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The nerve, artery, and vein are at 12 o’clock. The urethra is at 6 o’clock.

Two Types of Priapism

  • High flow (non-ischemic)
    • Common causes
      • Trauma
      • AV malformations
      • Tumors
    • Priapism from too much blood coming IN
    • Not painful
    • Consult urology
  • Low flow (ischemic)
    • Common causes
      • Sickle cell disease
      • Drug side-effects
    • Priapism from blood being unable to flow OUT
    • Patient requires emergent detumescence
      • 50% chance of erectile dysfunction

Step 1: Prepare (4c approach)

  • Collect
    • 19G needle
    • 21G needle
    • Variety of syringes
    • Gauze
    • Sterile drape
    • Betadine
    • Normal saline
  • Consent
    • 50% chance of erectile dysfunction even with successful procedure
  • Clean
    • Set up supplies and sterile field
  • Control pain

Step 2: Drain

  • Nerve/Artery/Vein on top (12 o’clock)
  • Urethra on bottom (6 o’clock)
  • Insert 19G needle at either 3 or 9 o’clock and aspirate
    • UPDATE: Recommended insertion at either 2 or 10 o’clock
  • 30% chance of detumescence at this step alone

Step 3: Send Venous Blood Gas

  • Confirms high-flow (non-ischemic) from low-flow (ischemic) priapism

Step 4: Irrigate

  • Inject normal saline through the needle and then aspirate

Step 5: Phenylepherine

  • Dilute 1ml (10 mg/ml) in 9 ml NS (results in 1mg/ml solution)
    • Inject 0.25 ml of 1 mg/ml solution and repeat q10 minutes
    • Alpha agonist effect constricts smooth muscle and facilitates venous outflow

Additional Reading