Non-ischemic priapism, high-flow priapism

Diagnosis

You may need medical attention if your erection lasts longer than four hours. 

The emergency room doctor will assess whether you have ischemic priapism or nonischemic priapism, as the treatments for each vary and immediate intervention is crucial for ischemic priapism. Diagnostic tests may be required to identify the type of priapism and further tests to determine its cause. In an emergency setting, treatment may often commence before all test results are available.

• Physical examination: To ascertain the type of priapism present, your doctor will conduct an assessment encompassing inquiries and physical examination of your genitals, abdomen, groin, and perineum. By gauging the level of pain and the degree of penile rigidity, your doctor may discern the specific type of priapism. Additionally, this examination may unveil indications of trauma or the presence of a tumor.
• Blood test: You can get a blood sample from your arm and have the amount of red blood cells and platelets counted. Findings may indicate the presence of diseases such sickle cell disease, other blood problems, or specific types of cancer.
• Doppler ultrasound: You might undergo Doppler ultrasonography, a noninvasive procedure that uses high–frequency sound waves (ultrasound) to evaluate blood flow by reflecting off circulating red blood cells. This test helps measure blood flow in the penis, indicating whether you have ischemic or nonischemic priapism. Additionally, the exam may uncover any injuries or abnormalities that could be contributing to the condition. 
• Penile blood gas measurement: In order to extract blood for analysis, a tiny needle may be inserted into the penis. Knowing which kind of priapism the patient is having will be made easier by this procedure. If the blood appears black, indicating it is oxygen–deprived, the condition is likely ischemic priapism. Conversely, if the blood is bright red, it suggests nonischemic priapism. Laboratory tests that measure the levels of certain gases in the blood can help confirm the type of priapism you have.

Treatment

Nonischemic priapism frequently resolves without the need for treatment. Due to the low risk of penile damage, your doctor may recommend a watchful waiting approach. Applying ice packs and pressure to the perineum could aid in resolving the erection.

In certain instances, surgery may be required to insert a substance, such as an absorbable gel, to temporarily obstruct blood flow to the penis. Eventually, your body absorbs the material. Surgery might also be necessary to address arterial or tissue damage caused by injury.