Page 112 - Remedial Andrology

Analyse the blood gas parameters from blood aspirated from the penis to differentiate Strong
between ischaemic and non-ischaemic priapism.
Perform colour duplex ultrasound of the penis and perineum before aspiration to Strong
differentiate between ischaemic and non-ischaemic priapism.
In cases of prolonged ischaemic priapism or refractory priapism, magnetic resonance Weak
imaging of the penis may be used as an adjunct to predict smooth muscle viability.
Perform selected pudendal arteriogram when embolisation is planned for the management Strong
of non-ischaemic priapism.

9.1.3 Disease management
Acute ischaemic priapism is a medical emergency. Urgent intervention is mandatory and should follow a
stepwise approach. The aim of any treatment is to restore penile detumescence, without pain, in order to
prevent corporal smooth muscle fibrosis and subsequent ED.

Figure 13: Medical and surgical management of ischaemic priapism

The treatment is sequential and physicians should move on to the next stage if treatment fails.

Ini al conserva ve measures
• Local anaesthesia of the penis
• Insert wide bore bu erfly (16-18 G) through the glans into the corpora cavernosa
• Aspirate cavernosal blood unl bright red arterial blood is obtained

Cavernosal irriga on
• Irrigate with 0.90% w/v saline soluon

Intracavernosaltherapy
• Inject intracavernosaladrenoceptoragonist
• Current first-line therapy is phenylephrine* with aliquots of 200 µg being injected every 3-5 minutes
unl detumescence is achieved (maximum dose of phenylephrine is 1mg within 1hour) *

Surgical therapy
• Surgical shunng
• Consider primary penile implantaon if priapism has been present for more than 48 hours

(*) Dose of phenylephrine should be reduced in children. It can result in significant hypertension and should be
used with caution in men with cardiovascular disease. Monitoring of pulse and blood pressure is advisable in
all patients during administration and for 1 hour afterwards. Its use is contraindicated in men with a history of
cerebro-vascular disease and significant hypertension.

9.1.3.1 Medical Management
Evidence Acquisition
The studies that were identified after abstract screening and used for this literature review pertaining to
medical management are reported in the table in Appendix 1. Most of these studies were retrospective
case series without an available protocol. Additionally, several limitations were encountered during their
assessment, including small study samples, unclear definitions of conditions, interventions and outcomes,

SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021 111