Ischemic priapism — the result of blood not being able to exit the penis — is an emergency situation that requires immediate treatment. This treatment usually begins with a combination of draining blood from the penis and using medications.
- Aspiration. After your penis is numbed with local anesthetic, excess blood is drained from it, using a small needle and syringe. As part of this procedure, the penile veins may also be flushed with a saline solution. This treatment relieves pain, removes oxygen-poor blood and may stop the erection. This treatment may be repeated until the erection ends.
- Medication. A medication called an alpha-adrenergic sympathomimetic, such as phenylephrine, may be injected into the spongy tissue of the penis. This drug constricts blood vessels that carry blood into the penis. This action allows blood vessels that carry blood out of the penis to open up and allow increased blood flow out. This treatment may be repeated over several hours if necessary. There is some risk of side effects, such as headache, dizziness and high blood pressure, particularly if you have high blood pressure or heart disease.
- Surgery. If other treatments aren't successful, a surgeon may implant a device that reroutes blood flow (a shunt) so that blood can move through your penis normally.
- Additional treatments. If you have sickle cell anemia, you may receive additional treatments that are used to treat disease-related episodes, such as supplemental oxygen or an intravenous solution to keep you hydrated.
Nonischemic priapism often goes away with no treatment. Because there isn't a risk of damage to the penis, your doctor may suggest a watch-and-wait approach. Putting ice and pressure on the perineum — the region between the base of the penis and the anus — may help end the erection.
Surgery may be necessary in some cases to insert material that temporarily blocks blood flow to the penis. The body eventually absorbs the material. Surgery may also be necessary to repair arteries or tissue damage resulting from an injury.
June 15, 2013
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- AUA guideline on the management of priapism. Linthicum, Md.: American Urological Association Education and Research Inc. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=priapism. Accessed March 14, 2013.
- Broderick GA, et al. Priapism: Pathogenesis, epidemiology, and management. Journal of Sexual Medicine. 2010;7:476.
- Burnett AL, et al. Priapism: Current principles and practice. Urology Clinics of North America. 2007;34:631.
- Deveci S. Priapism. http://www.uptodate.com/home. Accessed March 14, 2013.