[Priapism: current status and new insights].

Current guidelines recommend a strictly structured, stepwise approach to the management of priapism-from diagnosis and emergency treatment to prevention. New imaging techniques, especially magnetic resonance imaging, and emerging therapies (e.g., antithrombotic strategies) are promising but require further evidence-based studies before they can be integrated into clinical practice. In the acute setting, a structured treatment algorithm should be adhered to, beginning with cavernosal aspiration of up to 500 ml of blood, with or without intracavernosal phenylephrine administration. If unsuccessful, surgical intervention is indicated, ranging from the creation of a shunt to early implantation of a penile prosthesis. In this context, distal shunt techniques have surpassed proximal approaches in clinical preference. A newly described penoscrotal decompression technique has been mentioned as an innovative surgical option. In nonischemic priapism, the primary treatment strategy remains conservative. If conservative measures fail, multiple embolization procedures are preferred over surgical ligation, if necessary.