Low-flow Priapism (LFP) is a rare condition, but with potential severe effect on the erectile function. This study aimed to evaluate the efficacy of various treatment methods and the risk factors for erectile dysfunction (ED) in these patients.

Between January 2000 and June 2006, 15 patients with LFP have been treated in our department. Patientʼs history, clinical examination, blood tests, Doppler ultrasonography and cavernous blood gases identified 9 patients with LFP. Erectile function after treatment was assessed using the IIEF questionnaire. Penile Doppler ultrasonography evaluation was performed in patients with ED.

The causes of priapism were intracavernosal injection in 4 cases or idiopathic in 5 cases. Five patients presented at more than 48 hours after the Priapismʼs onset. Corporal blood aspiration and intracavernous injection with sympatomimetics was initially performed in all patients. In 4 patients (3 of them with Priapismʼs onset more than 48 hours before), failure of conservative management imposed cavernoglanular shunts (3 Winter procedures and 1 Al-Ghorab procedure). All cases were managed successfully. Five patients (55.6%) reported preserved erectile function after treatment. All 4 patients in which cavernoglandular shunt was performed reported subsequent deterioration of the erectile function. In these patients Doppler ultrasonography described extensive penile fibrosis and venous leakage in various sites.

In patients with LFP, delayed presentation to the urologist and aggressive surgical interventions may induce venogenic ED. The venous leakage may appear at shuntʼs site as well as in other locations, induced by penile fibrosis.