From the Guidelines
Priapism treatment should prioritize prompt medical attention, with initial management for ischemic priapism including aspiration of blood from the penis, irrigation with saline, and injection of sympathomimetic medications like phenylephrine, as recommended by the most recent guidelines 1. The goal of treatment is to achieve detumescence and preserve erectile function, while minimizing the risk of complications such as erectile dysfunction.
- For ischemic priapism, the initial management includes:
- Aspiration of blood from the penis using a needle and syringe
- Irrigation with saline
- Injection of sympathomimetic medications like phenylephrine (typically 100-500 mcg every 3-5 minutes for up to an hour) 1
- If these measures fail after several hours, surgical intervention may be necessary, such as creating a shunt between the corpus cavernosum and glans penis or corpus spongiosum 1.
- For non-ischemic priapism, which is less urgent, treatment may include:
- Observation
- Ice packs
- Compression
- Selective arterial embolization
- Underlying causes should be addressed, such as discontinuing medications that may have triggered the condition or treating blood disorders like sickle cell disease 1. Prompt treatment is crucial as prolonged priapism (especially beyond 4-6 hours) can lead to permanent erectile dysfunction due to tissue damage from oxygen deprivation and fibrosis of the penile tissue 1. The most recent guidelines emphasize the importance of early intervention and individualized treatment approaches, taking into account the specific type and duration of priapism, as well as the patient's underlying medical conditions and risk factors 1.
From the Research
Treatment Options for Priapism
The treatment for priapism depends on the type of priapism, which can be ischemic, nonischemic, or stuttering 2.
- Ischemic priapism is a urological emergency that requires immediate intervention to restore blood flow and prevent necrosis and erectile dysfunction 3.
- Nonischemic priapism is not an emergency and may be managed conservatively initially, as most of these episodes are self-limiting 2.
- Stuttering priapism involves recurrent self-limiting episodes of ischemic priapism, and the primary goal of therapy is prevention, but acute episodes should be managed in accordance with guidelines for ischemic priapism 2.
Treatment for Ischemic Priapism
The treatment for ischemic priapism may involve:
- Aspiration/irrigation with sympathomimetic injections 2, 3, 4
- Surgical shunts 2, 3
- Penile prosthesis implantation as a last resort 2, 3
- Intracavernosal injection of sympathomimetics, such as phenylephrine, which is superior to other agents due to its demonstrated efficacy and limited systemic side effects 5
Treatment for Nonischemic Priapism
Nonischemic priapism may be managed conservatively initially, as most of these episodes are self-limiting 2.
- The goal of management is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism 6.
Importance of Prompt Treatment
Prompt treatment is essential to minimize morbidity, including impotence, and to prevent long-term damage to the penis 3, 4.
- Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity 4.