The first and most important step is to determine whether the condition is ischemic or non-ischemic priapism, and intervene as early as possible in those patients with ischemic priapism

While treatment of any underlying condition is a key component of managing the problem of ischemic priapism, it should not delay treatment that is intended specifically to reverse penile erection.

Initiating surgical intervention is indicated only when repeated sympathomimetic injections are failed (approximately 1 hour)

The cavernoglandular shunt should be the first choice of shunting procedures. At our institution, we favor the T-shunt with or without tunneling for ischemic priapism.

After well discussing, the immediate insertion of penile prosthesis in patients with priapism not responding to medical and shunts treatment is an opinion.

Oral systemic therapy is not indicated for the treatment of “acute” ischemic priapism

The initial management of non-ischemic priapism should be conservative.

The goal of the management of a patient with stuttering priapism is prevention of recurrent episodes. A trial of PDE5I may be useful.