Editing Priapism (section)

===== Acute Ischemic Priapism >36 hours =====
*'''<span style="color:#ff0000">Options</span>[https://pubmed.ncbi.nlm.nih.gov/35536142/ ★]'''
*#'''<span style="color:#ff0000">Observation, pain control, and outpatient follow-up</span>'''
*#*May bypass more invasive procedures (e.g., surgical shunting).
*#'''<span style="color:#ff0000">Distal shunting, with or without tunneling</span>''' 
*#'''<span style="color:#ff0000">Early implantation of penile prosthesis</span>'''
*'''<span style="color:#ff0000">Unlikely the acute ischemic event will resolve with ICI therapy of phenylephrine and aspiration.</span>[https://pubmed.ncbi.nlm.nih.gov/35536142/ ★]'''
**'''The response to phenylephrine decreases with increased duration of priapism'''

*'''It is important to note that before considering conservative management or penile prosthesis placement in men with a priapism >36 hours, the timeline should be sufficiently confirmed.''' 
**Patient histories relating to an exact timeline may often be unreliable, particularly in cases of concomitant substance use, episodes of intermittent detumescence, recurrent priapism (e.g., SCD), or partial (not fully rigid) erections. In these settings, clinical judgment is required to identify the true timeline for onset of ischemia (i.e., onset of severe, persistent penile pain). 
**If the timeline is in question, clinicians should preferentially attempt to decompress the priapism, particularly in younger men or those with high baseline erectile function.