From the Guidelines
Priapism requires prompt medical treatment, and the most effective medication for its management is phenylephrine, which should be administered via intracavernosal injection. The initial management of ischemic priapism includes aspiration of blood from the corpus cavernosum followed by irrigation with phenylephrine 1. Phenylephrine is typically diluted to 100-500 mcg/mL and injected into the corpus cavernosum in 0.5-1 mL doses every 3-5 minutes until detumescence occurs, not exceeding 1 mg in one hour 1. Blood pressure monitoring is necessary during administration due to the potential for systemic absorption and adverse cardiovascular effects 1.
The use of phenylephrine is recommended due to its alpha1-selective adrenergic agonist properties, which minimize the risk of cardiovascular side effects compared to other sympathomimetic medications 1. For recurrent priapism, preventive medications such as pseudoephedrine, terbutaline, or baclofen may be used 1. In sickle cell disease-related priapism, hydration, pain control, and oxygen therapy are important, with hydroxyurea sometimes used for prevention 1. Non-ischemic priapism is less urgent and may resolve spontaneously or require embolization 1.
Key points to consider in the management of priapism include:
- Prompt treatment to prevent permanent erectile dysfunction
- Use of phenylephrine as the first-line medication for ischemic priapism
- Monitoring of blood pressure during phenylephrine administration
- Consideration of preventive medications for recurrent priapism
- Importance of hydration, pain control, and oxygen therapy in sickle cell disease-related priapism
- Potential for non-ischemic priapism to resolve spontaneously or require embolization.
Overall, the management of priapism requires a step-wise approach, with increasing invasiveness and risk balanced against the likelihood of prolonged ischemia and permanent damage to the corpora cavernosa if treatment is absent or delayed 1.
From the Research
Medication for Priapism
- The primary treatment for ischemic priapism involves the use of sympathomimetic drugs, such as phenylephrine, which can be administered via intracavernous injection 2, 3.
- Phenylephrine has been shown to be effective in treating priapism, with one study demonstrating detumescence in 8 out of 9 patients treated with the medication 3.
- The use of phenylephrine is recommended as part of the initial treatment for ischemic priapism, with the goal of reducing blood flow to the penis and alleviating the erection 2, 4.
- In cases where pharmacological treatment is not effective, surgical intervention may be necessary, including the use of penile prostheses 2, 4.
Types of Priapism and Treatment
- Ischemic priapism is the most common type of priapism and is characterized by a lack of blood flow to the penis 2, 4.
- Non-ischemic priapism, also known as arterial priapism, is typically caused by trauma to the penis and is not considered a medical emergency 2, 4.
- Stuttering priapism is a type of priapism characterized by recurrent episodes of ischemic priapism, and treatment is focused on preventing future episodes 2, 4.
Treatment Goals and Considerations
- The primary goal of treatment for priapism is to alleviate the erection and prevent long-term damage to the penis 2, 4.
- Treatment should be tailored to the specific type of priapism, with ischemic priapism requiring prompt intervention to prevent irreversible damage 2, 4.
- In cases of sickle cell disease-related priapism, treatment may involve targeting the underlying molecular mechanisms, such as reduced tonic NO/cGMP signaling and elevated oxidative/nitrosative stress 5.