimulation (S2-4) [P for parasympathetic, P for Point]
- Vasodilation leading to engorgement of the vessels and cavernous vascular sinusoids
- Relaxation of the smooth muscles
- Sympathetic Stimulation (T11-L2) [S for Sympathetic, S for Shoot]
- Ejaculation through contraction of the Vas, the seminal vesicle and closure of the bladder neck with rhythmic contraction of bulbospongiosus muscle
- Loss of parasympathetic supply and increase in sympathetic signals results in loss of vasodilation, smooth muscle contraction and detumescence
- Somatic Control via Pudendal Nerve
- Sensory fibres take sensory signals from the external genitalia and initiate erection
- Motor fibres supplying the bulbospongiosus and ischiocavernosus muscles cause contraction of these muscles
Vascular Mechanisms
- Contraction of the bulbospongiosus and ischiocarvernousus muscles reduces the venous outflow resulting in engorgement of the erectile tissues
- Vasodilation and smooth muscle relaxation causes distension of the corpora, which compresses the tunica albuginea and closes off the emissary veins, thus maintaining erection
- Relaxation of the bulbospongiosus and ischiocavernosus muscles, loss of vasodilation (or vasoconstriction) and return of smooth muscle tone causes shrinkage of the connective tissue releasing compression on the subtunical venous plexus and emissary veins leading to removal of blood
Biochemical Mechanisms (important in pharmacotherapy)
Nitric Oxide mediated mechanism
Nitric oxide is released from Parasympathetic NANC (non-adrenergic non-cholinergic) nerves and from the endothelial cells upon parasympathetic stimulation. This results in a cascade of reactions. cGMP and cAMP are formed, Protein Kinase is activated, which blocks the Ca Channels. This decreases the intra-cellular calcium levels and causes smooth muscle relaxation and vasodilation.
Types of Priapism
Ischemic (Veno-occlusive/ Low-Flow)
- Painful erection
- It is considered analogous to a compartment syndrome of the Penis
- It is caused by veno-occlusion, leading to poor or no blood flow (i.e. low flow), which lead to ischemia, which can be observed on blood gas analysis on penile aspirate blood
- It is the most common type of priapism (>95%)
- It is considered a urological emergency and urgent decompression is recommended
- Conservative measures are not successful and therefore are not recommended in clinical setting
- First line management: Penile coporal Aspiration with or without irrigation
- 2nd line management: Intra-corporal Phenylephrine injection
- 3rd line management: Shunt procedure
- 4th line management: Shunt procedure with tunneling or snake manouvre
- If complete detuescence is not achieved after shunting or tunneling, consider repeat blood gas. If arterial blood is identified then no further acute intervention is required as that signifies resolution of ischemia
- Early Penile Implant insertion: Delayed presentation of prolonged priapism can be considered for early penile implant insertion. If penile implant insertion is being considered, emergency shunting should not be done (as that increase risk of extrusion of the penile implant)
Non-Ischemic (Arterial/ High-Flow)
- Either painless or uncomfortable (not acutely painful)
- History of penile or perineal trauma is typically present
- Generally it is caused by AV fistula created from a traumatic event
- As arterial blood is flowing, blood gas does not show ischemia and therefore it is not considered a urological emergency
- Penile doppler US (including the perineum) should be considered to assess for AV fistual
- An initial period of monitoring/ observation is recommended as conservative management
- If conservative management fails and the fistula does not close spontaneously, embolisation can be considered
- If embolisation fails, a second attempt can be considered
Stuttering (Recurrent)
Stuttering priapism is a rare type of priapism characterized by recurrent episodes of priapism.
Often associated with SCD.
