genitourinary disorders
Priapism
Treatment of Priapism
Treatment is often difficult and sometimes unsuccessful, even when the etiology is known. Whenever possible, patients should be referred to an emergency department; patients should preferably be seen and treated urgently by a urologist. Other disorders should be treated. For example, priapism often resolves when sickle cell crisis is treated. Measures used to treat priapism itself depend on the type. Treatment should begin immediately, typically with aspiration of blood from the base of one of the corpora cavernosa using a nonheparinized syringe, often with saline irrigation and intracavernous injection of the alpha-receptor agonistphenylephrine. Forphenylephrineinjections, 1 mL of 1%phenylephrine(10 mg/mL) is added to 19 mL of 0.9% saline to make 500 mcg/mL; 100 to 500 mcg (0.2 to 1 mL) is injected every 5 to 10 minutes until relief occurs or a total dose of 1000 mcg is given. Before aspiration or injection, anesthesia is provided with a dorsal penile nerve block or local infiltration. If these measures are unsuccessful or if priapism has lasted>48 hours (and is thus unlikely to resolve with these measures), a surgical shunt can be created between the corpus cavernosum and glans penis or corpus spongiosum and another vein. Stuttering priapism, when acute, is treated in the same way as other forms of ischemic priapism. There is a report of several cases caused by Sickle Cell Disease that responded to a single oral dose of Conservative therapy (eg, ice packs and analgesics) is usually successful; if not, selective embolization or surgery is indicated. If other treatments are ineffective, a penile prosthesis can be placed. 