OBJECTIVE To define, based on the author's experience and the data of the literature, a simple and rigorous practical approach to the management of priapism in developing countries, for which the therapeutic approach is controversial and difficult due to the rarity of this condition. METHODS The reported series is based on 56 cases of priapism in black patients (49 adults and 7 children), observed and treated by the same operator over an 18-year period in Burkina (n = 8) and then in Chad (n = 12), Gabon (n = 19) and Niger (n = 17). The pathophysiology and aetiologies are reviewed. RESULTS All patients treated surgically underwent various surgical techniques for diversion of the corpora cavernosa. In this group of 51 reported cases, there were 17 successes (33.3%), 5 partial results (9.8%) and 29 failures (56.8%). The overall immediate success rate, resulting in detumescence, was 36/51 (70%). These initial successes almost exclusively concerned patients treated by unilateral cavernoglandular shunt within an interval not exceeding 2 days. Although the long-term results, all treatments combined, were disappointing (56.8% of patients with sufficient follow-up are impotent), creation of a unilateral cavernoglandular fistula to the glans, based on Al Ghorab's technique, appeared to provide the best results with a success rate of 52%, i.e. 13/25 cases of priapism correctly followed. CONCLUSIONS Except in the context of sickle-cell anaemia, in which concomitant aetiological treatment can be proposed, only emergency surgery is effective to avoid secondary impotence. The unilateral cavernoglandular shunt is extremely simple and, according to the author, remains the best procedure.