Treatment option:
- Antiandrogens
- Pseudoephedrine
- Etilefrine
- Penile Prosthesis
Blood Gas Analysis for Priapism
Ischemic Priapism Blood Gas Analysis
- Acidosis (<7.25)
- Hypoxia
- Hypercapnia
- Glucopenia
The presence of hypoxia, acidosis and glucopenia confirms a diagnosis of ischaemic priapism.(BAUS Consensus Statement 2018)
Non-ischemic Priapism Blood Gas Analysis
The presence of normoxia correlated with the clinical history indicates that this is a non-ischaemic priapism; however, this should be confirmed with penile Doppler studies.(BAUS Consensus Statement 2018)
Risk factors for Priapism
Most of the time priapism is idiopathic and no specific cause is identified. However following risk factors have been identified leading to priapism.
Risk factors for Ischemic Priapism
- Sickle Cell Disease
- Incidence with SCD (Nelson and Winter 1977)
- Most common cause in childhood priapism 63%
- Primary cause in 23% of adult cases
- SCD is predominantly associated with ischemic priapism
- Pelvic Malignancy (<2%)
- Haematological dyscrasias/ malignancy (<1%)
- e.g. SCD, thalasemia, leukaemia (CML)….
- Intracavernosal injection
- Higher risk in Papaverine-based injection (~5%)
- Low risk in prostaglandin E1 injections (<1%)
- Drug induced
- e.g. antipsychotics, anti-depressants, alpha blockers, anticoagulants….
- PDE5i (very rare and causation unclear, sporadic cases)
- Recreational Drugs
- e.g. Cocaine, marijuana….
- Neurological conditions
- e.g. Cauda Equina Syndrome, Spinal Cord injury ….
See EAU guidelines for a comprehensive list of etiologies.
Risk factors for Non-ischemic Priapism
- Penile/ Perineal Trauma
Assessment of patient with Priapism
History
Key points in history as per the BAUS Consensus 2018
1. Onset of the erection. 2. Any underlying haematological disorders. 3. Current medication. 4. Illicit drug use. 5. Symptoms to suggest an underlying pelvic malignancy. 6. Previous episodes including stuttering priapism. 7. Recent perineal or penile trauma; 8. Any neurological symptoms.
Also important to ask regarding
- Presence and degree of pain
- Use of intra-cavernosal injections
- Baseline erectile function
Examination
BAUS Consensus considers Abdominal, Rectal, Penile and Neurological exams as mandatory.
- Abdominal exam and Digital Rectal Exam: to assess for Pelvic Malignancy
- Neurological exam
Investigations
Blood tests
- FBC
- Coagulation profile
- Haematological screening
- Blood film/ Blood smear
- Haemoglobin electrophoresis (for SCD/ thalassemia)
- Urine Toxicology (for illicit drug use)
- Penile Blood Gas Analysis
Involve hematology in patient’s with SCD or if suspicion of any hematological disorder.
Imaging
- Penile US (can be used in diagnosis, but should not delay management and intervention to achieve detumescence)
- If considered it should be performed before aspiration (EAU)
- Abdominal and Pelvic Imaging (CT/MRI) to assess for underlying malignancy
- Penile MRI can assess viability of corpus cavernosum smooth muscle (EAU)
- Patients with viable smooth muscle generally preserve erectile function, whereas non-viable smooth muscle on MRI should be offered prosthesis if they which to regain sexual function
Significance of Time Duration of Priapism
- Prolonged priapism can cause irreversible changes such as
- Smooth muscle necrosis
- Corporal fibrosis
- Development of permanent ED
- Early histological study on patient with priapism by SPYCHER 1986 (n=22) reported
- <24hr: No necrosis
- >24hr: Focal necrosis
- >48hr: Extensive necrosis and thrombus formations
- No necrosis in patients with non-ischemic priapism
- Animal studies report that anoxia eliminates the smooth muscle contraction response to phenylephrine (Broderick 1994)
- Hence prolonged priapism have a higher risk of failure of phenylephrine injection therapy
- Nelson Bennett from MSKCC New York reported time related outcomes in 2008 (n=39)
