{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T12:15:24Z","timestamp":1780920924810,"version":"3.54.1"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T00:00:00Z","timestamp":1661212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2022,8,23]],"date-time":"2022-08-23T00:00:00Z","timestamp":1661212800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Ischemic priapism remains a significant cause of morbidity among men. To date, the precise time when penile ischemia results in permanent, non-reversible cavernosal smooth muscle injury, compromising subsequent erectile integrity, remains ill-defined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To review the medical literature pertaining to ischemic priapism, focusing on factors that predict the exact timeline of irreversible cavernous tissue injury.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A comprehensive literature search was performed. Our search included both publications on animal models and retrospective clinical series through January 2022. Articles were eligible for inclusion if they contained original data regarding nonreversible tissue injury on histology and\/or provided a timeline of erectile function loss or preservation and had full text available in English.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Innovative studies in the 1990s using invitro models with strips of rabbit, rat, canine and monkey corpus cavernosal tissue demonstrated that anoxia eliminated spontaneous contractile activity and reduced tissue responsiveness to electrical field stimulation or pharmacological agents. The same models demonstrated that the inhibitory effects of field stimulated relaxation, were mediated by nitric oxide. Subsequent studies using similar models demonstrated that exposure of corpus cavernosum smooth muscle to an acidotic environment impairs its ability to contract. A pH of 6.9 was chosen for these experiments based on a case series of men with priapism, in whom a mean pH of 6.9 was measured in corporal blood after 4\u20136 hours of priapism. Invivo animal studies demonstrated that after erection periods of 6\u20138 hours, microscopy shows sporadic endothelial defects but otherwise normal cavernous smooth muscle. In these studies, greater durations of ischemic priapism were shown to result in more pronounced ultrastructural changes and presumably irreversibility. In studies involving human corporal tissues, samples were obtained from men who had experienced priapism for at least 12 hours. Overall, erectile function outcome data is deficient in priapism reporting, especially within treatment windows less than 6 hours. Some reports on ischemic priapism have documented good erectile function outcomes with reversal by 12 hours.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Based on our extensive review of animal models and clinical reports, we found that many clinical papers rely on the same small set of animal studies to suggest the time point of irreversible ischemic damage at 4\u20136 hours. Our review suggests an equal number of retrospective clinical studies demonstrate that ischemic priapism reversed within 6\u201312 hours may preserve erectile function in many patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.sxmr.2022.06.007","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T05:28:52Z","timestamp":1661318932000},"page":"660-668","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":11,"title":["Priapism or Prolonged Erection: Is 4 \u2013 6 Hours of Cavernous Ischemia the Time Point of Irreversible Tissue Injury?"],"prefix":"10.1093","volume":"10","author":[{"given":"Snir","family":"Dekalo","sequence":"first","affiliation":[{"name":"Division of Urology , London, ON , Canada"},{"name":"Western University, Department of Surgery , London, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Stern","sequence":"additional","affiliation":[{"name":"Division of Urology , London, ON , Canada"},{"name":"Western University, Department of Surgery , London, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A.","family":"Broderick","sequence":"additional","affiliation":[{"name":"Department of Urology , Jacksonville, FL , USA"},{"name":"Mayo Clinic Florida , Jacksonville, FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Brock","sequence":"additional","affiliation":[{"name":"Division of Urology , London, ON , Canada"},{"name":"Western University, Department of Surgery , London, ON , Canada"},{"name":"Omega Fertility and Andrology Clinic , London, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,23]]},"reference":[{"issue":"1","key":"2023041308080473800_","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/S0022-5347(17)34928-5","article-title":"Anoxia and corporal smooth muscle dysfunction: A model for ischemic priapism","volume":"151","author":"Broderick","year":"1994","journal-title":"J Urol"},{"issue":"2","key":"2023041308080473800_","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1016\/S0022-5347(01)65258-3","article-title":"Acidosis impairs rabbit trabecular smooth muscle contractility","volume":"157","author":"de Tejada","year":"1997","journal-title":"J Urol"},{"issue":"5","key":"2023041308080473800_","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1097\/JU.0000000000002236","article-title":"Acute Ischemic Priapism: An AUA\/SMSNA Guideline","volume":"206","author":"Bivalacqua","year":"2021","journal-title":"J Urol"},{"issue":"1","key":"2023041308080473800_","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/S0022-5347(17)44746-X","article-title":"Priapism: A refined approach to diagnosis and treatment","volume":"136","author":"Lue","year":"1986","journal-title":"J Urol"},{"key":"2023041308080473800_","doi-asserted-by":"publisher","first-page":"b2700","DOI":"10.1136\/BMJ.B2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"2023041308080473800_","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1016\/J.JCLINEPI.2015.06.005","article-title":"ROBIS: A new tool to assess risk of bias in systematic reviews was developed","volume":"69","author":"Whiting","year":"2016","journal-title":"J Clin Epidemiol"},{"key":"2023041308080473800_","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/J.JCLINEPI.2013.12.002","article-title":"Defining consensus: A systematic review recommends methodologic criteria for reporting of Delphi studies","volume":"67","author":"Diamond","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"2023041308080473800_","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/J.EURURO.2021.06.007","article-title":"European Association of Urology Guidelines on Sexual and Reproductive Health-2021 Update: Male Sexual Dysfunction","volume":"80","author":"Salonia","year":"2021","journal-title":"Eur Urol"},{"issue":"1","key":"2023041308080473800_","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1002\/j.1939-4640.1994.tb01680.x","article-title":"Comparative studies on rabbit corpus cavernosal contraction and relaxation. 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