From the Guidelines
The initial management for persistent priapism due to neurological damage involves prompt urological consultation and therapeutic aspiration or intracavernous injection of sympathomimetics, as recommended by the American Urological Association guideline on the management of priapism 1. The goal of treatment is to achieve resolution as promptly as possible to prevent long-term damage and erectile dysfunction.
- The management of ischemic priapism should progress in a step-wise fashion, with initial intervention utilizing therapeutic aspiration (with or without irrigation) or intracavernous injection of sympathomimetics, based on panel consensus and review of limited data 1.
- It is essential to determine whether the priapism is ischemic or nonischemic to initiate appropriate management, as recommended by the American Urological Association guideline on the management of priapism 1.
- Acute ischemic priapism is a medical emergency that may lead to cavernous fibrosis and subsequent erectile dysfunction, emphasizing the need for prompt and effective treatment, as stated in the AUA/SMSNA guideline on acute ischemic priapism 1.
- The treatment approach may involve a multidisciplinary team, particularly for neurogenic priapism, which often results from spinal cord injury or other neurological conditions that disrupt the normal regulatory mechanisms controlling penile erection.
- In cases where initial management fails, further interventions such as aspiration of blood from the corpus cavernosum, irrigation with saline, or surgical intervention like shunt procedures may be necessary to achieve detumescence and prevent long-term complications.
From the Research
Initial Management of Persistent Priapism due to Neurological Damage
The initial management of persistent priapism due to neurological damage involves several key steps:
- Establishing the type of priapism (ischemic, nonischemic, or stuttering) to determine the appropriate treatment approach 2, 3
- Assessing the patient's history, physical examination, penile hemodynamics, and corporeal metabolic blood quality to distinguish between static or dynamic pathology 4
- Providing prompt evaluation and definitive diagnosis, as priapism is a rare condition that requires timely intervention 5
Treatment Options
Treatment options for persistent priapism due to neurological damage include:
- Aspiration/irrigation with sympathomimetic injections for ischemic priapism 2
- Surgical shunts as a last resort for ischemic priapism 2
- Conservative management for nonischemic priapism, as most episodes are self-limiting 2, 3
- Intracavernous vasoconstrictive agents or surgical shunting for priapism 4
- Alternative options, such as intracavernous injection of methylene blue or selective penile arterial embolization, for the management of high and low flow priapism 4
Considerations for Ischemic Priapism
Ischemic priapism is a urological emergency that requires intervention to alleviate pain and prevent irreversible damage to erectile tissues 2, 5
- Corporal blood aspirations and the instillation of alpha adrenergic agonists, such as phenylephrine, may be used to manage acute ischemic priapism 6
- However, high-dose phenylephrine may not be effective in patients with refractory ischemic priapism due to widespread apoptosis of the cavernosal smooth muscle 6