- <12hr : 100% patient recovered Erectile Function (EF)
- 12-24hr: ~60% patient recovered EF but acknowledged a decrement in erectile rigidity
- 24-36hr: only ~20% patient recovered EF
- >36hr: no patient recovered EF (i.e. 0%)
- Need for shunt surgery: 28% patients required shunt procedure, all had priapic episodes >24hr duration
- Zacharakis & David Ralph 2014 reported similar outcomes after shunt procedures (n=45)
- <12hr: 100% patients preserved Erectile Function (EF)
- >48hr: All patients reported Severe Erectile Dysfunction on IEFF
- Between 12-48hr: 50% chance of severe ED vs 50% chance of some recovery
- BAUS consensus categories patients into 3 categories based on duration of priapism
- <48hr (early presentation)
- 48-72hr (delayed presentation)
- >72hr (prolonged ischemic priapism)
- Basic principles of management based on time
- Aspiration +/- irrigation and phenylephrine can be trialled in all patients
- Delayed presentation patients should undergo imaging (MRI) to assess for smooth muscle viability and if viable can be offer shunting +/- tunneling or Penoscrotal decompression
- Late presentation patient should be offered Penoscrotal Decompression or Penile Prosthesis implantation (shunting should be avoided if considering immediate/primary penile prosthesis)
- Shunt procedures can be considered for pain management without any intended beneficial effect on erectile function preservation
- EAU 2026 categories patients into 3 categories based on duration of priapism
- <36hr
- 36-48hr
- >48hr
- AUA considers >36hr as late presentation
BAUS consensus statement is the most flexible in terms of time duration, where other guidelines consider 36-48hr as late presentation (aka prolonged ischemic priapism)
Management of Priapism
The goals of treatment
- To achieve penile detumescence to
- Prevent corporal smooth muscle fibrosis
- Preserve erectile function
- Relieve pain
Conservative Measure
Evidence supporting the use of conservative measures is limited. Following conservative measure have been described in the EAU guidelines,
- Exercise (walking up and down stairs)
- Ejaculation
- Ice packs (at penis and perineum)
- Cold baths
- Cold-water enemas
AUA guidelines suggest these measures are unlikely to be successful and therefore should not delay definitive management.
These options can be considered within the first 4 hours of persistent unwanted erection.
Oral terbutaline has a success rate of 60% in cases of priapism secondary to injection of intracavernous erectogenic agents (EAU)
Aspiration Technique for Priapism
In line with the BAUS Consensus 2018
Pre-requisites
- Penile Block
- Antibiotics
What to insert
- A large bore needle/cannula or butterfly (18G Green)
AI generated image
Where to insert
Inserted into the corpus cavernosum, either through the lateral penile shaft or through the glans penis into the tip of the corpus cavernosum
Insertion on the shaft is at the lateral aspects (consider 3 or 9 o’clock) to avoid injury to the urethra and the dorsal neurovascular bundle
How much to aspirate
Aspiration is done until fresh red blood is obtained.
No specific volume of aspiration is mentioned in the guidelines. OHOU 4th Edition suggested 50ml, however this specific volume has been taken out in the 5th Edition. 50ml is a very conservative amount, and can often be insufficient to achieve detumescence in clinical practice.
Irrigation
Irrigation with 0.9% saline can be considered.
Irrigation can be done from the same puncture site or an additional separate puncture can be done on the contralateral side.
Data is limited to suggest if aspiration with irrigation is superior to aspiration alone.
Phenylephrine Penile Injections (As per the BAUS Consensus 2018)
What is Phenylephrine
Phenylephrine is an alpha-1 adrenergic agonist, therefore acts as a sympathomimetic amine and causes vasoconstriction and smooth muscle contraction. This encourages detumescence.
