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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
- Common causes
- 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
- Common causes
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
- Penile nerve block (YouTube)
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