Priapism.

Priapism in adult patients with sickle cell disease is a devastating complication for which there is no consensus regarding management. Innumerable attempts at pharmacologic and surgical intervention have been employed. Distinction between infarctive low-flow priapism with hypoxia and acidosis and normal-flow priapism without acidosis can be obtained using currently available imaging techniques. Cavernosonography and radionuclide scanning to assess penile hemodynamics are useful in determining whether priapism is of the low-flow type. Advances in our understanding of the physiology of erection have prompted a more physiologic approach to the assessment and management of priapism. Based on this technology, it would be possible to develop a prospective multiinstitutional study, thereby providing sufficient numbers of patients to better evaluate therapy. After the episode of priapism has abated and detumescence has occurred, we recommend that the patient be given the option of beginning a trial of hydroxyurea or another antisickling agent.