Prerequisite:
- Cardiovascular monitoring throughout the procedure and then every 15mins for 1 hours afterwards (EAU)
- Blood Pressure
- Pulse
Dose of single injection:
- 200-250ug
Repeition interval between doses:
- Every 5-10mins (EAU=5min, BAUS=10min)
Maximum dose:
1000ug (i.e. 1mg)
How to prepare:
See BAUS Consensus Statement 2018
Other sympathomimetic agents that are described in EAU guidelines include
- Etilefrine (described in Priapism associated with SCD)
- Ephedrine
- Epinephrine
- Norepinephrine
- Metaraminol
- Adrenaline
As phenylephrine offers the safest risk profile, it is considered the first line option for injectable therapy for priapism.
Side effects:
- headache, dizziness, hypertension, reflex bradycardia, tachycardia and palpitations, and sporadic subarachnoid hemorrhage
Contraindications:
- In patients with malignant or poorly controlled hypertension (risk of CVA)
- Alongside monoamine oxidase inhibitors (risk of hypertensive crisis)
Shunts for Priapism
All shunt procedure have a very high rates of achieving detumescence but low rates of preserving erectile function (especially in case of prolonged ischemic priapism/ late presentation).
Some studies report a reoperation rate of 50% and ED rate as high as 90% (Nixon 2003).
Essentially, the risk of needing shunting (due to failure of other management options) increases after 24hr of priapism and similarly the risk of loss of erectile function also sharply rises after 24hr of priapism. Hence, patient who require shunting are inherently part of the cohort who would be at a high risk of erectile dysfunction with or without the shunting procedure. (data from Nelson Bennett MSKCC 2008)
Shunting procedures in patients who fail other management options would help resolve pain, achieve detumescence and limit ischemia and resultant fibrosis and penile shortening. Thus in early presentation it can potentially preserve erectile function whereas in late presentations it can improve outcomes of penile prosthesis implantation.
Distal Shunts
Winter Shunt 1976
Described in 1976
What to use: A trucut biopsy needle
How to do it:
- Insert the needle through the glans and into the cavernosa and take 2 cores of tissue (one on each side) through the septum separating the glans and the corpora cavernosa.
- Glans can be closed with absorbable suture
Significance: Least invasive but high rates of failure and early closure (Nixon 2003)
Ebbehoj Shunt 1974/ T-Shunt 2008
Ebbehoj described back in 1974 what is now known as the T-shunt. Ebbehoj describes the incision with a ‘narrow bladed knife’.
Garcia published a paper in 2008 illustrating the technique describing it as T-shunt and later Brant, Garcia et al. in 2009 published their series.
What to use:
- 10 blade (as described in the 2008 T-shunt paper)
- 11 blade (as described by Ebbehoj and suggested in the BAUS consensus 2018)
How to do it:
- Insert the blade at mid-glans at least 4mm away from the meatus through to the tip of the cavernosa incising the tunica albuginea, rotate 90 degree away from the urethra (laterally) and withdraw.
- Squeeze the penis to withdraw all congealed clotted old blood
- Close the incision using absorbable sutures
- Observe for 15 minutes
- If priapism recurs or does not resolve, repeat procedure on the other side
- If old blood is not obtained through the T-shunt alone (as can be the case in prolonged priapism), tunneling manoeuvre should be done
Significance:
- Less technically challenging
- Can be done under LA (was described under LA)
*The original paper from Ebbehoj actually describes a 90 degree twist of the blade, however across contemporary literature Ebbehoj is described as a stab incision whereas T-Shunt is described as a modification of Ebbehoj with the 90 degree twist away from the meatus. Not sure why this is the case with the descriptions.
Tunneling Procedure
Tunneling is an adjunct to the T-shunt procedure which was described by Garcia 2008 in their original paper on T-shunt and reported in the later series by Brant, Garcia et al. in 2009.
The technique involves using a 7mm (21Fr) straight sound and passing it through the shunt all the down to the crura (base) of the corpora.
This technique is used in prolonged priapism where shunting alone is not adequate for removal of organized clots and restoration of detumescence.
Tunneling by nature of the procedure destroys the corporal tissue and hence in theory would not preserve erectile function. However Brant 2009 in their original series on T-Shunt and tunneling reported a surprisingly good rate of preservation of erectile function (which they acknowledge was surprising).
