First stage of help
After blocking the dorsal nerves, a 19–21 G needle is inserted into the corpus cavernosum from the side, dark oxygen-free blood is aspirated (its gas composition confirms the ischemic type) until bright red appears, the cavities are washed with saline, then phenylephrine is injected in fractions while monitoring pulse and pressure every 5 minutes. If detumescence occurs, the patient is observed for 1–2 hours; in case of relapse, the procedure is repeated; if ineffective, they proceed to bypass surgery. If priapism is caused by intracavernosal injections, the dose of the drug is reconsidered.
Priapism - counting the clock
Ischemic priapism is a painful erection lasting longer than 4 hours without stimulation, in which the blood in the cavernous bodies stagnates and the tissues are deprived of oxygen. Causes: overdose of intracavernosal drugs, some psychotropic drugs, sickle cell anemia, leukemia, trauma. After 12 hours, damage to smooth muscles begins, after 24–36 hours - irreversible fibrosis with loss of erection. Treatment in stages: aspiration with the introduction of a vasoconstrictor, then shunting, with prolonged priapism - early penile replacement.
What after treatment
Erectile function is restored in most men who apply within the first 12 hours, and decreases in proportion to the delay. After bypass surgery, temporary ED is possible, which resolves within weeks. The cause must be eliminated: drug doses are adjusted, the underlying disease is treated, and in case of recurrent priapism, prophylaxis is prescribed.
