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Ischemic priapism Low flow (ischemic) priapism is a penile erection persisting beyond four hours unrelated to sexual interest or stimulation.This type of priapism causes a compartment syndrome of the corporal bodies with progressive hypoxia, hypercarbia and acidosis.Clinically,it is typified by progressive penile pain with rigid, tender corporal bodies and soft glans penis and corpus spongiosum.Treatment of ishemic priapism is an emergency and should begin in a stepwise fashion.The duration of priapism is the most significant predictor of future erectile function.Ischemic priapism longer than 4 hours in duration should begin immediately with aspiration and intracavernosal injection of sympathomimetic medication.If fails, one should proceed with a shunt procedure.The objective of shunt surgery is to re-establish outflow from the cavernosal bodies to the glans, corpus spongiosum or vein.Typically distal shunt procedures should be attempted before proximal shunt procedures.