Al-Gorab Shunt 1981 & Snake Manoeuvre 2009
Al-Ghorab shunt s an Open Distal Shunt described in 1981
How to do it: A 2cm glans incision is made 1 cm distal to the corona. Dissection is done til the tips of corpora cavernosa are identified. 5x5mm Tunica Albuginea cone is excised. Old blood is extracted by compressing the penis from proximal to distal end until bright red fresh blood is recieved. Glans incision is closed with absorbable sutures.
Snake Manoeuvre was described by Burnett in 2009 as an adjunct to Al-Ghorab shunt in people who failed to achieve detumescence with just the shunting procedure.
This modification similar to tunneling, involves insertion of 7/8 Hegar dilator through the tunical opening, which is advanced several centimeters into the corporal body.
The authors interestingly did not report a complete loss of erectile function with 1/3 patient reported to have some ‘meaningful erection recovery’.
In their follow-up study by Segal 2013, they reported a very low rate (2/9) and a poor degree of erectile function recovery.
Proximal Shunts
These are now historical and are not favored or performed anymore
Quackles Shunt 1964
It is described as a proximal anastomosis between the corpora cavernosa and the spongiosum.
It is technically more challenging, with higher risk of problematic complications and therefore it is no longer practised.
Venous Shunts
Anastomosis of Corpus Cavernosum to a vein
Grayhack 1964 = Great Saphenous vein
Barry shunt 1976 = Superficial or Deep Dorsal penile vein
Drawbacks: As these are technical more difficult procedure, these are rarely practiced and therefore do not have good published data on efficacy and risks.
Post shunting care
- Antibiotics for 5-7 days
- Short-term blood thinner can be considered to prevent clot formation and early closure of the shunt
- EAU 2026: 325 Aspirin pre-operatively with 5000IU Heparin or 75mg Clopidogrel for 5 days post-operatively
Penoscrotal Decompression
Described by Morey in 2018 as a safer final resort measure instead of an immediate penile implant in cases of Refractory Ischemic Priapism (RIP) when all other measures fail.
It involves making a 3cm peno-scrotal incision to reach the proximal corpora cavernosa. A 2cm corporotomy is done, which delivers dark ischemic bloods. Then a paediatric sucker is inserted through the corporotomy to such out rest of the old blood until fresh red oxygenated blood is recieved. Iriigation is done with saline. Similar procedure can be repeated on the other side.
The original paper describes closure of all layers however some expert suggest leaving a drain behind instead to prevent early recurrence.
Original paper reported a case series of 6 patients with 100% success rate and no significant complications reported. They compared it with 8 other patients who underwent immediate malleable penile implant, which had a 37% rate of revision surgery mainly due to implant extrusion.
A follow-up multi-institutional US retrospective study in 2020 on PSD was published by Morey on 25 patients, with key findings as
- Unilateral PSD had a 20% rate of recurrence of priapism, which was successfully managed with bilateral PSD. Therefore authors recommend doing bilateral PSD as standard.
- Mean duration of priapism was 71hr (minimum was 24hr)
- No significant complications were reported
- 15 patients completed follow-up. Of those 9 (60%) reported spontaneous erections adequate for penetration while 6 (40%) reported ED. Patients with preservation of erectile function has a shorter mean duration of priapism (59hr vs 72hr)
Penile Prosthesis Implantation
Types of Penile Implants:
- Malleable Semi-rigid implant
- Cheaper
- 3-piece inflatable implant
- More expensive
Timing of Penile Implantation:
- Immediate Implant
- Immediate implantation has been advocated in literature for Refractory Ischemic Priapism (RIP) when all other measures have been unsuccessful
- Immediate implant is offered after appropriate counseling and after smooth muscle biopsy or Penile MRI scan to confirm smooth muscle necrosis
- A malleable semi-rigid penile prosthesis is considered the implant of choice in most cases of Immdediate Penile Prosthesis Implantation
- David Ralph in UCLH reported their long-term data in 2009
- 50 patients who underwent immediate penile prosthesis implantation
- 96% patient satisfaction rate reported
- 84% had resumed sexual intercourse on follow-up
- 6% rate of infection reported
- Peno-scrotal decompression is being presented as a safer alternative in this group of patients with early studies showing very promising results (Morey 2020)
- Early Implant
- BAUS Consensus statement 2018 recommends early implantation (as compared to immediate or delayed implantation)
- EAU suggest early implant to be within 3 weeks of priapism episode
- This duration allows resolution of edema and healing from any shunt procedure that might have been attempted
- This is the preferred timing as it prevents the excessive penile fibrosis that happens with delayed implantation
- Delayed Implant
- It is considered less optimal as delays lead to fibrosis setting in which results in penile shortening, a difficult and more challenging procedure and therefore a higher risk of complications.
BAUS Consensus on Priapism
Guidelines on Priapism
EAU Guidelines
AUA Guidelines
A Most Comprehensive Review of Priapism - published in Journal of Sexual Medicine
If you want to read a single most comprehensive paper on Priapism, read the paper ”Priapism: Pathogenesis, Epidemiology, and Management” by Broderick in 2009
- Labanaris AP, Zugor V, Wagner C, Witt JH. 1037 FROM PRIAPUS TO PRIAPISM. Journal of Urology [Internet]. 2012 Apr 1 [cited 2026 Mar 26];187(4S):e421. Available from: https://doi.org/10.1016/j.juro.2012.02.1142
- Gannon, M., Krug, A., Emadeldin, M. et al. Surgical illustrative review of the treatment of ischaemic priapism. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01054-1
- Bivalacqua TJ, Allen BK, Brock G et al: Acute Ischemic Priapism: an AUA/SMSNA Guideline. J Urol 2021; 206: 1114
- Winter, C C. “Cure of idiopathic priapism: new procedure for creating fistula between glans penis and corpora cavernosa.” Urology vol. 8,4 (1976): 389-91. doi:10.1016/0090-4295(76)90498-2
- Ebbehoj, J. “A new operation for priapism.” Scandinavian journal of plastic and reconstructive surgery vol. 8,3 (1974): 241-2. doi:10.3109/02844317409084400
- Brant, William O et al. “T-shaped shunt and intracavernous tunneling for prolonged ischemic priapism.” The Journal of urology vol. 181,4 (2009): 1699-705. doi:10.1016/j.juro.2008.12.021
- Ercole, C J et al. “Changing surgical concepts in the treatment of priapism.” The Journal of urology vol. 125,2 (1981): 210-1. doi:10.1016/s0022-5347(17)54971-x
- Fuchs, Joceline S et al. “Penoscrotal Decompression-Promising New Treatment Paradigm for Refractory Ischemic Priapism.” The journal of sexual medicine vol. 15,5 (2018): 797-802. doi:10.1016/j.jsxm.2018.02.010
- Nixon, Randy G et al. “Efficacy of shunt surgery for refractory low flow priapism: a report on the incidence of failed detumescence and erectile dysfunction.” The Journal of urology vol. 170,3 (2003): 883-6. doi:10.1097/01.ju.0000081291.37860.a5
- Broderick, Gregory A., et al. “Anoxia and Corporal Smooth Muscle Dysfunction: A Model for Ischemic Priapism.” 1994. Journal of Urology, vol. 151, no. 1, WoltersKluwer, Jan. 1994, pp. 259–262, doi:10.1016/S0022-5347(17)34928-5.
- Nelson JH III, Winter CC. Priapism: Evolution of management in 48 patients in a 22-year series. J Urol 1977;117:455–8.
- BAUS Section of Andrology Genitourethral Surgery et al. “BAUS consensus document for the management of male genital emergencies: priapism.” BJU international vol. 121,6 (2018): 835-839. doi:10.1111/bju.14140